N245 Exam 3 Study Guide:
Shocks
-all have HYPOTENSION
Cardiogenic: heart related (MI, cardiac tamponade, cardiomyopathy, cardiac trauma)
-DO NOT GIVE FLUIDS RESUSCITATION!!!
-Cool, clammy, pallor skin, tachycardic, hypotensive, tachypnea, decreased cap refill, confusion,
agitation, diaphoresis, hypoactive bowel sounds.
-Drug therapy: Nitro, vasodilators, nitrates, diuretics, dopamine, B-adrenergic blockers to reduce
HR
Hypovolemic shock:
-Absolute: = fluids going away from the body (vomit, diarrhea, fistula drainage, hemorrhage, GI
bleed, excessive diuresis)
-Relative: = fluids retain, fluid shifting into tissues. Do need fluids (sepsis, burns, ascites, internal
bleeding, bowel obstruction)
-3:1 ratio giving fluids: lose 1000cc of fluid give 3000cc of fluids
-isotonic fluids (LR, NS)
-Treat the cause !!!
-Cool, clammy, tachycardic, hypotensive, decreased cap refill, increased urinary output,
decreased bowel sounds.
Neurogenic: T5 & above spinal cord injury or spinal anesthesia.
-causes: drugs, severe pain, hypoglycemia, injury
-s/sx: incontinence (cath or bladder training), Bradycardic (the only shock), hypotensive, dry skin,
not clammy, massive vasodilation (heat loss, important to prevent hypothermia, keep them
covered/warm)
-Poikilothermia (taking on the temp of the room) = late sign.
-give vasopressors/vasoconstrictors [dopamine, epinephrine, norepinephrine (Levophed),
phenylephrine]
-atropine (for bradycardia)
-DO NOT GIVE FLUIDS RESUSCITATION!!!
Anaphylactic:
-Allergic reaction (drugs chemicals, vaccine, food, insect venom, mismatch of blood)
-First monitor resp status = big concern !!!
-Stridor, angioedema, bronchospasm, hypotension, tachycardia, generalized edema, incontinent,
flushed skin, anxious, confused, sense of impending doom!!!
-Give them epinephrine, Benadryl (diphenhydramine), steroids
-Give fluids resuscitation
-May have to be intubated
Obstructive: something obstructing the perfusion, reduced CO
-Causes: PE, cardiac tamponade, tension pneumothorax, abdominal compartment syndrome, tumor
-Cool, clammy, tachycardic, hypotensive, decreased CO, increased afterload, JVD, pulsus
paradoxus.
-find and treat cause
***Give fluids
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, Septic: infections (all body), also parasites, fungi, viruses can cause it
- warm & flushed skin first, then cool & clammy, tachycardic, hypotension. Glucose levels <180.
-give fluid bolus first, then antibiotics within the first hour (CULTURES BEFORE ANTIBIOTICS)
-If pt is still hypotensive after you give them bolus of fluids, it means they’re in septic shock
-if still hypotensive after bolus fluids, give vasopressors [dopamine, epinephrine, norepinephrine
(Levophed), phenylephrine]
⁃it’s the only one with FEVER
*** #1-fluids (isotonic), #2-antibiotics, #3-vasopressors/vasoconstrictors
-Antibiotics can be nephrotoxic – monitor kidney function
***MAP should be above 65 !!! MAP = (DBP x 2) + SBP / 3
***3 major pathos for shock: Vasodilation, maldistribution blood flow, myocardial dysfunction
This study source was downloaded by 100000900412927 from CourseHero.com on 09-24-2025 11:51:34 GMT -05:00
https://www.coursehero.com/file/251255433/Exam-3-Study-Guide-N245pdf/
Shocks
-all have HYPOTENSION
Cardiogenic: heart related (MI, cardiac tamponade, cardiomyopathy, cardiac trauma)
-DO NOT GIVE FLUIDS RESUSCITATION!!!
-Cool, clammy, pallor skin, tachycardic, hypotensive, tachypnea, decreased cap refill, confusion,
agitation, diaphoresis, hypoactive bowel sounds.
-Drug therapy: Nitro, vasodilators, nitrates, diuretics, dopamine, B-adrenergic blockers to reduce
HR
Hypovolemic shock:
-Absolute: = fluids going away from the body (vomit, diarrhea, fistula drainage, hemorrhage, GI
bleed, excessive diuresis)
-Relative: = fluids retain, fluid shifting into tissues. Do need fluids (sepsis, burns, ascites, internal
bleeding, bowel obstruction)
-3:1 ratio giving fluids: lose 1000cc of fluid give 3000cc of fluids
-isotonic fluids (LR, NS)
-Treat the cause !!!
-Cool, clammy, tachycardic, hypotensive, decreased cap refill, increased urinary output,
decreased bowel sounds.
Neurogenic: T5 & above spinal cord injury or spinal anesthesia.
-causes: drugs, severe pain, hypoglycemia, injury
-s/sx: incontinence (cath or bladder training), Bradycardic (the only shock), hypotensive, dry skin,
not clammy, massive vasodilation (heat loss, important to prevent hypothermia, keep them
covered/warm)
-Poikilothermia (taking on the temp of the room) = late sign.
-give vasopressors/vasoconstrictors [dopamine, epinephrine, norepinephrine (Levophed),
phenylephrine]
-atropine (for bradycardia)
-DO NOT GIVE FLUIDS RESUSCITATION!!!
Anaphylactic:
-Allergic reaction (drugs chemicals, vaccine, food, insect venom, mismatch of blood)
-First monitor resp status = big concern !!!
-Stridor, angioedema, bronchospasm, hypotension, tachycardia, generalized edema, incontinent,
flushed skin, anxious, confused, sense of impending doom!!!
-Give them epinephrine, Benadryl (diphenhydramine), steroids
-Give fluids resuscitation
-May have to be intubated
Obstructive: something obstructing the perfusion, reduced CO
-Causes: PE, cardiac tamponade, tension pneumothorax, abdominal compartment syndrome, tumor
-Cool, clammy, tachycardic, hypotensive, decreased CO, increased afterload, JVD, pulsus
paradoxus.
-find and treat cause
***Give fluids
This study source was downloaded by 100000900412927 from CourseHero.com on 09-24-2025 11:51:34 GMT -05:00
https://www.coursehero.com/file/251255433/Exam-3-Study-Guide-N245pdf/
, Septic: infections (all body), also parasites, fungi, viruses can cause it
- warm & flushed skin first, then cool & clammy, tachycardic, hypotension. Glucose levels <180.
-give fluid bolus first, then antibiotics within the first hour (CULTURES BEFORE ANTIBIOTICS)
-If pt is still hypotensive after you give them bolus of fluids, it means they’re in septic shock
-if still hypotensive after bolus fluids, give vasopressors [dopamine, epinephrine, norepinephrine
(Levophed), phenylephrine]
⁃it’s the only one with FEVER
*** #1-fluids (isotonic), #2-antibiotics, #3-vasopressors/vasoconstrictors
-Antibiotics can be nephrotoxic – monitor kidney function
***MAP should be above 65 !!! MAP = (DBP x 2) + SBP / 3
***3 major pathos for shock: Vasodilation, maldistribution blood flow, myocardial dysfunction
This study source was downloaded by 100000900412927 from CourseHero.com on 09-24-2025 11:51:34 GMT -05:00
https://www.coursehero.com/file/251255433/Exam-3-Study-Guide-N245pdf/
