Shock questions
What is the initial stage of shock?
Decreased cardiac output Tissue perfusion threatened
What is seen in the progression of the shock response?
Decreased cardiac output and tissue perfusion Lactic acidosis (metabolic acidosis that begins in the kidneys)Hypovolemia Decreased tissue perfusion Cellular death Manifested in major organs
What is the progressive stage of shock?
Decreased tissue perfusion → lactic acidemia Vasodilation and increased vascular permeability → decreased intravascular volume, tissue edema, and further decreased tissue perfusion → SIRS → irreversible cell damage and cellular death → cells unable to use oxygen Every body system affected Confusion Nonresponsive Concentrated urine Weak thready pulse
What is the compensatory stage of shock?
Almost immediately, body's homeostatic mechanisms attempt to maintain CO, BP, and tissue perfusion Mediated by SNS
A patient with neurogenic shock is experiencing a heart rate of 30 bpm. What medication does the respiratory therapist anticipate will be ordered by the physician STAT? A. Adenosine B. Warfarin C. Atropine D. Norepinephrine
C. Atropine
You are assigned to the intensive care unit (ICU) you should monitor which patient who is at most risk for septic shock? A. 66 y.o. F with infectious pneumonia B. 34 y.o. M with a traumatic head injury C. 46 y.o. F with mitral valve prolapse D. 22 y/o/ M with spontaneous pneumothorax
A. 66 y.o. F with infectious pneumonia
Your patient has been diagnosed with sepsis and is taken to the intensive care unit (ICU). Which assessment helps you monitor your patient's hemodynamic status? A. Assessing the client's capillary refill B. Observing vital signs C. Palpating peripheral pulses D. Monitoring the CVP line
D. Monitoring the CVP line
A patient has a 10% loss of their blood volume. Select all the signs and symptoms this patient may present with? A. Cool, clammy skin B. Blood pressure within normal limits C. Anxiety D. Capillary refill less than 2 seconds E. Urinary output greater than 30 mL/hr F. Mild tachycardia
B. Blood pressure within normal limits D. Capillary refill less than 2 seconds E. Urinary output greater than 30mL/hr
You are concerned that a patient admitted to the cardiac care unit (CCU) after a motor vehicle crash is demonstrating signs of septic shock. Which assessment findings support this concern? A. Blood pressure is 100/72 B. CVP is 1 C. Pulse 60 D. O2 Saturation of 92%
B. CVP is 1
A patient who has cardiogenic shock is experiencing labored breathing and low oxygen levels. A STAT chest x-ray is ordered. The x-ray results show pulmonary edema. The physician orders Furosemide IV. What finding would require immediate respiratory therapist action? A. Blood pressure 98/54 B. Urinary output 45 mL/hr C. Potassium 1.8 mEq/L D. Heart rate 110 bpm
C. Potassium 1.8 mEq/L
A patient is 1 hour post-op from abdominal surgery and had lost 20% of their blood volume during surgery. The patient is experiencing signs and symptoms of hypovolemic shock. What position is best for this patient? A. Trendelenburg B. Trendelenburg C. High Fowler's D. Supine
A. Trendelenburg
You receive a patient in the ER who has sustained a cervical spinal cord injury. You know this patient is at risk for neurogenic shock. What hallmark signs and symptoms, if experienced by this patient, would indicate the patient is experiencing neurogenic shock? Select all that apply: A. Blood pressure 69/38 B. Heart rate 170 bpm C. Blood pressure 250/120 D. Heart rate 29 E. Warm and dry extremities F. Cool and clammy extremities G. Temperature 104.9 'F H. Temperature 95 'F
A. Blood pressure 69/38 D. Heart rate 29 E. Warm and dry extremities H. Temperature 95 'F
The physician orders a patient in septic shock to receive a large IV fluid bolus. How would the respiratory therapist know if this treatment was successful for this patient? A. The patient's blood pressure changes from 75/48 to 110/82. B. Patient's CVP 2 mmHg C. Patient's skin is warm and flushed. D. Patient's urinary output is 20 mL/hr.
A. The patient's blood pressure changes from 75/48 to 110/82.
You're providing care to a patient who has experienced a 45% loss of their fluid volume and is experiencing hypovolemic shock. The patient has hemodynamic monitoring and fluid resuscitation is being attempted. Which finding indicates the patient is still in hypovolemic shock? A. Low central venous pressure B. High pulmonary artery wedge pressure C. Elevated mean arterial pressure D. Low systemic vascular resistance
A Low central venous pressure
You're providing care to four patients. Select all the patients who are at risk for developing sepsis: A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place. B. A 55-year-old male who is a recent kidney transplant recipient. C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery. D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.
