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Perfusion (Shock) Questions and Answers 100% Accurate
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Exam of 5 pages for the course Perfusion at Perfusion (Perfusion (Shock))
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Perfusion (Shock)Classifications of Shock - answer- Hypovolemic: decreased intravascular volume due to
fluid loss
- Cardiogenic: impairment or failure of myocardium
- Septic: (circulatory shock) overwhelming infection causing relative hypovolemia
- Neurogenic: loss of sympathetic tone causing relative hypovolemia
- Anaphylactic: (circulatory shock) severe allergic reaction producing overwhelming
systemic vasodilation, relative hypovolemia
Compensatory Stage of Shock - answer- SNS causes vasoconstriction, increased HR &
heart contractility (this maintains BP, CO
- body shunts blood from skin, kidneys, GI tract; resulting in cool, clammy skin,
hypoactive bowel sounds, decreased urine output
- perfusion of tissues is inadequate
- acidosis occurs from anaerobic metabolism
respiratory rate increases due to acidosis (may cause compensatory respiratory
alkalosis).
- confusion my occur
Progressive Stage of Shock - answer- Mechanisms that regulate BP can no longer
compensate: BP and MAP decrease
- All organs suffer from hypoperfusion
- Vasoconstriciton continues, further compromising cellular perfusion
- Mental status further deteriorates due to decreased cerebral perfusion
- Mental status further deteriorates d/t decreased cerebral perfusion, hypoxia
- Lungs begin to fail, decreased pulmonary bloodflow causes further hypoxemia, CO2
levels increase, alveoli collapse, pulmonary edema occurs
- Inadequate perfusion of heart leads to dysrhthymias, ischemia
- As MAP falls below 7-, GFR cannot be maintained (acute renal failure may occur)
- Liver function, GI function, hematological function all affected
- DIC (disseminated intravascular coagulation) may occur as cause of complication of
shock
Irreversible Stage of Shock - answer- Organ damage is so severe that patient does not
respond to treatment, cannot survive.
- BP remains low
- Renal, liver function fail
- Anaerobic metabolism worsens acidosis
- Multiple organ dysfunction progresses to complete organ failure
- Judgement that shock is irreversible only made in retrospect
- Intubated at this stage; "coding" your patient
- Cellular death --> tissue death --> organ death --> systemic death
, For all types of shock - answer- early identification, timely treatment
- identify, treat underlying cause
-sequence of events for different types of shock will vary
Treatment of Shock - answer- Fluid replacements: crystalloid, collaoid solutions;
complications of fluid administration
- vasoactive-medication therapy
- nutritional support
- oxygen or mechanincla ventialtion
- glucose control 140-180 mg/dL
- corticosteroid
Hypovolemic Shock - answer- Decrease in intravascular volume of 15% or more
- Medical treatment: treatment of underlying cause; fluid/blood replacement (LR, NS),
redistribution of fluid, pharmacological therapy
- Nursing management: administration of blood, fluids safely, implement other
measures, NPO until GI returns to normal, administer oxygen, assess LOC/resp. effort,
modified trendelenburg (HOB elevated 10-degrees & lower extremities elevated 20
degrees)
- Causes: hemorrhage, burns, severe dehydration, vomiting, or diarrhea, NG suctioning,
diabetes inspidus, fluid shifts, third spacing (ascites, pleural effusion, or intestinal
obstruction)
- s/s: decreased BP, increased HR, vasoconstriction, blood flow to organs decrease,
acidiotic environment
Cardiogenic Shock - answer- Medical management: correction of underlying causes &
initiation of first-line treatment: oxygenation, pain control, hemodynamic monitoring,
laboratory-marker monitoring, fluid therapy, mechanical-assistive devices.
- Pharmacological thearapy: dobutamine (stimulates beta-blockers for myocardial
strength), nitroglycerin (vasodialtor to reduce preload), dopamine (low-dose: improves
tissue perfusion & increases CO; high-dose: causes vasoconstriction & increases
workload), morphine (dilates blood vessels), antiarrhythmic medications.
Fluid Repalcement - answer- crystalloids - 0.9% NS, LR, hypertonic solutons (3%saline)
- colloids - albumin 5%, dextran (may interfere with platelet aggregation)
- blood components - hypovolemic shock
- complications: fluid overload, pulmonary edema, hypothermia
Vasoactive Medications - answer- Sued with fluid therapy alone does not maintain MAP
- support hemodynamic status; stimulate SNS
- VS frequently (every 2-5 minutes)
- give through central line if possible - extravasation
- dosage are titrated; wean dose before discontinuing
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