Podcast
Questions and Answers
What is the primary characteristic of cardiogenic shock?
What is the primary characteristic of cardiogenic shock?
- Fluid volume loss from dehydration
- Decreased cardiac output (correct)
- Increased tissue perfusion
- Vasodilation and maldistribution of blood flow
What distinguishes absolute hypovolemia from relative hypovolemia?
What distinguishes absolute hypovolemia from relative hypovolemia?
- Relative hypovolemia involves fluid loss into the vascular space
- Relative hypovolemia involves fluid moving outside the vascular space (correct)
- Absolute hypovolemia occurs due to tissue injury
- Absolute hypovolemia is caused solely by hemorrhage
Which type of shock can occur within 30 minutes of a spinal cord injury?
Which type of shock can occur within 30 minutes of a spinal cord injury?
- Septic Shock
- Obstructive Shock
- Neurogenic Shock (correct)
- Anaphylactic Shock
Which of the following is NOT a consequence of septic shock?
Which of the following is NOT a consequence of septic shock?
What is the common mortality rate associated with cardiogenic shock?
What is the common mortality rate associated with cardiogenic shock?
What is a primary characteristic of obstructive shock?
What is a primary characteristic of obstructive shock?
Which condition is NOT a cause of obstructive shock?
Which condition is NOT a cause of obstructive shock?
When managing a patient with obstructive shock, which position is currently recommended to promote venous return?
When managing a patient with obstructive shock, which position is currently recommended to promote venous return?
What assessment finding may indicate impaired gas exchange in a patient with obstructive shock?
What assessment finding may indicate impaired gas exchange in a patient with obstructive shock?
In the context of managing sepsis, what is an important intravenous fluid goal?
In the context of managing sepsis, what is an important intravenous fluid goal?
Which nursing diagnosis is directly related to a decrease in renal perfusion?
Which nursing diagnosis is directly related to a decrease in renal perfusion?
What is a potential consequence of abdominal compartment syndrome?
What is a potential consequence of abdominal compartment syndrome?
What vital sign measurement is crucial for monitoring hypovolemia in a patient?
What vital sign measurement is crucial for monitoring hypovolemia in a patient?
Which medication is primarily used in managing anaphylactic shock?
Which medication is primarily used in managing anaphylactic shock?
What is a key consideration when using mechanical support like MAST or PASG?
What is a key consideration when using mechanical support like MAST or PASG?
What is the primary purpose of administering isotonic crystalloid boluses in hypovolemic shock?
What is the primary purpose of administering isotonic crystalloid boluses in hypovolemic shock?
In the management of cardiogenic shock, what is an appropriate starting dose for Nitroprusside?
In the management of cardiogenic shock, what is an appropriate starting dose for Nitroprusside?
What is the recommended dose of sodium Nitroprusside for a 40 kg child?
What is the recommended dose of sodium Nitroprusside for a 40 kg child?
When managing hemorrhagic hypovolemic shock, what is the guideline for crystalloid infusion?
When managing hemorrhagic hypovolemic shock, what is the guideline for crystalloid infusion?
Which of the following is a common treatment for cardiogenic shock?
Which of the following is a common treatment for cardiogenic shock?
What should be monitored after administering mechanical support in a shock patient?
What should be monitored after administering mechanical support in a shock patient?
What is the primary treatment goal for managing anaphylactic shock?
What is the primary treatment goal for managing anaphylactic shock?
Which medication should be administered as the first-line treatment in anaphylactic shock?
Which medication should be administered as the first-line treatment in anaphylactic shock?
In the management of neurogenic shock, which position should be used to improve venous return?
In the management of neurogenic shock, which position should be used to improve venous return?
Which fluid dosage is typically administered to restore blood pressure in neurogenic shock?
Which fluid dosage is typically administered to restore blood pressure in neurogenic shock?
What initial treatment is crucial during the management of septic shock?
What initial treatment is crucial during the management of septic shock?
Which medication is administered for hypotensive vasodilated shock?
Which medication is administered for hypotensive vasodilated shock?
When should stress-dose hydrocortisone be ordered in septic shock management?
When should stress-dose hydrocortisone be ordered in septic shock management?
Which additional abnormality should be corrected during the management of septic shock?
Which additional abnormality should be corrected during the management of septic shock?
Which assessment parameter is used to evaluate treatment effectiveness in septic shock?
Which assessment parameter is used to evaluate treatment effectiveness in septic shock?