A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place. B. A 55-year-old male who is a recent kidney transplant recipient. C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery. D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.
Your patient, who is post-op from a gastrointestinal surgery, is presenting with a temperature of 103.6 'F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply: A. Blood pressure of 70/34 after the fluid bolus B. Serum lactate less than 2 mmol/L C. Patient needs Norepinephrine to maintain a mean arterial pressure D. (MAP) greater than 65 mmHg despite fluid replacement E. Central venous pressure (CVP) of 18
A. Blood pressure of 70/34 after the fluid bolus C. Patient needs Norepinephrine to maintain a mean arterial pressure
A patient is receiving treatment for an acute myocardial infarction. The respiratory therapist is closely monitoring the patient for signs and symptoms associated with cardiogenic shock. Which value below is associated with cardiogenic shock? A. index 1.5 L/min/m2 B. Pulmonary capillary wedge pressure (PCWP) 10 mmHg C. Central venous pressure (CVP) 4 mmHg D. Troponin <0.01 ng/mL
A. Cardiac index 1.5 L/min/m2
Ikaika, a 68-year-old with a history of diabetes mellitus, is admitted with an infected diabetic foot ulcer. Upon admission you notice that he is confused and his vital signs are: temperature 102.6-degree F, blood pressure 81/39 mmHg, and pulse 55. Which diagnosis is indicative of his symptoms? A. Ineffective tissue perfusion B. Ineffective metabolic status C. Impaired nutritional status D. Imbalanced fluid volume
A. Ineffective tissue perfusion
In neurogenic shock, a patient will experience a decrease in tissue perfusion. This deprives the cells of oxygen that make up the tissues and organs. Select all the mechanisms, in regards to pathophysiology, of why this is occurring: A. Loss of vasomotor tone B. Increase systemic vascular resistance C. Decrease in cardiac preload D. Increase in cardiac afterload E. Decrease in venous blood return to the heart F. Venous blood pooling in the extremities
A. Loss of vasomotor tone C. Decrease in cardiac preload E. Decrease in venous blood return to the heart F. Venous blood pooling in the extremities
Your patient is receiving aggressive treatment for septic shock. Which findings demonstrate treatment is NOT being successful? Select all that apply: A. MAP (mean arterial pressure) 40 mmHg B. Urinary output of 10 mL over 2 hours C. Serum Lactate 15 mmol/L D. Blood glucose 120 mg/dL E. CVP (central venous pressure) 2 mmHg
A. MAP (mean arterial pressure) 40 mmHg B. Urinary output of 10 mL over 2 hours C. Serum Lactate 15 mmol/L E. CVP (central venous pressure) 2 mmHg
The progression of sepsis leads to reduced organ perfusion and eventually which syndrome? A. Multiple-organ dysfunction syndrome (MODS) B. toxic shock syndrome (TSS) C. Systemic inflammatory response syndrome 9SIRS) D. Systemic shock syndrome (SSS)
A. Multiple-organ dysfunction syndrome (MODS)
________________ is the amount the ventricle stretches at the end of diastole. A. Preload B. Afterload C. Stroke Volume D. Contractility
A. Preload
The patient is at risk for infectious sepsis through which portals of entry? (Select all that apply) A. Surgical wounds B. Pulse oximetry monitoring C. Peptic ulcerations D. Sexually Transmitted infections E. Intravenous catheters
A. Surgical wounds C. Peptic ulcerations D. Sexually Transmitted infections E. Intravenous catheters
What is distributive shock?
Abnormality in the vascular system that produces a maldistribution circulating blood volume (something else causing problems with circulation and perfusion)
What is the hormonal response to the compensatory stage of shock?
