Hypovolemic Shock
A patient is receiving fluid boluses to treat hypovolemic shock. For which of the following assessment findings should the nurse stop the fluid boluses and notify the physician?
1. Tachycardia and hypotension
2. Crackles throughout the lung fields
3. Peripheral cyanosis
4. Increased oxygen saturation percentages
2. Crackles throughout the lung fields
When identifying a symptom of pulmonary congestion from respiratory compromise due to fluid volume overload.
Septic shock is caused by
1. Massive blood loss
2. Compromised myocardial contractility
3. Interruption of the sympathetic nervous system
4. Release of bacterial toxin in the blood vessel
4. Release of bacterial toxin in the blood vessel
Toxins cause massive vasodilation causing decreased tissue perfusion and decreased tissue oxygenation.
A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?
1. Hypertension.
2. Bradycardia.
3. Bounding pulse.
4. Confusion.
4 Confusion
Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.
True or False All these are risk factors for Anaphylactic Shock -
Drug, Food, Insect bites/stings
True
Which of this is a major clinical sign of Neurogenic Shock?
1. Hypotension and bradycardia
2. Hypertension and Tachycardia
3. Altered Mental status and Deep slow breathing
4. Hyperthermia and Tachycardia
1. - Hypotension and bradycardia
Patients are generally hypotensive with warm, dry skin. The loss of sympathetic tone may impair the ability to redirect blood flow from the periphery to the core circulation leading to excessive heat loss and hypothermia. Bradycardia is a characteristic finding of neurogenic shock. They have Altered Mental status BUT rapid and shallow respirations.
MODS is most commonly seen in what type of shock
Septic Shock
Elevate HR
Increased resp
Normal BP
Anxiety
Confusion
Cool and Clammy skin
Compensated Shock
Which of the following is most important goal of nursing care for a client who is in Hypovolemic shock?
1.Manage fluid overload.
2.Manage increased cardiac output.
3.Manage inadequate tissue perfusion.
4.Manage vasoconstriction of vascular bed
3.Manage inadequate tissue perfusion.
Nursing intervention and collaborative management are focused on correcting and maintaining adequate tissue perfusion. Inadequate tissue perfusion may be caused by hemorrhage as in hypovolemic shock.
Who is at risk for developing a septic shock?
1. An obese Patient
2. Patient who is on Corticosteroids
3. Immunosuppressed Patient
4. Patient who has decreased Liver functions
3. Immunosuppressed Patient -
An immunosuppressed patient has decreased ability to deal with infections.
Dobutamine (Dobutrex) is used to treat a client experiencing cardiogenic shock. Nursing intervention includes:
1. Monitoring for fluid overload.
2. Monitoring for cardiac dysrhythmias.
3. Monitoring respiratory status.
4. Monitoring for hypotension.
2 Dobutamine
Beneficial in cases where shock is caused by heart failure. The drug increases contractility, and has the potential to cause dysrhythmias
Which of these should not be done when the patient is having or is at risk for Anaphylactic Shock?
1. Ask the patient about their past and previous allergies, regardless of the data provided.
2. Place a pillow under the person's head if he or she is having trouble breathing
3. Give antihistamines, such as diphenhydramine, and corticosteroids, such as prednisone, to further reduce symptoms.
4. Avoid oral medication if the person is having difficulty breathing.
2-Place a pillow under the person's head if he or she is having trouble breathing
Do NOT place a pillow under the person's head if he or she is having trouble breathing. This can block the airways.
Which of the following are the causes of Neurogenic Shock? Select all that apply
1. Spinal cord injury
2. Spinal anesthesia
3. Depressant actions of medications
4. Glucose deficiency
5. Systemic vascular resistance
ALL OF THEM
Occurs because cells lack adequate perfusion leading to deprivation of oxygen and nutrients
Anaerobic metabolism
Hypotension
Decreased LOC
Shallow breathing
Progressive/ Decompensated Shock
Which of the following assessment findings is an early indication of hypovolemic shock?