What is the maximum dose of Diphenhydramine for treating anaphylactic shock?
What is the maximum dose of Diphenhydramine for treating anaphylactic shock?
Study Notes
Overview of Shock
- Shock is characterized by decreased tissue perfusion and impaired cellular metabolism.
- An imbalance arises between the delivery and demand of oxygen and nutrients.
- Four main categories: cardiogenic, hypovolemic, distributive, and obstructive.
Cardiogenic Shock
- Results from heart dysfunction leading to reduced cardiac output (CO).
- Mortality rates approach 60%; major cause of death from acute myocardial infarction.
- Signs include:
- Systolic Blood Pressure (SBP) < 30 mmHg
- Heart Rate (HR) > 60 bpm
- Oliguria (low urine output)
- Possible organ congestion
Hypovolemic Shock
- Occurs due to loss of intravascular fluid volume, affecting vascular space filling.
- Two types:
- Absolute hypovolemia: loss through hemorrhage, GI losses, etc.
- Relative hypovolemia: fluid migration from vascular to extravascular spaces.
- Physiological effects are similar regardless of volume loss type.
Distributive Shock
- Includes several subtypes:
- Neurogenic Shock: Can occur within 30 minutes of T5 spinal cord injury; lasts up to 6 weeks.
- Anaphylactic Shock: Severe allergic reactions to substances like drugs or food.
- Septic Shock: Sepsis with hypotension despite adequate fluids; leads to tissue hypoxia due to vasodilation and maldistribution of blood flow.
Obstructive Shock
- Caused by physical obstruction to blood flow, leading to decreased CO.
- Causes include:
- Cardiac tamponade (compression of the heart)
- Tension pneumothorax
- Abdominal compartment syndrome (pressure on inferior vena cava)
- Pulmonary embolism
Assessment and Nursing Diagnoses
- Customized assessments based on shock type severity.
- Common nursing diagnoses:
- Altered tissue perfusion due to vasoconstriction or decreased myocardial contractility.
- Impaired gas exchange from ventilation-perfusion imbalance.
- Decreased cardiac output related to lost circulating blood volume.
- Altered urinary elimination from renal perfusion reduction.
- Fluid volume deficit due to blood loss.
Nursing Care Plan and Implementation
- Main goal: Promote venous return and circulatory perfusion.
- Positioning: Elevate the foot of the bed 20 degrees; avoid Trendelenburg position.
- Ventilation: Monitor respiratory effort, ensure oxygen is administered.
- IV fluid management: Administer 2-6 liters for sepsis; aim for CVP >12 mmHg.
- Continuous monitoring of vital signs and urine output; ECG assessments primary for cardiac function.
Medications for Shock Management
- Varies based on shock type; includes:
- Vasopressors: Dobutamine, Norepinephrine, Isoproterenol, Dopamine for cardiogenic, neurogenic, septic shock.
- Antiarrhythmics for cardiogenic shock.
- Antibiotics for septic shock; corticosteroids for anaphylactic shock.
Mechanical Support and Advanced Therapies
- Use of MAST or PASG garments for internal transfusion and bleeding control.
- Continuous cautious monitoring to prevent complications like compartment syndrome.
Management Strategies for Types of Shock
Cardiogenic Shock
- Administer oxygen and support ventilation.
- Establish vascular access; persist with fluid boluses as needed.
- Employ medications like catecholamines and vasodilators.
Hypovolemic Shock
- Key management involves aggressive fluid resuscitation.
- For nonhemorrhagic cases, aim for significant isotonic crystalloid infusion.
- In hemorrhagic shock, maintain a 3:1 crystalloid replacement for blood loss.
Neurogenic Shock
- Administer fluids and consider vasopressors for mild hypotension.
- Positioning intervention to enhance venous return.
Anaphylactic Shock
- Focus on addressing bronchoconstriction and vasodilation.
- Immediate epinephrine administration is crucial, along with supportive medications.
Septic Shock
- Begin with fluid resuscitation and antibiotic therapy.
- Monitor ScvO2; adjust vasopressors based on patient response.
Evaluation/Outcome Criteria
- Essential to achieve stable vital signs within normal limits for successful management.
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Description
This quiz covers the fundamentals of shock, including its types, underlying mechanisms, and physiological effects. Key categories such as cardiogenic, hypovolemic, and distributive shock are discussed, along with their characteristics and implications for patient care. Test your knowledge on this vital topic in critical care.
