NURS 460 Shock Review Questions and Answers

NURS 460 Shock Review Questions and Answers Shock ✅A clinical syndrome characterized by inadequate tissue perfusion that results in cellular, metabolic, and hemodynamic derangements. Hypoperfusion -> leads to anaerobic metabolism (higher lactate acid level, send blood down on ice) Hypercoagulability (greater risk for clotting) Activation of the inflammatory response ✅similarities of different shock types Resuscitation ✅the process undertaken to restore adequate circulating blood volume and therefore tissue perfusion Hypovolemic Cardiogenic Distributive (massive vasodilation): - anaphylactic - septic - neurogenic ✅types of shock Compensate ✅older adults may be limited in their ability to _____ due to normal physiologic age related changes Glucose (if liver starts failing, glucose will drop) BUN/Cr (kidney function - Cr best indicator) Sodium , potassium, chloride (key components in heart function) Lactacte (increases with anaerobic metabolism) CBC with diff (bleeding, infection) Bilirubin (liver function) Abgs (lung function and oxygenation) Cultures (infection, especially in septic shock) ✅important labs A systolic of 90 A map 65 ✅adequate perfusion must be at least... Vasoconstrictors/vasopressors - Dopamine - Norepinephrine - Vasopressin Vasodilators (if pressure can tolerate, decreases work effort of heart) - Nitroglycerine - ACE Inhibitors Inotropic Agents (cardiogenic) - Dobutamine Antibiotics (septic) ✅medications for shock Hypovolemic shock ✅the circulating volume (blood or fluid) is inadequate for the body's needs = the tank is not full External fluid loss (burn, severe dehydration, trauma) Internal fluid loss (GI bleed, fluid shift) ✅causes of hypovolemic shock Increased: HR, RR, hematocrit (if loss of fluid) Decreased: BP, U/O; cool, pale skin; mentation; flat neck veins, CO, CVP, hematocrit (if loss of blood) ✅clinical presentation of hypovolemic shock If you can feel radial pulse = at least 80 If you can feel femoral pulse = at least 70 If you can feel carotid pulse = at least 60 ✅estimating systolic blood pressure by pulse palpation Eliminate the cause Replace what is lost (need a good working IV) ✅resuscitation of hypovolemic shock Crystalloid ✅hypertonic, hypotonic, isotonic; saline or lactated ringers; add more fluid to the intravascular system; able to diffuse through capillary wall; 3:1 rule (3 ml for every 1ml of blood loss) Colloid ✅blood (gives patient hemoglobin), albumin, volume expanders; can't diffuse through capillary wall and stay in intravascular space Gravity (only basic fluids with no additive): just hang wide open, possibly with pressure bag Pump: highest you can set is 999 ✅How to give fluid bolus Get consent Start within 30 minutes of arrival and must be completed within 4 hours Monitor for reaction (most likely to occur in the first 15 minutes): back pain, fever, tachycardia, etc; stop transfusion if suspected; send back to blood bank 2 nurses check off Can run with NORMAL SALINE ✅How to give blood Cardiogenic shock ✅results when an inefficient heart cannot sustain adequate circulation