1.Diminished bowel sounds
2.Increased urinary output
3.Tachycardia
4.Hypertension
3.Tachycardia
Tachycardia is an early symptom as the body compensates for a declining blood pressure the heart rate increases to circulate the blood faster to prevent tissue hypoxia.
When assessing a client for early septic shock the nurse observes for which of the following?
1. Cool, Clammy Skin
2. Warm, flushed skin
3. Decreased systolic blood pressure
4. Hemorrhage
2. Warm, flushed skin
Warm, flushed skin from a high cardiac output with vasodilation occurs in warm shock or hyperdynamic phase (first phase) of septic shock. Other signs and symptoms of early septic shock include fever with restlessness and confusion, decreased blood pressure, with tachypnea and tachycardia, increased or normal urine output and N/V or diarrhea
Which of the following drug is most commonly used to treat cardiogenic shock?
1. Dopamine (Intropin)
2. Enalapril (Vasotec)
3. Furosemide (Lasix)
4. Metoprolol (Lopressor)
1. Dopamine
Improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure.
A child reports to the camp nurse's office after stepping on a bee. The child has pain, erythema, and edema of the lower aspect of the left foot. As the nurse is observing the foot, the child says, "I feel like my throat is getting tight." The first action the nurse should take is:
1. Assess the child's airway and breathing
2. Call 911 and request an ambulance
3. Administer subcutaneous epinephrine
4. Remove the stinger from the foot
1 - Assess the child's airway and breathing
The situation indicates that the child is having anaphylactic reaction. The first action by the nurse is to assess airway and breathing. Priority assessment is ABC.
A 70-year-old man presents to the emergency department with a 2-day history of fever, chills, cough, and right-sided pleuritic chest pain. On the day of admission, the patient’s family noted that he was more lethargic and dizzy and was falling frequently. The patient’s vital signs are:temperature, 101.5°F; heart rate 120 bpm; respiratory rate 30 breaths/min; blood pressure 70/35 mm Hg; and oxygen saturation as measured by pulse oximetry - 80% without oxygen supplementation. A chest radiograph shows a right lower lobe infiltrate. What is the first step in the initial management of this patient?
1. Antibiotic therapy
2. β-Blocker therapy to control heart rate
3. Intravenous (IV) fluid resuscitation
4. Supplemental oxygen and airway management
5. Vasopressor therapy with dopamine
4 Supplemental oxygen and airway management.
The initial evaluation of any critically ill patient in shock should include assessing and establishing an airway, evaluating breathing (which includes consideration of mechanical ventilator support), and restoring adequate circulation. Adequate oxygenation should be ensured with a goal of achieving an arterial oxygen saturation of 90% or greater.
What type of acid-base balance is the result of shock?
Resp. Acidosis
Resp. Alkalosis
Metabolic Acidosis
Metabolic alkalosis
Metabolic Acidosis
Treat underlying cause
Restore tissue perfusion with fluid management
Respiratory support
Progressive Shock
When compensatory mechanisms for hypovolemic shock are activated, the nurse would expect which two patient findings to normalize?
1. Intensity of peripheral pulses and body temperature
2. Peripheral pulses and heart rate
3. Metabolic alkalosis and oxygen saturation
4. Cardiac output and blood pressure
4. Cardiac output and blood pressure
The effectiveness of the sympathetic nervous system and the rennin-angiotensin-aldosterone system will increase blood volume and increase the heart rate to return the blood pressure and cardiac output for a brief time to within normal limits for that patient.
Which nursing intervention is most important in preventing septic shock?
