Cardiogenic shock
What is the most common cause of cardiogenic shock?
1. heart failure
2. heart attack
3. hypertension
4. fluid loss
Heart attack
What is the main treatment for hypovolemic shock due to hemorrhage?
1. iv fluids
2. diuretics
3. blood product transfusion
4. monitor, no treatment
Blood transfusion including packed red blood cells, plasma and platelets.
What is the first treatment for anaphylaxis?
1. diuretic
2. beta- blocker
3. epinephrine
4. atropine
epinephrine
Choose two early signs of systemic inflammation.
1. bradycardia
2. bradypnea
3. tachypnea
4. fever
5. low WBC count
6. tachycardia
Fever (temperature higher than 38 C or hypothermia (temperature less than 36 C)
Tachycardia (heart rate more than 90 beats per minute)
Tachypnea (respiratory rate more than 20 breaths per minute)
Leukocytosis (WBC greater than 12,000/cu mm) / leukopenia (white blood cells (WBC) less than 4,000/cu mm) with or without bandemia (more than 10%)
What is the number one cause of neurogenic shock?
1. brain injury
2. blunt cervical spine injury
3. car accident
4. lumbar spine injury
blunt cervical spine injury
What are three other causes of cardiogenic shock?
1. heart failure
2. hypotension
3. stroke
4. pneumonia
5.chest injures
6. blood clot
Heart failure; chest injuries; medicine side effects; and conditions that prevent blood from flowing freely through your heart, such as a blood clot in the lungs.
What are the two causes of hypovolemic shock?
Hemorrhage (blood loss) and extracellular fluid loss
What should patients be encouraged to wear for safety?
1. watch
2. fitness tracker
3. ekg monitor
4. medical alert bracelet
medical alert braclet
What type of antibiotics should be administered to the patient and how quickly?
1. pcn
2. broad spectrum
3. narrow spectrum
4. bactericidal
Broad-spectrum antibiotics within one hour of diagnosis for all patients. Initial empiric anti-infective therapy should have activity against all likely pathogens and adequate penetration of source tissue.
Neurogenic shock is associated with which segment(s) of injury to the spine? SATA
1. lumbar
2. thoracic
3. sacral
4. cervical
cervical and high thoracic spine injury
What type of diagnostics may be ordered to evaluate a patient for cardiogenic shock? SATA
1. labs
2. chest xray
3. echocardiogram
4. cardiac CT scan
5. coronary angiography
6. ekg
Labs (such as abg, bmp, cbc), cardiac CT scan, chest x-ray, coronary angiography, echocardiogram, EKG
Choose three causes of hemorrhagic shock?
1. diuretics
2. bleed from ectopic pregnancy
3. diabetic ketoacidosis
4. liver failure
5. trauma
6. gi. bleed
7. infection
- Trauma (#1 cause)
-gastrointestinal (GI) bleed
-bleed from an ectopic pregnancy
-bleeding from surgical intervention
-vaginal bleeding
How will the physician determine the cause of anaphylactic shock?
1. physical assessment
2. medical history
3. allergy list
4. allergy testing
allergy testing
Name three signs/symptoms that will be observed in septic shock.
1. anuria
2. increased urine output
3. hyperactive bowel sounds
4. ileus
5. fever
6. nausea
7. agression
Altered mental status
Oliguria or anuria
Hypoxia
Cyanosis
Ileus
hypotension
fever
tachycardia
tachypnea
hypothermia
Besides trauma, choose three causes of neurogenic shock.
1. spinal anesthesia
2. lung cancer
3. autonomic nervous system toxins
4. hemorrhagic stroke
5. Trisomy 21
-spinal anesthesia
-Guillain-Barre syndrome
-autonomic nervous system toxins
-transverse myelitis
-other neuropathies
-Trisomy 21
-skeletal dysplasia
-tonsillopharyngitis
How will cardiogenic shock be diagnosed? SATA
1. medical history
2. nursing assessment
3.physical assessment
4. ekg results
5. lab tests
6. diagnostic tests
Physician will check medical history, perform a physical exam, and do tests and procedures to diagnose cardiogenic shock.
What is the main treatment for hypovolemic shock related to fluid loss?
1. blood product administration
2. encourage oral fluid intake
3. monitor, no treatment
4. iv fluid resuscitation
Fluid resuscitation with 2 liters of isotonic crystalloid solution infused rapidly. (Isotonic saline is hyperchloremic relative to blood plasma, and resuscitation with large amounts can lead to a hyperchloremic metabolic acidosis. Several other isotonic fluids with lower chloride concentrations exist, such as lactated Ringer's solution or PlasmaLyte. Fluid chosen will be upon patient chemistry and physician preference.)
