Types of Shock
4 Types of shock
What is septic, cardiogenic, hypovolemic, and neurogenic (will accept anaphylactic shock & obstructive as well)
What two factors are used to calculate cardiac output?
What is heart rate and stroke volume?
Your patient, who is post-op from a gastrointestinal surgery, is presenting with a temperature of 103.6 ‘F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21.
What is septic shock
A CVP of 18 means what?
What is volume overload (normal CVP 2-6 mm)
Your patient is receiving aggressive treatment for septic shock. Which findings demonstrate treatment is NOT being successful? Select all that apply:
A. MAP (mean arterial pressure) 40 mmHg
B. Urinary output of 10 mL over 2 hours
C. Serum Lactate 15 mmol/L
D. Blood glucose 120 mg/dL
E. CVP (central venous pressure) less than 2 mmHg
What is A, B, C, and E
Obstructive shock refers to this preventing oxygenated blood from reaching vital organs?
What is blockage
IV fluids help a patient with hypovolemic shock by ___ (increasing/decreasing) CO by ____ (increasing or decreasing afterload/preload).
What is increasing CO by increasing preload
The patient's blood pressure is 80/52, heart rate 120, and oxygen saturation 87%. Audible wheezing is noted along with facial redness and swelling. Name that shock and first line treatment.
What is anaphylactic shock and 1st line treatment is epinephrine.
Your patient’s blood pressure is 72/56, heart rate 126, and respiration 24. The patient has a fungal infection in the lungs. The patient also has a fever, warm/flushed skin, and is restless. You notify the physician who suspects septic shock. You anticipate that the physician will order what treatment FIRST?
A. Low-dose corticosteroids
B. Crystalloids IV fluid bolus
C. Norepinephrine
D. 2 units of Packed Red Blood Cells
What is B - IVF
During anaphylactic shock the mast cells and basophils release large amounts of histamine. What effects does histamine have on the body during anaphylactic shock? Select all that apply:
A. Decreases capillary permeability
B. Vasodilation of vessels
C. Decreases heart rate
D. Shifts intravascular fluid to interstitial space
E. Constricts the airways
F. Stimulates contraction of GI smooth muscles
G. Inhibits the production of gastric secretions
H. Itching
What is B, D, E, F, and H
The heart cannot adequately pump blood resulting in poor cardiac output during this type of shock due to defect in heart itself, medications, or trauma to heart.
What is cardiogenic shock?
What two classes of medication decrease cardiac preload?
What is diuretics and vasodilators?
IV dobutamine and dopamine are commonly used for this type of shock. Also, name the class of drug.
What is cardiogenic shock and positive inotropes
If IVF is unsuccessful in maintaining tissue perfusion, what would you anticipate to be ordered next?
What is pressors
A patient with neurogenic shock is experiencing a heart rate of 30 bpm. What medication does the nurse anticipate will be ordered by the physician STAT?
What is atropine
Hypovolemic shock may be caused by these 2 conditions.
What is loss of circulatory blood (hemorrhagic shock) or loss of internal body water (dehydration, burns, vomiting, diarrhea, and sweating).
____ is the amount of blood pumped by the left ventricle with each beat?
What is stroke volume
A 42-year-old male patient is admitted with a spinal cord injury. The patient is experiencing severe hypotension and bradycardia.
What is spinal shock
The patient’s vital signs are the following during antibiotic administration: blood pressure 89/62, heart rate 118 bpm, and oxygen saturation 88% on room air. While auscultating the lungs you note wheezing. You suspect anaphylactic shock. Whats the best intervention?
What is administer oxygen (call a rapid response and obtain epinephrine, stop the medication).
Your patient in neurogenic shock is not responding to IV fluids. The patient is started on vasopressors. What option below, if found in your patient, would indicate the medication is working?
A. Decreased CVP (central venous pressure)
B. Mean arterial pressure (MAP) 90 mmHg
C. Serum lactate 6 mmol/L
D. Blood pH 7.20
What is B
You’re caring for a patient who is experiencing shock. Which lab result demonstrates that the patient’s cells are using anaerobic metabolism?
What is an elevated lactate level
Two conditions that result in increased cardiac afterload?
What is vasoconstriction, pulmonary HTN (also aortic stenosis)
What causes low fluid volume in the intravascular compartment?
What is hypovolemic shock
You’re providing care to a patient experiencing neurogenic shock due to an injury at T4. As the nurse, you know which of the following is a patient safety priority?
A. Keeping the head of the bed greater than 45 degrees at all times.
B. Repositioning the patient every thirty minutes.
C. Keeping the patient’s spine immobilized.
D. Avoiding log-rolling the patient during transport.
What is C
Whose at risk for sepsis? (select all that applies)
A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place.
B. A 55-year-old male who is a recent kidney transplant recipient.
C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery.
D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.
What is all the above