Hypovolemic Shock Exam Questions with Verified Solutions Latest Update () Already Passed

Hypovolemic Shock Exam Questions with Verified Solutions Latest Update () Already Passed Syndrome characterized by: (2) - Answers decreased tissue perfusion and impaired cellular metabolism Shock: imbalance in supply/demand for O2 and nutrients - Answers Mismatch Low Blood Flow Hypovolemic Shock Absolute hypovolemia: loss of intravascular fluid volume (6) - Answers Hemorrhage GI loss (vomiting, diarrhea) Fistula drainage Diabetes insipidus Hyperglycemia Diuresis Dialysis pts who are overdiuresed -- - Answers replace fluid Low blood flow hypovolemic shock Relative hypovolemia: results when fluid volume moves out of the __________ space into _________ space - Answers vascular space into extravascular space (e.g. intracavitary space) Relative hypovolemia: termed - Answers third spacing Relative hypovolemia notes - Answers intravascularly depleted may still need fluids even if edematous Third spacing -- not in vessels "wet or dry" - Answers Wet: fluid overloaded Dry: intravascularly depleted Gunshot wound to abdomen, BP 58/30, HR 146 what type of shock? hypovolemic. Lost fluids -- affects BP and HR - Answers Know stages of shock: if given info -- know which stage of shock and what treatment will be Cool and cyanotic -- later stage Clinical presentation: hypovolemic shock - Answers preload Stroke volume: decreased Cap refill: increased time RR: increased in early, decreased UO: minimum 30ml/hr, 0.5ml/kg/hr Skin: early -- flushed and warm. Later -- cool and clammy Neurologic system: decreased LOC, agitation, anxiety, confusion -- decreased cerebral perfusion Renal system: kidneys try to compensate -- RAAS system -- reabsorption of water GI system: blood 'cut' from GI system. Assess bowel sounds -- hypoactive or absent (skin is also not prioritized -- cool and clammy in later stages) Diagnostic findings shock Hematocrit Hemoglobin Urine specific gravity Lactate - Answers Hematocrit: decreased (if bleed) Hemoglobin: decreased (if bleed) Urine specific gravity: measure of concentrated urine (will be MORE concentrated, specific gravity will increase) Lactate: increased (anaerobic metabolism) Lactate cleared through liver If have liver disease -- - Answers may have high levels but lactate is not being cleared Lactate 4 associated with 20% - Answers mortality rate 8 above 80% mortality rate Response to acute volume loss depends on: - Answers extent of injury Age: younger people can compensate better General state of health Compensatory mechanisms: We can lose about 15% of circulating volume (~750 ml), can compensate without showing anything is wrong Above 15-30% loss: - Answers SNS response -- increased HR, vasoconstriction, increased RR, death , CVP would decrease Clinical manifestations hypovolemic shock: (4) - Answers anxiety, tachypnea, increase in CO, HR Decrease in stroke volume, urinary output IF loss is 30%, blood volume is - Answers replaced Once we get above 40%, lose ability to - Answers autoregulate -- now we have irreversible tissue damage CBC, chem 7, chem 10, K+, Mg, phos, ionized calcium, lactate, ABG -- expecting - Answers hypoxia and acidosis How do we know person is perfusing?* - Answers URINE OUTPUT BP does NOT mean they are perfusing organs Initial stage of shock - Answers Usually NOT clinically apparent Metabolicm changes from aerobic to anerobic: lactic acid accumulates and must be removed by blood and broken down by liver; process requires unavailable O2 up to 15% loss Compensatory stage _____________ in carotid and aortic bodies activate SNS in response to decreased BP - Answers baroreceptors