Name the substance released by the body during anaphylaxis.
1. histamine
2. aldosterone
3. anti-histamine
4. anti-diuretic hormone
Histamine
Name four risk factors that put a patient at risk for septic shock.
1. hemodialysis
2. malignancy
3. urinating independently
4. stroke
5. heart attack
6. alcoholism
7. diabetes
8. trauma
Diabetes
Malignancy
Chronic kidney and liver disease
Use of corticosteroids
Immunosuppressed state
Burns
Major surgery
Trauma
Presence of indwelling catheters
Prolonged hospitalization
Hemodialysis
Extremes of age
Name the three things utilized to diagnose neurogenic shock.
1. CT/MRI
2. c-xray
3. clinical exam
4. previous medical history
5. hemodynamic monitoring
-radiographic imaging (CT/MRI)
-hemodynamic monitoring
-clinical exam
What occurs in the body during cardiogenic shock?
1. blood clots develop
2. decreased oxygenation to the brain
3. decreased blood and oxygen to all vital organs
4. release of histamines due to allergergic reaction
Your heart cannot pump enough blood and oxygen to the brain, kidneys, and other vital organs.
What is the first change in seen in vital signs in hypovolemic shock?
1. hypotension
2. tachypnea
3. increase in diastolic blood pressure
4. hypertension
5. tachycardia
6. bradycardia
Increase in diastolic blood pressure with narrowed pulse pressure.
Which is a result the release of histamine can have on the body?
1. diuresis
2. increased glucose
3. pulmonary edema
4. hypertension
-drop in blood pressure
-Fluid can leak into the lungs, causing swelling (pulmonary edema)
-heart rhythm disturbances.
Name three complications of septic shock.
1. acute liver failure
2. GI bleed
3. ARDS
4. breast cancer
5. multiple organ failure
ARDS
Acute/chronic renal injury
DIC
Mesenteric ischemia
Acute liver failure
Myocardial dysfunction
Multiple organ failure
Define neurogenic shock.
1. Injury to the spinal cord with associated autonomic dysregulation
2. Injury to the brain stem with associated autonomic dysregulation
3. Injury to chest wall with associated autonomic dysregulation
Injury to the spinal cord with associated autonomic dysregulation.
What are the symptoms of cardiogenic shock? SATA
1. orthostatic changes
2. confusion
3. tachypnea
4. loss of consciousness
5. vomiting blood
6. increased bruising
5.
A patient may have mild symptoms, such as feeling confused or breathing rapidly, or may have no symptoms and then suddenly lose consciousness.
What are four signs of hypovolemic shock?
1. moist mucous membranes
2. adequate urine output
3. increased heart rate
4. hypertension
5. decreased systolic hypertension
6. dry mucous membranes
7. skin warm, dry and pink
8. decreased skin turgor
-increased heart rate
-increased cardiac contractility
-increased peripheral vasoconstriction
-decreased systolic blood pressure
-dry mucous membranes
-decreased skin turgor
-low jugular venous distention
-decreased urinary output.
-appear cold, clammy, and cyanotic
What are three of the most common food allergies?
1. gluten
2. peanuts
3. eggs
4. chocolate
5. strawberries
6. cow's milk
-peanuts
-walnuts and hazelnuts
-fish
-chicken eggs
-cow's milk
Name two interventions used to treat septic shock.
1. encourage oral intake
2. IV fluids
3. mechanical ventilation
4. echocardiogram
5. surgical intervention
1. Fluid resuscitation with crystalloid (NS or albumin) and colloid (blood products) up to 80 ml/kg
2. Mechanical ventilation to reduce metabolic demand
3. First-line vasoactive agents (epinephrine in cold shock versus norepinephrine in warm shock) when fluid-refractory
Name three signs/symptoms seen in neurogenic shock?
1. hypertension
2. cool pale skin
3. hypotension
4. bradyarrythmia
5. temperature dysregulation
6. increased urination
-Bradyarrhythmia
-hypotension
-flushed warm skin
(These first three are the most common)
-orthostatic hypotension
-autonomic dysreflexia
-temperature dysregulation
Name four cardiac conditions that put you at risk for cardiogenic shock?
Choose four symptoms patients may complain of that are signs of hypovolemic shock.
1. thirst
2. anxiety
3. lethargy
4. shortness of breath
5. chest pain
6. agitation
7. urinary frequency
8. nausea
Thirst, muscle cramps, orthostatic hypotension, abdominal or chest pain (due to mesenteric and coronary ischemia), agitation, lethargy, or confusion (as a result of brain malperfusion).