Activation of renin-angiotensin-aldosterone-ADH mechanism → sodium and water retention Secretion of ACTH→ production of glucocorticoids → increased BS Release of epinephrine and norepinephrine→ vasoconstriction
A patient with a fever is lethargic and has a blood pressure of 89/56. The patient's white blood cell count is elevated. The physician suspects the patient is developing septic shock. What other findings indicate this patient is in the "early" or "compensated" stage of septic shock? Select all that apply: Urinary output of 60 mL over 4 hours Warm and flushed skin Tachycardia Bradypnea
B. Warm and flushed skin C. Tachycardia
A patient is receiving large amounts of fluids for aggressive treatment of hypovolemic shock. The respiratory therapist makes it PRIORITY to? A. Rapidly infuse the fluids B. Warm the fluids C. Change tubing in between bags D. Keep the patient supine
B. Warm the fluids
A patient is being treated for cardiogenic shock. Which statement below best describes this condition? Select all that apply: A. "The patient will experience an increase in cardiac output due to an increase in preload and afterload." B. "A patient with this condition will experience decreased cardiac output and decreased tissue perfusion." C. "This condition occurs because the heart has an inadequate blood volume to pump." D. "Cardiogenic shock leads to pulmonary edema."
B. "A patient with this condition will experience decreased cardiac output and decreased tissue perfusion." D. "Cardiogenic shock leads to pulmonary edema."
You're precepting a new respiratory therapist. You ask the new respiratory therapist to list the purpose of why a patient with cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the new respiratory therapist understands the purpose of an intra-aortic balloon pump? Select all that apply: A. "This device increases the cardiac afterload, which will increase cardiac output." B. "This device will help increase blood flow to the coronary arteries." C. "The balloon pump will help remove extra fluid from the heart and lungs." D. "The balloon pump will help increase cardiac output."
B. "This device will help increase blood flow to the coronary arteries." D. "The balloon pump will help increase cardiac output."
A patient is on IV Norepinephrine for treatment of septic shock. Which statement is FALSE about this medication? A. "The respiratory therapist should titrate this medication to maintain a MAP of 65 mmHg or greater." B. "This medication causes vasodilation and decreases systemic vascular resistance." C. "It is used when fluid replacement is not unsuccessful." D. "It is considered a vasopressor."
B. "This medication causes vasodilation and decreases systemic vascular resistance."
You're working on a neuro unit. Which of your patients below are at risk for developing neurogenic shock? Select all that apply: A. A 36-year-old with a spinal cord injury at L4. B. A 42-year-old who has spinal anesthesia. C. A 25-year-old with a spinal cord injury above T6. D. A 55-year-old patient who is reporting seeing green halos while taking Digoxin.
B. A 42-year-old who has spinal anesthesia. C. A 25-year-old with a spinal cord injury above T6.
Your patient is started on an IV antibiotic to treat a severe infection. During infusion, the patient uses the call light to notify you that she feels a tight sensation in her throat and it's making it hard to breathe. You immediately arrive to the room and assess the patient. While auscultating the lungs you note wheezing. You also notice that the patient is starting to scratch the face and arms, and on closer inspection of the face you note redness and swelling that extends down to the neck and torso. The patient's vital signs are the following: blood pressure 89/62, heart rate 118 bpm, and oxygen saturation 88% on room air. You suspect anaphylactic shock. Select all the appropriate interventions for this patient: A. Slow down the antibiotic infusion B. Call a rapid response C. Place the patient on oxygen D. Prepare for the administration of Epinephrine
B. Call a rapid response C. Place the patient on oxygen D. Prepare for the administration of Epinephrine
Your patient, who is post-op from a kidney transplant, has developed septic shock. Which statement below best reflects the interventions you will perform for this patient? A. Administer Norepinephrine before attempting a fluid resuscitation. B. Collect cultures and then administer IV antibiotics. C. Check blood glucose levels before starting any other treatments. D. Administer Drotrecogin Alpha within 48-72 hours.
