Chapter 39 Care of Patients with Shock Practice
Questions and Answers
Review of oxygenation & tissue perfusion
Oxygenation & perfusion depend on how much oxygen from arterial
blood perfuses the tissue.
Tissue & organ perfusion is related to mean arterial pressure (MAP)
Causes & types of shock by functional impairment
-Hypovolemic shock- Total body fluid decreased (in all fluid
compartments)
Specific Cause or risk factors- trauma, GI ulcer, surgery, inadequate
clotting- hemophilia, liver disease, malnutrition, bone marrow
suppression, cancer,anticoagulation therapy, diabetes insipidus, -
Dehydration' hyperglycemia, vomiting, diarrhea, heavy diaphoresis,
diuretic therapy, Nasogatric suction
-Cardiogenic shock
Direct pump failure (fluid volume not affected), specific cause or risk
,factor- myocardial Infarction, cardiac arrest, ventricular
dysrhythmias (v fib, v tachy), cardiac amylodosis, cardiomyopathies-
viral, toxic, myocardial degeneration.
-Distributive shock- Fluid shifted from central vascular space
(total body fluid volume normal or increased)- neural-induced,
pain, anesthesia, stress, head trauma, chemical-induce-
anaphylaxis, capillary leak, burns extensive- trauma, liver
impairment
,Obstructive shock- Cardiac function decreased by non cardiac factor
(indirect pump failure) total body fluid is not affected although central
volume is decreased . Specific Cause or risk factors- Cardiac tamponade,
arterial stenosis, pulmonary embolism, pulmonary hypertension,
constructive pericarditis, thoracic tumors, tension pneumothorax.
Key features:Shock
Cardiovascular manifestations: decreased cardiac output, increased
pulse rate, thready pulse, decreased BP, narrowed pulse pressure,
postural hypotension ¥, low central venous pressure, flat neck & hand
veins in dependent positions, alow capillary refill nailbeds
Respiratory - increased respiratory rate, shallow depth of
respirations, increased paco2, increased paco2, cyanosis (lips & nail
beds)
Neuromuscular- anxiety, restlessness, increased thirst
LATE- Decreased CNS activity (lethargy to coma); Generalized muscle
weakness, diminished or absent deep tendon reflexes, sluggish
pupillary response to light.
KIDNEY- decreased urine output; increased specific gravity; sugar &
acetone present in urine
, INTEGUMENTARY- Cool to cold; pale to mottled to cyanotic; moist,
clammy; mouth dry; pastelike coating presenting
GASTROINTESTINAL- Decreased motility; diminished or absent bowel
sounds; nausea & vomiting; constipation.
TYPE OF SHOCKS- HYPOVOLEMIC
Questions and Answers
Review of oxygenation & tissue perfusion
Oxygenation & perfusion depend on how much oxygen from arterial
blood perfuses the tissue.
Tissue & organ perfusion is related to mean arterial pressure (MAP)
Causes & types of shock by functional impairment
-Hypovolemic shock- Total body fluid decreased (in all fluid
compartments)
Specific Cause or risk factors- trauma, GI ulcer, surgery, inadequate
clotting- hemophilia, liver disease, malnutrition, bone marrow
suppression, cancer,anticoagulation therapy, diabetes insipidus, -
Dehydration' hyperglycemia, vomiting, diarrhea, heavy diaphoresis,
diuretic therapy, Nasogatric suction
-Cardiogenic shock
Direct pump failure (fluid volume not affected), specific cause or risk
,factor- myocardial Infarction, cardiac arrest, ventricular
dysrhythmias (v fib, v tachy), cardiac amylodosis, cardiomyopathies-
viral, toxic, myocardial degeneration.
-Distributive shock- Fluid shifted from central vascular space
(total body fluid volume normal or increased)- neural-induced,
pain, anesthesia, stress, head trauma, chemical-induce-
anaphylaxis, capillary leak, burns extensive- trauma, liver
impairment
,Obstructive shock- Cardiac function decreased by non cardiac factor
(indirect pump failure) total body fluid is not affected although central
volume is decreased . Specific Cause or risk factors- Cardiac tamponade,
arterial stenosis, pulmonary embolism, pulmonary hypertension,
constructive pericarditis, thoracic tumors, tension pneumothorax.
Key features:Shock
Cardiovascular manifestations: decreased cardiac output, increased
pulse rate, thready pulse, decreased BP, narrowed pulse pressure,
postural hypotension ¥, low central venous pressure, flat neck & hand
veins in dependent positions, alow capillary refill nailbeds
Respiratory - increased respiratory rate, shallow depth of
respirations, increased paco2, increased paco2, cyanosis (lips & nail
beds)
Neuromuscular- anxiety, restlessness, increased thirst
LATE- Decreased CNS activity (lethargy to coma); Generalized muscle
weakness, diminished or absent deep tendon reflexes, sluggish
pupillary response to light.
KIDNEY- decreased urine output; increased specific gravity; sugar &
acetone present in urine
, INTEGUMENTARY- Cool to cold; pale to mottled to cyanotic; moist,
clammy; mouth dry; pastelike coating presenting
GASTROINTESTINAL- Decreased motility; diminished or absent bowel
sounds; nausea & vomiting; constipation.
TYPE OF SHOCKS- HYPOVOLEMIC
