SHOCK & MODS (PATHOPHYSIOLOGY) QUESTIONS AND ANSWERS
ELABORATIONS!!
shock and patho
Answers :widespread serious reduction of tissue perfusion (lack of oxygen &
nutrients) that, if prolonged, leads to generalized impairment in cellular
functioning
may develop slowly or rapidly
hypoperfusion -> hypoxia -> cell dysfunction -> cell death -> organ dysfunction ->
organ death
shock - hypovolemic
Answers :r/t external/internal blood/fluid loss
most common
shock - cardiogenic
Answers :r/t ischemia/impairment in tissue perfusion resulting from MI, serious
arrhythmia, or HF
all of these cause decreased CO
shock - distributive (description)
Answers :results from excessive vasodilation and impaired distribution of blood
flow
shock - distributive - anaphylactic
Answers :r/t allergens
can be acute and life-threatening w/respiratory distress r/t bronchial constriction
leading to airway obstruction
vascular collapse may follow
,shock - distributive - neurogenic
Answers :r/t injury to descending sympathetic pathways in spinal cord
results from loss of vasomotor tone and sympathetic innervation to the heart
shock - distributive - septic
Answers :r/t endotoxins released by bacteria, which cause vascular pooling,
diminished venous return, and reduced CO
shock - obstructive
Answers :physical obstruction r/t tamponade, emboli, compartment syndrome that
impedes the filling or outflow of blood resulting in reduced CO
shock - compensatory (aka pre-shock) phase - description
Answers :BP WNL
CO and SVR maintain d/t vasoconstriction, tachycardia, increased contractility
fight/flight
body shunts blood from skin, kidneys, GI to brain and heart
shock - compensatory (aka pre-shock) phase - assessment
Answers :BP near normal
skin cool, clammy
hypoactive bowel sounds
mildly decreased UO
HR >100
RR >20
, confusion
respiratory alkalosis
shock - compensatory (aka pre-shock) phase - interventions
Answers :#1: recognize compensatory measures and act, remember pts taking BB
may not show tachycardia, fever may not manifest in immunocompromised/old
assess hemodynamic status, vitals, labs, mentation, UO
ID cause and correct it
fluids, meds
safety
shock - progressive phase - description
Answers :loss of ability to compensate
MAP may be 20 below norm
inflammatory response -> cytokines -> leaky, permeable capillaries
coag system activated, watch for DIC
shock - progressive phase - assessment
Answers :SBP <80-90
HR 100-150
rapid, shallow breathing w/crackles
skin mottled, petechiae
severely decreased UO
lethargic
metabolic acidosis
shock - progressive phase - interventions
ELABORATIONS!!
shock and patho
Answers :widespread serious reduction of tissue perfusion (lack of oxygen &
nutrients) that, if prolonged, leads to generalized impairment in cellular
functioning
may develop slowly or rapidly
hypoperfusion -> hypoxia -> cell dysfunction -> cell death -> organ dysfunction ->
organ death
shock - hypovolemic
Answers :r/t external/internal blood/fluid loss
most common
shock - cardiogenic
Answers :r/t ischemia/impairment in tissue perfusion resulting from MI, serious
arrhythmia, or HF
all of these cause decreased CO
shock - distributive (description)
Answers :results from excessive vasodilation and impaired distribution of blood
flow
shock - distributive - anaphylactic
Answers :r/t allergens
can be acute and life-threatening w/respiratory distress r/t bronchial constriction
leading to airway obstruction
vascular collapse may follow
,shock - distributive - neurogenic
Answers :r/t injury to descending sympathetic pathways in spinal cord
results from loss of vasomotor tone and sympathetic innervation to the heart
shock - distributive - septic
Answers :r/t endotoxins released by bacteria, which cause vascular pooling,
diminished venous return, and reduced CO
shock - obstructive
Answers :physical obstruction r/t tamponade, emboli, compartment syndrome that
impedes the filling or outflow of blood resulting in reduced CO
shock - compensatory (aka pre-shock) phase - description
Answers :BP WNL
CO and SVR maintain d/t vasoconstriction, tachycardia, increased contractility
fight/flight
body shunts blood from skin, kidneys, GI to brain and heart
shock - compensatory (aka pre-shock) phase - assessment
Answers :BP near normal
skin cool, clammy
hypoactive bowel sounds
mildly decreased UO
HR >100
RR >20
, confusion
respiratory alkalosis
shock - compensatory (aka pre-shock) phase - interventions
Answers :#1: recognize compensatory measures and act, remember pts taking BB
may not show tachycardia, fever may not manifest in immunocompromised/old
assess hemodynamic status, vitals, labs, mentation, UO
ID cause and correct it
fluids, meds
safety
shock - progressive phase - description
Answers :loss of ability to compensate
MAP may be 20 below norm
inflammatory response -> cytokines -> leaky, permeable capillaries
coag system activated, watch for DIC
shock - progressive phase - assessment
Answers :SBP <80-90
HR 100-150
rapid, shallow breathing w/crackles
skin mottled, petechiae
severely decreased UO
lethargic
metabolic acidosis
shock - progressive phase - interventions