B. Collect cultures and then administer IV antibiotics
Your patient's blood pressure is 72/56, heart rate 126, and respiration 24. The patient has a fungal infection in the lungs. The patient also has a fever, warm/flushed skin, and is restless. You notify the physician who suspects septic shock. You anticipate that the physician will order what treatment FIRST? A. Low-dose corticosteroids B. Crystalloids IV fluid bolus C. Norepinephrine D. 2 units of Packed Red Blood Cells
B. Crystalloids IV fluid bolus
Select all the conditions below that increases a patient's risk for absolute hypovolemic shock: A. Burns B. Vomiting C. Long bone fracture D. Surgery E. Diarrhea F. Sepsis
B. Vomiting D. Surgery E Diarrhea
A patient in neurogenic shock is ordered intravenous fluids due to severe hypotension. During administration of the fluids the respiratory therapist will monitor the patient closely and immediately report? A. Increase in blood pressure B. High central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP) C. Urinary output of 300 mL in the past 5 hours D. Mean arterial pressure (MAP) 85 mmHg
B. High central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP)
Which diagnostic test results are expected for a patient with septic shock? (Select all that apply.) A. An increase in PaO2 B. Increased neutrophil count C. Normal white blood cell count D. Decreased glucose level E. Decreased BUN and elevated creatinine
B. Increased neutrophil count D. Decreased glucose level
Your patient in neurogenic shock is not responding to IV fluids. The patient is started on vasopressors. What option below, if found in your patient, would indicate the medication is working? A. Decreased CVP (central venous pressure) B. Mean arterial pressure (MAP) 90 mmHg C. Serum lactate 6 mmol/L D. Blood pH 7.20
B. Mean arterial pressure (MAP) 90 mmHg
A patient with cardiogenic shock has a blood pressure of 70/38. In addition, the patient is experiencing dyspnea with a respiratory rate of 32 breaths per minute and has an oxygen saturation of 82% on room air. On auscultation, you note crackles throughout the lung fields. You notify the physician. What order below would you ask for an order clarification? A. Dopamine IV stat B. Normal saline IV bolus stat C. Furosemide IV stat D. Place patient on CPAP (continuous positive airway pressure)
B. Normal saline IV bolus stat
A patient in hypovolemic shock is receiving rapid infusions of crystalloid fluids. Which patient finding requires immediate respiratory therapist action? A. Patient heart rate is 115 bpm B. Patient experiences dyspnea and crackles in lung fields C. Patient is anxious D. Patient's urinary output is 35 mL/hr
B. Patient experiences dyspnea and crackles in lung fields
You are caring for several patients in a step-down unit at a local hospital. Which patient would require priority assessment for septicemia? A. Patient with a non-ruptured appendix with stable vital signs B. Patient with an indwelling urinary catheter and a temperature of 101.5 degrees F C. Patient with GERD who is NPO D. Patient with a history of myocardial infarction with BP 130/90
B. Patient with an indwelling urinary catheter and a temperature of 101.5 degrees F
You're assessing your patient with cardiogenic shock, what signs and symptoms do you expect to find in this condition? Select all that apply: A. Warm, flushed skin B. Prolonged capillary refill C. Urinary output >30 mL/hr D. Systolic blood pressure <90 mmHg E. Crackles in lung fields F. Dyspnea G. Decreased BUN and creatinine H. Strong peripheral pulses I. Chest pain
B. Prolonged capillary refill D. Systolic blood pressure <90 mmHg E. Crackles in lung fields F. Dyspnea H. Strong peripheral pulses I. Chest pain
What is the BEST position for a patient in anaphylactic shock? A. Lateral recumbent B. Supine with legs elevated C. High Fowler's D. Semi-Fowler's
B. Supine with legs elevated
A 42-year-old male patient is admitted with a spinal cord injury. The patient is experiencing severe hypotension and bradycardia. The patient is diagnosed with neurogenic shock. Why is hypotension occurring in this patient with neurogenic shock? A. The patient has an increased systemic vascular resistance. This increases preload and decreases afterload, which will cause severe hypotension. B. The patient's autonomic nervous system has lost the ability to regulate the diameter of the blood vessels and vasodilation is occurring. C. The patient's parasympathetic nervous system is being unopposed by the sympathetic nervous system, which leads to severe hypotension. D. The increase in capillary permeability has depleted the fluid volume in the intravascular system, which has led to severe hypotension.
B. The patient's autonomic nervous system has lost the ability to regulate the diameter of the blood vessels and vasodilation is occurring.
