215 TEST 2 Exam Study Questions with Verified
Correct Answers
Shock Overview
• Syndrome characterized by decreased tissue perfusion
and impaired cellular metabolism
• Imbalance between supply of and demand for O₂ and
nutrients
Classification of Shock
• Cardiogenic
• Hypovolemic
- Absolute
- Relative
• Distributive
- Anaphylactic
- Septic
• Obstructive
Cardiogenic Shock Definition
• Systolic or diastolic dysfunction
- Systolic dysfunction is the heart's inability to pump the blood
forward.
- Most common cause is MI
• ↓ filling of the heart will result in ↓ stroke volume
• Low cardiac output (CO) and cardiac index
Cardiogenic Shock Precipitating causes
• Myocardial infarction
• Cardiomyopathy
• Blunt cardiac injury
• Severe systemic or pulmonary hypertension
• Cardiac tamponade
• Myocardial depression from metabolic problems
,Early Manifestations of Cardiogenic Shock
• Tachycardia
• Hypotension
• Narrowed pulse pressure
• Increased systemic vascular resistance (SVR)
• Increased myocardial O₂ consumption
Manifestations of Cardiogenic Shock: Physical assessment
• Tachypnea, pulmonary congestion
• Pallor and cool, clammy skin
• Decreased capillary refill time
Manifestations of Cardiogenic Shock
• Increased pulmonary artery wedge pressure (PAWP)
• Stroke volume variation (SVV) and pulmonary vascular
resistance
• Decreased renal perfusion and urinary output
Hypovolemic Shock: Absolute hypovolemia
loss of intravascular fluid volume:
- Hemorrhage
- GI loss (e.g., vomiting, diarrhea)
- Fistula drainage
- Diabetes insipidus
- Diuresis
Hypovolemic Shock: Relative hypovolemia
- Results when fluid volume moves out of the vascular space
into extravascular space (e.g., intracavitary space)
- Termed third spacing
Hypovolemic Shock: What does the response to acute volume loss depend on?
- Extent of injury
- Age
- General state of health
• Patient may compensate for up to 15% loss (~750 mL)
• Loss of 15% - 30% results in SNS-mediated response
, Manifestations of Hypovolemic Shock
• Anxiety
• Tachypnea
• Increase in heart rate, CO, respiratory rate and depth
• Decrease in stroke volume, CVP, PAWP, urinary
output
• If loss is greater than 30%, blood volume is replaced
Anaphylactic Shock
• Acute, life-threatening hypersensitivity (allergic) reaction:
- Massive vasodilation
- Release of vasoactive mediators
- Increase in capillary permeability: Fluid leaks into interstitial space
Manifestations of Anaphylactic Shock
• Anxiety
• Confusion, dizziness
• Sense of impending doom
• Chest pain
• Incontinence
• Swelling of lips and tongue, angioedema
• Wheezing, stridor due to laryngeal edema
• Flushing, pruritus, urticaria
• Respiratory distress and circulatory failure
Sepsis
systemic inflammatory response to
documented or suspected infection
Severe sepsis
sepsis complicated by organ
dysfunction
Septic Shock
• Presence of sepsis with hypotension despite fluid
resuscitation
• Presence of inadequate tissue perfusion resulting in
hypoxia
Correct Answers
Shock Overview
• Syndrome characterized by decreased tissue perfusion
and impaired cellular metabolism
• Imbalance between supply of and demand for O₂ and
nutrients
Classification of Shock
• Cardiogenic
• Hypovolemic
- Absolute
- Relative
• Distributive
- Anaphylactic
- Septic
• Obstructive
Cardiogenic Shock Definition
• Systolic or diastolic dysfunction
- Systolic dysfunction is the heart's inability to pump the blood
forward.
- Most common cause is MI
• ↓ filling of the heart will result in ↓ stroke volume
• Low cardiac output (CO) and cardiac index
Cardiogenic Shock Precipitating causes
• Myocardial infarction
• Cardiomyopathy
• Blunt cardiac injury
• Severe systemic or pulmonary hypertension
• Cardiac tamponade
• Myocardial depression from metabolic problems
,Early Manifestations of Cardiogenic Shock
• Tachycardia
• Hypotension
• Narrowed pulse pressure
• Increased systemic vascular resistance (SVR)
• Increased myocardial O₂ consumption
Manifestations of Cardiogenic Shock: Physical assessment
• Tachypnea, pulmonary congestion
• Pallor and cool, clammy skin
• Decreased capillary refill time
Manifestations of Cardiogenic Shock
• Increased pulmonary artery wedge pressure (PAWP)
• Stroke volume variation (SVV) and pulmonary vascular
resistance
• Decreased renal perfusion and urinary output
Hypovolemic Shock: Absolute hypovolemia
loss of intravascular fluid volume:
- Hemorrhage
- GI loss (e.g., vomiting, diarrhea)
- Fistula drainage
- Diabetes insipidus
- Diuresis
Hypovolemic Shock: Relative hypovolemia
- Results when fluid volume moves out of the vascular space
into extravascular space (e.g., intracavitary space)
- Termed third spacing
Hypovolemic Shock: What does the response to acute volume loss depend on?
- Extent of injury
- Age
- General state of health
• Patient may compensate for up to 15% loss (~750 mL)
• Loss of 15% - 30% results in SNS-mediated response
, Manifestations of Hypovolemic Shock
• Anxiety
• Tachypnea
• Increase in heart rate, CO, respiratory rate and depth
• Decrease in stroke volume, CVP, PAWP, urinary
output
• If loss is greater than 30%, blood volume is replaced
Anaphylactic Shock
• Acute, life-threatening hypersensitivity (allergic) reaction:
- Massive vasodilation
- Release of vasoactive mediators
- Increase in capillary permeability: Fluid leaks into interstitial space
Manifestations of Anaphylactic Shock
• Anxiety
• Confusion, dizziness
• Sense of impending doom
• Chest pain
• Incontinence
• Swelling of lips and tongue, angioedema
• Wheezing, stridor due to laryngeal edema
• Flushing, pruritus, urticaria
• Respiratory distress and circulatory failure
Sepsis
systemic inflammatory response to
documented or suspected infection
Severe sepsis
sepsis complicated by organ
dysfunction
Septic Shock
• Presence of sepsis with hypotension despite fluid
resuscitation
• Presence of inadequate tissue perfusion resulting in
hypoxia