1. Administering I.V. fluid replacement therapy as ordered
2. Obtaining vital signs every 4 hours for all clients
3. Monitoring red blood Cells counts for elevation
4. Maintaining asepsis of indwelling urinary catheters
4 Maintaining asepsis of indwelling urinary catheters
Essential to prevent infection. Preventing septic shock is a major focus of nursing care because of the mortality rate for septic shock. Septic shock is as high as 90% in some population
Which of the following is the initial treatment goal for cardiogenic shock
1. Correct Hypoxia
2. Prevent infarction
3. Correct metabolic acidosis
4. Increase myocardial oxygen supply
4. Increase myocardial oxygen supply:
A balance must be maintained between supply and demand. In a shock state, the myocardium requires more O2. If it ant get more O2 the shock worsens. Increasing the oxygen will also play a large role in correcting metabolic acidosis and hypoxia. Infarction typically causes the shock state, so prevention isn’t an appropriate foal for this condition
Which of the following is signs and symptoms of anaphylactic reaction? Select all that apply
1. Cool pale skin
2. Respiratory distress
3. Low BP and Increased HR
4. Rash
5. Hearing Loss
1,2,3,4
What is a treatment of neurogenic shock? Select all that apply
1. Stabilization of spine
2. Antibiotic therapy
3. Falls precautions
4. Log rolling
1,3,4
Formation of glucose proteins and fats
Gluconeogenesis
Treat underlying cause
Fluid replacement
Supplementation oxygen, decrease patient anxiety
Maintain BP and tissue perfusion
Compensatory Shock
Which type of fluid is most appropriate for volume replacement for a patient with non-hemorrhagic hypovolemic shock?
1. Lactated Ringers
2. 10% Dextrose in water
3. .45% normal saline
4. Packed RBC’s
1. Lactated Ringers
Lactated Ringers solution is an isotonic crystalloid that will stay within and expand the intravascular space for a longer period of time to raise the blood pressure by increasing the circulating blood volume. Normal Saline is the other acceptable solution that will improve this type of shock.
Which of the following is an indication of a complication of Septic Shock?
1. Anaphylaxis
2. ARDS
3. COPD
4. Mitral Valve prolapse
2. ARDS
ARDS causes respiratory failure and may lead to death, even after the client has recovered from shock.
Which of the following steps has been shown to have a mortality benefit in patients with cardiogenic shock caused by to myocardial infarction (MI)?
1.Addition of glycoprotein IIb/IIIa inhibitors
2.β-Adrenergic agonists
3.Early cardiac catheterization followed by revascularization by (PCI) or surgical revascularization
4.Initial medical stabilization with BP control prior to catheterization
5.Thrombolytic infusion
3 Early cardiac catheterization followed by revascularization by PCI or surgical revascularization.
The SHOCK trial compared emergent revascularization for cardiogenic shock due to MI with initial medical stabilization and delayed revascularization. The results of the study revealed a mortality benefit at 30 days that increased over time at 6 months and 1 year.
The nurse is caring for a client experiencing anaphylactic shock. Which of the following should be included in the plan of care for this client? Select all that apply
1. Maintain an adequate airway.
2. Support the blood pressure.
3. Restore body fluids.
4. Remove the source of infection.
5. Remove the mechanical barrier to blood flow.
1 and 2
The nurse is planning care for the client in Neurogenic shock. Which of the following actions would be most helpful in minimizing the effects of vasodilation below the level of the injury? Select all that apply
1. Monitoring vital signs before and during position changes
2. Using vasopressor medications as prescribed
3. Moving the client quickly as one unit
4. Applying Teds or compression stockings.
1,2,4
Reflex vasodilation below the level of the spinal cord injury places the client at risk for orthostatic hypotension, which may be profound. Measures to minimize this include measuring vital signs before and during position changes, use of a tilt-table with early mobilization, and changing the client’s position slowly. Venous pooling can be reduced by using Teds (compression stockings) or pneumatic boots. Vasopressor medications are administered per protocol.
Stages of shock
Compensatory
Progressive/Decompensated
Irreversible
Organ failure
Unable to maintain BP
Oliguria
Irreversible Shock