You're caring for a patient with cardiogenic shock. Which finding below suggests the patient's condition is worsening? Select all that apply: A. Blood pressure 95/68 B. Urinary output 20 mL/hr C. Cardiac Index 3.2 L/min/m2 D. Pulmonary artery wedge pressure 30 mmHg
B. Urinary output 20 mL/hr
A patient with a severe infection has developed septic shock. The patient's blood pressure is 72/44, heart rate 130, respiration 22, oxygen saturation 96% on high-flow oxygen, and temperature 103.6 'F. The patient's mean arterial pressure (MAP) is 53 mmHg. Based on these findings, you know this patient is experiencing diminished tissue perfusion and needs treatment to improve tissue perfusion to prevent organ dysfunction. In regards to the pathophysiology of septic shock, what is occurring in the body that is leading to this decrease in tissue perfusion? Select all that apply: A. Absolute hypovolemia B. Vasodilation C. Increased capillary permeability D. Increased systemic vascular resistance E. Clot formation in microcirculation F. A significantly decreased cardiac output
B. Vasodilation C. Increased capillary permeability E. Clot formation in microcirculation
During anaphylactic shock the mast cells and basophils release large amounts of histamine. What effects does histamine have on the body during anaphylactic shock? Select all that apply: A. Decreases capillary permeability B. Vasodilation of vessels C. Decreases heart rate D. Shifts intravascular fluid to interstitial space E. Constricts the airways F. Stimulates contraction of GI smooth muscles G. Inhibits the production of gastric secretions H. Itching
B. Vasodilation of vessels D. Shifts intravascular fluid to interstitial space E. Constricts the airways H Itching
The patient with hypovolemic shock is in need of clotting factors. Which type of fluid would best benefit this patient? A. Platelets B. Albumin C. Fresh Frozen Plasma D. Packed Red Blood Cells
C Fresh frozen plasma
You are caring for a patient with sepsis. The patient's family asks you why there is a need for a blood culture when a diagnosis has already been issued. Which response by the respiratory therapist is the most appropriate? A. "The blood culture monitors potassium levels." B. "The blood culture determines if liver damage is occurring." C. "The blood culture determines the most appropriate antibiotics." D. "The blood culture will allow us to monitor oxygenation status."
C. "The blood culture determines the most appropriate antibiotics."
Which medications below are used in cardiogenic shock that provide a positive inotropic effect on the heart? Select all that apply: A. Nitroglycerin B. Sodium Nitroprusside C. Dobutamine D. Norepinephrine E. Dopamine
C. Dobutamine E Dopamine
A 35-year-old male arrives to the emergency room with multiple long bone fractures and an internal abdominal injury. The patient is anxious. Patient's vital signs are: Blood pressure 70/54, heart rate 125 bpm, respirations 30, oxygen saturation on 2 L nasal cannula 96%, temperature 99.3 'F, pain 6 on 1-10 scale. During assessment it is noted the skin is cool and clammy. The respiratory therapist will make it priority to? A. Collect a urine sample B. Obtain an EKG C. Establish 2 large-bore IV access sites D. Place a warming blanket on the patient
C. Establish 2 large-bore IV access sites
One of your patients begins to vomit large amounts of bright red blood. The patient is taking Warfarin. You call a rapid response. Which assessment findings indicate this patient is developing hypovolemic shock? Select all that apply: A. Temperature 104.8 'F B. Heart rate 40 bpm C. Heart rate 140 bpm D. Anxiety, restlessness E. Urinary output 15 mL/hr F. Blood pressure 70/56 G. Pale, cool skin H. Weak peripheral pulses I. Blood pressure 220/106
C. Heart rate 140 bpm D. Anxiety, restlessness, E. Urinary output 15mL/hr F. Blood pressure 70/56 G. Pale, cool skin H Weak peripheral pulses
Your patient is having a sudden and severe anaphylactic reaction to a medication. You immediately stop the medication and call a rapid response. The patient's blood pressure is 80/52, heart rate 120, and oxygen saturation 87%. Audible wheezing is noted along with facial redness and swelling. As the respiratory therapist you know that the first initial treatment for this patient's condition is? A. IV Diphenhydramine B. IV Normal Saline Bolus C. IM Epinephrine D. Nebulized Albuterol
C. IM Epinephrine
Which diagnosis is appropriate for a patient with sepsis? A. Risk for body image disturbance B. Altered nutritional status C. Ineffective peripheral tissue perfusion D. Risk for painful abdominal distention
C. Ineffective peripheral tissue perfusion
A patient is in anaphylactic shock. The patient has a severe allergy to peanuts and mistakenly consumed an eggroll containing peanut ingredients during his lunch break. The patient is given Epinephrine intramuscularly. As the respiratory therapist, you know this medication will have what effect on the body? A. It will prevent a recurrent attack. B. It will cause vasoconstriction and decrease the blood pressure. C. It will help dilate the airways. D. It will help block the effects of histamine in the body
