NSG 430 Exam 4 Questions and
Answers 100% VERIFIED
Low blood flow cardiogenic shock - Answer--comprimised cardiac output. systolic
and diastolic dysfunction
CAUSES
-MI, cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary HTN,
cardiac tamponade, myocardial depression from metabolic problems
EARLY MANIFESTATIONS
-tachycardia
-hypotension
-narrowed pulse pressure
-increased myocardial o2 consumption
-tachypnea, pulmonary congestion, decreased cap refill time
-anxiety, confusion, agitation, increased pulmonary artery wedge pressure,
decreased UO
INTERPROFESSIONAL CARE
-goal: decrease heart workload
-angioplasty w stenting, vavle replacement
-hemodynamic monitoring
-drugs: nitrates, diuretics, vasodilators, b adrenergic blockers
Low blood flow hypovolemic shock - Answer--absolute hypovolemia: loss of
intravascular fluid volume
-when fluid moves out of the vascular space into the extravascular space
,-*burns?
TYPES?
-hemorrhage, vomiting, diarrhea
-fistula drainage, diabetes insipidus
-hyperglycemia, diuresis
MANIFESTATIONS
-anxiety, tachypnea, increased CO, heart rate
-decrease in stroke volume, PAWP, urinary output
-*if loss >30%, blood volume needs replacing
INTERPROFESSIONAL CARE
-*3:1 rule- 3ml of isotonic crystalloid for every 1ml of EBL
Distributive shock: neurogenic shock - Answer--can occur within 30 minutes of a
spinal cord injury at the fifth thoracic vertebra or above. can last up to 6 weeks.
-can be induced by spinal anesthesia
-DEFINED: massive vasodilation, leading to pooling of blood in vessels, tissue
hypoperfusion, impaired cellular metabolism
MANIFESTATIONS
-hypotension, bradycardia
-inability to regulate body temperature (heat loss)-> poikilothermia (taking on
temp of environment)
-dry skin
INTERPROFESSIONAL CARE
-*stability for spinal cord injury
-*atropine for hypotension and bradycardia
,-monitor for hypothermia
Distributive shock: anaphylactic shock - Answer--acute life threatening allergic
reaction
-massive vasodilation, release of vasoactive mediators, increased capillary
permeability
MANIFESTATIONS
-anxiety, confusion, dizzy
-sense of impending doom, chest pain
-incontinence
-swelling of lips and tongue, flushing, allergic rxn sx
-*resp distress and circulatory failure
INTERPROFESSIONAL CARE
-epi, diphenhydramine, famotidine
-*maintain patent airway (bronchodilators, aerosolized epi, ET tube may be
necessary
-*fluid replacement
Distributive shock: septic shock - Answer--sepsis: systemic inflammatory response
to suspected or documented infection
SEPTIC SHOCK
-sepsis w hypotension despite fluid resuscitation
-inadequate tissue perfusion resulting in hypoxia
MANIFESTATIONS
-increased coagulation and inflammation, decreased fibrinolysis: formation of
microthrombi, obstruction of microvasculature
, -hyperdynamic state- increased CO and decreased SVR
-tachypnea, hyperventilation -> *respiratory alkalosis and resp failure
-urine output decreased
-altered neuro status
-GI dysfunction, GI bleed, paralytic ileus
PATHOPHYSIOLOGICAL EFFECTS
-vasodilation
-maldistribution of blood flow
-myocardial dysfunction (decreased EF and ventricular dilation)
INTERPROSFESSIONAL CARE
-antibiotics within 1st hour!!!
