NSG 233 Exam 1 Questions and Answers
100% Solved
Irreversible Shock Requires mechanical or pharmacologic support
Erratic
Requires intubation and mechanical ventilation and oxygenation
Jaundice
Anuric, Requires Dialysis
Unconscious
Profound Acidosis
Assessing MODS Multiple organ dysfunction syndrome (MODS) is altered organ
function in acutely ill patients that requires medical intervention to support continued organ
function. It is another phase in the progression of shock states. MODS may be a complication of
any form of shock, but it is most commonly seen in patients with sepsis and is a result of
inadequate tissue perfusion.
Clinical Severity Assesment Tools: These clinical assessment tools include APACHE (Acute
Physiology and Chronic Health Evaluation); SAPS (Simplified Acute Physiology Score); PIRO
(Predisposing factors, the Infection, the host Response, and Organ dysfunction); and SOFA score
,Assessing Hypovolemic Shock Hypovolemic shock can be caused by external fluid
losses, as in traumatic blood loss, or by internal fluid shifts, as in severe dehydration, severe
edema, or ascites
Decreased intravascular volume
Decreased venous return
Decreased stroke volume, cardiac output, and tissue perfusion
Assessing Neurogenic Shock Neurogenic shock can be caused by spinal cord injury,
spinal anesthesia, or other nervous system damage. It may also result from the depressant action
of medications or from lack of glucose (e.g., insulin reaction)
Normally, during states of stress, the sympathetic stimulation causes the BP and heart rate to
increase. In neurogenic shock, the sympathetic system is not able to respond to body stressors.
Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic
stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in
hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the
tachycardia that characterizes other forms of shock.
Medication Treatment Anaphylactic Shock Epinephrine is the adrenergic drug of choice
for relief of anaphylactic shock, the most serious allergic reaction
, Diphenhydramine (Benadryl) is given intravenously to reverse the effects of histamine, thereby
reducing capillary permeability. Nebulized medications, such as albuterol (Proventil), may be
given to reverse histamine-induced bronchospasm.
IM or SC epinephrine is first-line treatment**
1:1,000 concentration
Never give IV - this is 10x stronger than concentration given for cardiac treatment
Medications Neurogenic Shock Treatment of neurogenic shock involves restoring
sympathetic tone, either through the stabilization of a spinal cord injury or, in the instance of
spinal anesthesia, by positioning the patient properly. Specific treatment depends on the cause of
the shock.
Prevent further damage by cervical spine and back stabilization
Maintain patent airway and assist with breathing as needed
Cautious fluid resuscitation (preload)
Vasopressors for vasoconstriction of blood vessels-----> increase BP (afterload)
Atropine or cardiac pacing for bradycardia------>increase HR
100% Solved
Irreversible Shock Requires mechanical or pharmacologic support
Erratic
Requires intubation and mechanical ventilation and oxygenation
Jaundice
Anuric, Requires Dialysis
Unconscious
Profound Acidosis
Assessing MODS Multiple organ dysfunction syndrome (MODS) is altered organ
function in acutely ill patients that requires medical intervention to support continued organ
function. It is another phase in the progression of shock states. MODS may be a complication of
any form of shock, but it is most commonly seen in patients with sepsis and is a result of
inadequate tissue perfusion.
Clinical Severity Assesment Tools: These clinical assessment tools include APACHE (Acute
Physiology and Chronic Health Evaluation); SAPS (Simplified Acute Physiology Score); PIRO
(Predisposing factors, the Infection, the host Response, and Organ dysfunction); and SOFA score
,Assessing Hypovolemic Shock Hypovolemic shock can be caused by external fluid
losses, as in traumatic blood loss, or by internal fluid shifts, as in severe dehydration, severe
edema, or ascites
Decreased intravascular volume
Decreased venous return
Decreased stroke volume, cardiac output, and tissue perfusion
Assessing Neurogenic Shock Neurogenic shock can be caused by spinal cord injury,
spinal anesthesia, or other nervous system damage. It may also result from the depressant action
of medications or from lack of glucose (e.g., insulin reaction)
Normally, during states of stress, the sympathetic stimulation causes the BP and heart rate to
increase. In neurogenic shock, the sympathetic system is not able to respond to body stressors.
Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic
stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in
hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the
tachycardia that characterizes other forms of shock.
Medication Treatment Anaphylactic Shock Epinephrine is the adrenergic drug of choice
for relief of anaphylactic shock, the most serious allergic reaction
, Diphenhydramine (Benadryl) is given intravenously to reverse the effects of histamine, thereby
reducing capillary permeability. Nebulized medications, such as albuterol (Proventil), may be
given to reverse histamine-induced bronchospasm.
IM or SC epinephrine is first-line treatment**
1:1,000 concentration
Never give IV - this is 10x stronger than concentration given for cardiac treatment
Medications Neurogenic Shock Treatment of neurogenic shock involves restoring
sympathetic tone, either through the stabilization of a spinal cord injury or, in the instance of
spinal anesthesia, by positioning the patient properly. Specific treatment depends on the cause of
the shock.
Prevent further damage by cervical spine and back stabilization
Maintain patent airway and assist with breathing as needed
Cautious fluid resuscitation (preload)
Vasopressors for vasoconstriction of blood vessels-----> increase BP (afterload)
Atropine or cardiac pacing for bradycardia------>increase HR
