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NUR 445 Exam 4 Shock Trauma & Burns Questions and
Answers with Complete Solutions UPDATED!!!
What is distributive shock?
Shock due to widespread vasodilation, includes anaphylactic,
septic, and neurogenic shock (spinal injury, spinal anesthesia)
What is cardiogenic shock? s/s?
- Occurs when the heart is damaged and unable to pump
enough blood forwards so blood is backed up, often as a result
of an acute MI, severe valve disfunction, or severe HF
- s/s: chest pain, diaphoresis, N/V, pallor, decreased CO, lung
crackles, dyspnea, cardiac enzymes elevated, increased CVP
- dx: 12 lead EKG,
- tx: 100% o2 nonrebreather, vasopressor
(dopamine, norepinephrine, phenylephrine), inotropic
(dobutamine), nitro for chest pain but careful because can
lower BP, diuretics for pulm congestion, morphine to decrease
cardiac O2 demand, surgical interventions (emergency
revascularization, ventricular assist device, intra-aortic balloon
pump)
What is the main issue with shock?
- decreased oxygen supply to vital organ tissues
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What is hypovolemic shock? causes? s/s? tx?
- not enough blood volume in circulatory system which
decreases the amount of oxygen that can be delivered
- causes: blood loss (trauma, internal bleeds, hemothorax),
secondary fluid loss following vomiting, diarrhea, excessive
urination, BURNS, excessive third spacing fluid loss (ascites)
- s/s: start out with anxiety/restlessness, confusion, decreased
peripheral extremity perfusion, tachycardia, tachypnea
(respiratory alkalosis), and increased BG; turns into lethargy,
low BP (low cardiac output), pallor, metabolic and respiratory
acidosis as no urine is being excreted and hyperventilation fails
and turns into hypoventilation, may result in coma and
renal/hepatic failure
- tx: ***100% O2 non-rebreather, fluid
resuscitation*** dependent on cause of hypovolemia, monitor
urine output, vitals, CVP (should increase as volume increases
and Tx works), neuro status, and peripheral perfusion; if
hemorrhagic treat with 1:1:1 of PRBC (O- is universal donor),
plasma, platelets
4 Stages of shock
initial stage: hypoxia (decreased SPO2), subtle manifestations,
decreased CO
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compensatory stage: body attempts to compensate for hypoxia
by increasing RR, HR, peripheral vasoconstriction (pale, clammy,
cold extremities, weakened peripheral pulses, cap refil >3sec.,
DECREASED URINARY OUTPUT), metabolic acidosis begins
progressive stage: compensatory mechanisms fail and BP drops,
severe shunting of blood to vital organs and poor perfusion to
peripheral organs, metabolic acidosis worsens, severe
electrolyte imbalance occurs, respiratory acidosis begins
refractory stage: prolonged inadequate blood supply causes cell
death, multi-system organ failure, anaerobic metabolism occurs
resulting in building of lactic acid; once this stage is reached, it
is irreversible
What are nursing interventions that need to be done quickly for
hypovolemic shock?
Apply 100% O2 via non-rebreather
Prep for intubation
Insert 2 large bore IV lines (18G or larger) for fluid resuscitation
What is obstructive shock?
- def: ventricular filling blocked possibly from cardiac
tamponade (pericarditis), tension pneumothorax, PE (increases
afterload)
- s/s: decreased CO, LOC, UO, pulse strength, poor peripheral
perfusion, decreased bowel sounds, chest pain (pleuritic if PE),
NUR 445 Exam 4 Shock Trauma & Burns Questions and
Answers with Complete Solutions UPDATED!!!
What is distributive shock?
Shock due to widespread vasodilation, includes anaphylactic,
septic, and neurogenic shock (spinal injury, spinal anesthesia)
What is cardiogenic shock? s/s?
- Occurs when the heart is damaged and unable to pump
enough blood forwards so blood is backed up, often as a result
of an acute MI, severe valve disfunction, or severe HF
- s/s: chest pain, diaphoresis, N/V, pallor, decreased CO, lung
crackles, dyspnea, cardiac enzymes elevated, increased CVP
- dx: 12 lead EKG,
- tx: 100% o2 nonrebreather, vasopressor
(dopamine, norepinephrine, phenylephrine), inotropic
(dobutamine), nitro for chest pain but careful because can
lower BP, diuretics for pulm congestion, morphine to decrease
cardiac O2 demand, surgical interventions (emergency
revascularization, ventricular assist device, intra-aortic balloon
pump)
What is the main issue with shock?
- decreased oxygen supply to vital organ tissues
,2|Page
What is hypovolemic shock? causes? s/s? tx?
- not enough blood volume in circulatory system which
decreases the amount of oxygen that can be delivered
- causes: blood loss (trauma, internal bleeds, hemothorax),
secondary fluid loss following vomiting, diarrhea, excessive
urination, BURNS, excessive third spacing fluid loss (ascites)
- s/s: start out with anxiety/restlessness, confusion, decreased
peripheral extremity perfusion, tachycardia, tachypnea
(respiratory alkalosis), and increased BG; turns into lethargy,
low BP (low cardiac output), pallor, metabolic and respiratory
acidosis as no urine is being excreted and hyperventilation fails
and turns into hypoventilation, may result in coma and
renal/hepatic failure
- tx: ***100% O2 non-rebreather, fluid
resuscitation*** dependent on cause of hypovolemia, monitor
urine output, vitals, CVP (should increase as volume increases
and Tx works), neuro status, and peripheral perfusion; if
hemorrhagic treat with 1:1:1 of PRBC (O- is universal donor),
plasma, platelets
4 Stages of shock
initial stage: hypoxia (decreased SPO2), subtle manifestations,
decreased CO
, 3|Page
compensatory stage: body attempts to compensate for hypoxia
by increasing RR, HR, peripheral vasoconstriction (pale, clammy,
cold extremities, weakened peripheral pulses, cap refil >3sec.,
DECREASED URINARY OUTPUT), metabolic acidosis begins
progressive stage: compensatory mechanisms fail and BP drops,
severe shunting of blood to vital organs and poor perfusion to
peripheral organs, metabolic acidosis worsens, severe
electrolyte imbalance occurs, respiratory acidosis begins
refractory stage: prolonged inadequate blood supply causes cell
death, multi-system organ failure, anaerobic metabolism occurs
resulting in building of lactic acid; once this stage is reached, it
is irreversible
What are nursing interventions that need to be done quickly for
hypovolemic shock?
Apply 100% O2 via non-rebreather
Prep for intubation
Insert 2 large bore IV lines (18G or larger) for fluid resuscitation
What is obstructive shock?
- def: ventricular filling blocked possibly from cardiac
tamponade (pericarditis), tension pneumothorax, PE (increases
afterload)
- s/s: decreased CO, LOC, UO, pulse strength, poor peripheral
perfusion, decreased bowel sounds, chest pain (pleuritic if PE),