-keep glucose <180
-give PPIs for stress ulcer prophylaxis (pantoprazole)
-DVT: heparin, enoxaparin
-exogenous vasopressin
-*IV corticosteroids: for pts who cannot maintain an adequate BP with
vasopressor therapy despite fluid resuscitation
Obstructive shock - Answer-CAUSES
-SVC syndrome, abdominal compartment syndrome, cardiac tamponade, tension
pneumo, pulmonary embolism
MANIFESTATIONS
-decreased CO, increased afterload
-*need rapid assessments and immediate tx
CARE
Answers 100% VERIFIED
Low blood flow cardiogenic shock - Answer--comprimised cardiac output. systolic
and diastolic dysfunction
CAUSES
-MI, cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary HTN,
cardiac tamponade, myocardial depression from metabolic problems
EARLY MANIFESTATIONS
-tachycardia
-hypotension
-narrowed pulse pressure
-increased myocardial o2 consumption
-tachypnea, pulmonary congestion, decreased cap refill time
-anxiety, confusion, agitation, increased pulmonary artery wedge pressure,
decreased UO
INTERPROFESSIONAL CARE
-goal: decrease heart workload
-angioplasty w stenting, vavle replacement
-hemodynamic monitoring
-drugs: nitrates, diuretics, vasodilators, b adrenergic blockers
Low blood flow hypovolemic shock - Answer--absolute hypovolemia: loss of
intravascular fluid volume
-when fluid moves out of the vascular space into the extravascular space
,-*burns?
TYPES?
-hemorrhage, vomiting, diarrhea
-fistula drainage, diabetes insipidus
-hyperglycemia, diuresis
MANIFESTATIONS
-anxiety, tachypnea, increased CO, heart rate
-decrease in stroke volume, PAWP, urinary output
-*if loss >30%, blood volume needs replacing
INTERPROFESSIONAL CARE
-*3:1 rule- 3ml of isotonic crystalloid for every 1ml of EBL
Distributive shock: neurogenic shock - Answer--can occur within 30 minutes of a
spinal cord injury at the fifth thoracic vertebra or above. can last up to 6 weeks.
-can be induced by spinal anesthesia
-DEFINED: massive vasodilation, leading to pooling of blood in vessels, tissue
hypoperfusion, impaired cellular metabolism
MANIFESTATIONS
-hypotension, bradycardia
-inability to regulate body temperature (heat loss)-> poikilothermia (taking on
temp of environment)
-dry skin
INTERPROFESSIONAL CARE
-*stability for spinal cord injury
-*atropine for hypotension and bradycardia
,-monitor for hypothermia
Distributive shock: anaphylactic shock - Answer--acute life threatening allergic
reaction
-massive vasodilation, release of vasoactive mediators, increased capillary
permeability
MANIFESTATIONS
-anxiety, confusion, dizzy
-sense of impending doom, chest pain
-incontinence
-swelling of lips and tongue, flushing, allergic rxn sx
-*resp distress and circulatory failure
INTERPROFESSIONAL CARE
-epi, diphenhydramine, famotidine
-*maintain patent airway (bronchodilators, aerosolized epi, ET tube may be
necessary
-*fluid replacement
Distributive shock: septic shock - Answer--sepsis: systemic inflammatory response
to suspected or documented infection
SEPTIC SHOCK
-sepsis w hypotension despite fluid resuscitation
-inadequate tissue perfusion resulting in hypoxia
MANIFESTATIONS
-increased coagulation and inflammation, decreased fibrinolysis: formation of
microthrombi, obstruction of microvasculature
, -hyperdynamic state- increased CO and decreased SVR
-tachypnea, hyperventilation -> *respiratory alkalosis and resp failure
-urine output decreased
-altered neuro status
-GI dysfunction, GI bleed, paralytic ileus
PATHOPHYSIOLOGICAL EFFECTS
-vasodilation
-maldistribution of blood flow
-myocardial dysfunction (decreased EF and ventricular dilation)
INTERPROSFESSIONAL CARE
-antibiotics within 1st hour!!!
-keep glucose <180
-give PPIs for stress ulcer prophylaxis (pantoprazole)
-DVT: heparin, enoxaparin
-exogenous vasopressin
-*IV corticosteroids: for pts who cannot maintain an adequate BP with
vasopressor therapy despite fluid resuscitation
Obstructive shock - Answer-CAUSES
-SVC syndrome, abdominal compartment syndrome, cardiac tamponade, tension
pneumo, pulmonary embolism
MANIFESTATIONS
-decreased CO, increased afterload
-*need rapid assessments and immediate tx
CARE
