Shock 2

Early Vs Late Shock

100

A patient with rising HR and cool skin, but a normal BP, is in what stage of shock?

Early/compensated shock.

200

Which finding shows the body is no longer compensating?

Falling blood pressure

300

A patient in shock becomes restless, then becomes confused.  What does this change indicate?

Worsening cerebral perfusion

400

You give fluids but the patient remains hypotensive.  What does this suggest about the stage of shock?

It is progressive

500

The main indicator a patient is entering irreversible shock is this failure?

Multi-organ failure. Patient's may also go into DIC (disseminated intravascular coagulation).

Priorities and Interventions

100

You suspect shock, what is always your first assessment priority?

Airway!

ABCs

200

After stabilizing airway, what intervention should the nurse always take for any type of shock?

High-flow oxygen

300

A patient's BP is 78/40 after surgery. What is the best position to improve perfusion?

Supine with legs elevated.

400

You suspect septic shock. Before starting antibiotics, the nurse MUST do this?

Collect cultures.

500

Despite fluids, BP remains dangerously low. What class of medications does the nurse anticipate?

Vasopressors

Differentiating Shock Types

100

In which type of shock is giving a fluid bolus potentially dangerous?

Cardiogenic

200

A patient has bradycardia and warm, dry skin after a trauma. What shock is this likely?

Neurogenic

300

A patient has hives, wheezing, and sudden hypotension. What type of shock is most likely?

Anaphylactic

400

Your patient has a fever and hypotension.  What shock type is most likely?

Septic

500

A patient is pale with weak pulses, tachycardia, and a history of vomiting.  What shock type is this most likely? 

Non-hemorrhagic hypovolemic 

Medications and Fluids

100

Which type of IV fluid do we give FIRST for most shock types?

Isotonic

200

Which medication is first in anaphylactic shock?

IM epi

300

Which medication class improves contractility in cariogenic shock?

Inotropes like dobutamine

400

What medication may be required if a patient in neurogenic shock has persistent bradycardia?

Atropine

500

Which medication class is needed when septic shock does NOT respond to fluids?

Vasopressors like norepinephrine

Critical Thinking

100

Your post-op patient has a sudden drop in BP and a rapidly swelling abdomen.  What is the FIRST suspicion?

Internal hemorrhage, hypovolemic shock

200

A patient recovering from an MI becomes extremely short of breath with frothy sputum.  What action is PRIORITY?

Apply O2 and prepare to give diuretics

300

A patient with septic shock has urine output less than 20mL/hr.  What should the nurse anticipate next? 

Kidney damage/failure, renal perfusion is decreased

400

A patient develops tingling lips, tightness in the throat, and wheezing after IV antibiotics.  What do you do FIRST?

STOP infusion 

500

A patient with a spinal injury has low BP and HR is 48.  Fluids made no improvement.  What is your next action?

Prepare for vasopressors (BP) and give atropine (HR)