What respiratory intervention(s) may be needed when severe? SATA
1. cough and deep breathe
2. raise head of bed
3. intubation
4. respiratory assessment
5. tracheostomy
intubation or tracheostomy
What is the definition of septic shock?
1. persistent hypotension
2. persistent tachycardia
3. persistent hypotension despite adequate fluid resuscitation
4. system wide infection
Septic shock is defined by persistent hypotension despite adequate fluid resuscitation from 60 ml/kg to 80 mL/kg of either crystalloid or colloid fluid.
Name two treatments for neurogenic shock.
1. anti-hypertensives
2. lipid lowering agents
3. atropine
4. fluid restriction
5. iv fluids
- iv fluids
-vasopressors
-atropine
-spinal immobilization
-surgical intervention
Which types of medications might be used to treat cardiogenic shock? SATA
1. beta-blockers
2. vasopressors
3. lipid lowering agents
4. blood thinners
5. diuretic
Anti-arrhythmic, blood thinner or anti-platelet, vasopressors or inotropes
Which of the following occur in the body during hypovolemic shock? SATA
1. hypovolemia
2. fluid overload
3. decreased peripheral perfusion
4. infection
Severe hypovolemia with decreased peripheral perfusion.
Choose six symptoms of Anaphylactic shock?
1. confusion
2. wheezing
3. frequent urination
4. vomiting
5. swelling of the lips, tongue and throat
6. bradycardia
7. tachycardia
8. dizziness
9. urinating blood
10. irregular heart rhythm
What are two signs will the nurse observe in warm shock (patient remains compensated)?
1. tachycardia
2. slowed capillary refill time
3. increased edema
4. bounding peripheral pulses
-warm to the touch
-reduction in capillary refill (flash cap refill)
-tachycardia
-bounding peripheral pulses
Name two things the physician should consider while making a diagnosis of neurogenic shock.
1. respiratory status
2. neurologic deficits
3. vital signs
4. mechanism of injury
5. home medications
6. past medical history
-mechanism of injury
-the presence of midline spinal tenderness
-a distracting injury that may take attention from a spinal area
-loss of consciousness
-neurologic deficits
-intoxication that may misconstrue the exam
Besides medications, name three treatments for cardiogenic shock.
1. CPR
2. CABG
3. cardioversion
4. pacemaker/defibrillator
5. hospice
6. dialysis
Pacemaker/defibrillator, balloon pump, CABG, ECMO, ventricular assist device, heart transplant and hospice if recovery if survival not expected.
Choose four lab values that may be abnormal in hypovolemic shock.
1. increased bun/creat
2. elevated sodium in the urine
3. hemoglobin
4. acidosis or alkalosis
5. elevated potassium
6. low calcium level
7. sodium
-increased BUN and serum creatinine
-Hypernatremia or hyponatremia
-hyperkalemia or hypokalemia
-lactate level- may be acidotic or alkalotic depending upon reason for fluid loss (patients with large GI losses can become alkalotic)
-hemoglobin and hematocrit- can be low or high (with a reduction in plasma volume, hematocrit and hemoglobin can be increased due to hemoconcentration)
-Low urinary sodium (commonly found in hypovolemic patients as the kidneys attempt to conserve sodium and water to expand the extracellular volume)
Choose two patients that should be given an emergency kit.
1. any patient with history of anaphylactic reaction
2. any patient with history of anaphylactic reaction unless the trigger can be avoided
3. only patients who have severe reactions
4. have an allergic reaction to even small amounts of an allergen
have had an anaphylactic reaction in the past, unless the trigger can be avoided (like most medications can).
are known to have mastocytosis. In this rare disorder, certain immune cells in the tissue start multiplying a lot. Mastocytosis can occur in various organs, causing symptoms such as stomach ache, itching, exhaustion and muscle pain.
have had an allergic reaction to peanuts, walnuts or sesame in the past. These foods are particularly likely to lead to anaphylaxis.
have an allergic reaction to even small amounts of an allergen (a trigger)
What are two sign/symptoms of cold shock (uncompensated)?
1. hypertension
2. strong bounding pulses
3. weak thready pulses
4. cool extremities
5. confusion
6. diarrhea
-hypotension
-cool extremities
-delayed capillary refill (more than three seconds)
-thready pulses
How long can neurogenic shock signs/symptoms continue for?
1. 3-5 days
2. 1 week
3. 4-5 weeks
4. 24 hours
4-5 weeks