C. It will help dilate the airways.
Smith is a 54-year-old women admitted to the critical care unit 2 days ago with community-acquired pneumonia and respiratory failure. Although she has been on antibiotics, she is requiring increased amounts of oxygen and is diagnosed with sepsis. Which therapy would be the most effective for Ms. Smith at this time? A. Lasix 40 mg IV q 12 hours B. Keflex 80 mg IVP q 6 hours C. NS @ 125 mL/hr D. Morphine 2 mg IV q 2 hours
C. NS @ 125 mL/hr
You are caring for a patient diagnosed with septic shock. Which assessment finding should you report immediately to the healthcare provider? A. hypertension, and warm, dry skin B. Hyperactive bowel sounds with abdominal distention C. Urine output of 15mL/hr and BP of 82/45 D. Bradycardia with an elevated temp of 102.4 degrees F
C. Urine output of 15mL/hr and BP of 82/45
They physician orders a Dobutamine IV drip on a patient in cardiogenic shock. After starting the IV drip, the respiratory therapist would make it priority to monitor for? A. Rebound hypertension B. Ringing in the ears C. Worsening hypotension D. severe headache
C. Worsening hypotension
A patient who is experiencing hypovolemic shock has decreased cardiac output, which contributes to ineffective tissue perfusion. The decrease in cardiac output occurs due to? A. An increase in cardiac preload B. An increase in stroke volume C. A decrease in cardiac preload D. A decrease in cardiac contractility
C. a decrease in cardiac preload
Which patient below is at MOST risk for developing cardiogenic shock? A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish. B. A 25-year-old female who has experienced an upper thoracic spinal cord injury. C. A 72-year-old male who is post-op from a liver transplant. D. A 49-year-old female who is experiencing an acute myocardial infarction.
D. A 49-year-old female who is experiencing an acute myocardial infarction.
_____________ is the force the heart has to pump against to get blood out of the ventricle. A. Cardiac output B. Cardiac index C. Preload D. Afterload
D. Afterload
Hafner is a 43-year-old man recovering from a ruptured diverticulum. His vital signs are as follow: Temperature 102.2 degrees F, HR 120 beats/minute, BP 79/42 mmHg, and respiratory rate 24/minute. Upon examination you notice that he is confused, his skin is cool and pale, and there is a small amount of bleeding around his IV site. What would you expect Mr. Hafner's blood test to reveal? A. Deep vein thrombosis (DVT) B. Systemic inflammatory response syndrome (SIRS) C. Multiple-organ dysfunction syndrome (MODS) D. Disseminated intravascular coagulation (DIC)
D. Disseminated intravascular coagulation (DIC)
A patient in septic shock receives large amounts of IV fluids. However, this was unsuccessful in maintaining tissue perfusion. As the respiratory therapist, you would anticipate the physician to order what NEXT? A. IV corticosteroids B. Colloids C. Dobutamine D. Norepinephrine
D. Norepinephrine
You are caring for a patient diagnosed with septic shock. Which arterial blood gas (ABG) finding would indicate the patient is in shock? A. decreased PaCO2 B. decreased CO2 level C. increased O2 level D. decreased pH level
D. decreased pH level
What is obstructive shock?
Problems that impair the ability of the normal heart muscle to pump effectively. The heart itself remains normal, but conditions outside the heart (ex. masses, pericarditis, and cardiac tamponade) prevent either adequate filling of the heart or adequate contraction of the healthy heart muscle
What are global indicators of systemic perfusion and oxygenation?
Serum lactate Serum bicarbonateSVO2 levels
What is the refractory stage of shock?
Shock unresponsive to therapy and irreversible As organ systems die, MODS occurs→ death Cell damage from lack of oxygen Unresponsive to therapy Irreversible Respiratory acidosis (must be on vent, want ABGs)MODS is 2 or more systems Non-palpable pulses Extremities cold and dusky
True or False: Septic shock causes system wide vasodilation which leads to an increase in systemic vascular resistance. In addition, septic shock causes increased capillary permeability and clot formation in the microcirculation throughout the body.
False
True or False: The parasympathetic nervous system loses the ability to stimulate nerve impulses in patients who are experiencing neurogenic shock. This leads to hemodynamic changes.
False
What is the neural response to the compensatory stage of shock?
Increased HR and contractility, vasoconstriction, and shunting of blood to vital organs
What is lactic acidosis?
Lactate>5.0 (normal 0.6-2.2)Not enough O2 in muscle to break down glucose→ anaerobic metabolism