MDC 4 Exam #2 Concept Guide
You are responsible for reading the chapters assigned for this module. For all concepts,
please review: Management of Care, Safety and Infection Control, Health Promotion and
Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral
Therapies, Reduction of Risk Potential, Physiological Adaptation. ADPIE, Priority,
Complications, Patient and Family Education and Self-Management, Ethics, Delegation,
Cultural/Spiritual Considerations, red flags/alerts.
Pay special attention to the following concepts:
● Shock:
o Distributive (Septic, Neurogenic, Anaphylactic), Hypovolemic, Cardiogenic,
Obstructive
▪ Distributive (Septic/Neurogenic/Anaphylactic):
• Neurogenic: Decresaed sympathetic tone (nerval impulses)/loss of
autonomic and motor reflexes, vasodilation is widespread; very
uncommon; occurs due to expensive spinal cord injury above T5
• Presentation: flaccid paralysis, bradycardia, hypothermia
• Treatment: treat hypovolemia/prevent hypoxemia, promote normal
body temperature, monitor for dysrhythmias, and inotropic and
vasoconstrictor drugs
• Anaphylactic shock (WE KNOW THIS) push EPI!!!!
• Septic Shock: A widespread infection that triggers whole-body
inflammation. It leads to distributive shock when infectious
microorganisms are present in the blood.
• Stages: SIRS—>Sepsis—>Severe sepsis—>septic shock->MODS;
identify and treat as early as possible
▪ Hypovolemic: Lack of circulating blood volume
• Treatment~FLUIDS=aggressive fluid replacement with close
monitoring, colloids or crystalloids; colloids and fluids help pull
from the interstitum back into interstitial space; ex) mannitol,
albumin
• Blood transfusion may include PRBCs, whole blood, FFP, PLTs
and cryoprecipitate
• Fluid restrictions may be in place: Monitor for fluid overload, lung
sounds, JVD, increased pulmonary artery pressure, arterial wedge
pressure, and R atrial pressures
, MDC 4 Exam #2 Concept Guide
▪ Cardiogenic: Direct Pump Failure~Fluid volume not affected
• Most difficult to treat and has the highest mortality rate
• Causes: MI, ventricular dysrhythmias, cardiac arrest,
cardiomyopathy, myocardial degeneration
• Signs and Symptoms: hypotension/tachy, cool and clammy skin,
crackles/SOB/dyspnea, anxiety/restlessness
• AGGRESSIVELY TREAT THE UNDERLYING CAUSE:
vasodilators (nitro), fluids, vasopressors (dopamine)
▪ Obstructive: Mechanical obstruction to cardiac filling or ventricular
outflow
• Results from: Cardiac tamponade, constrictive pericarditis,
tension pneumothorax, and massive pulmonary embolism
• Presentation of shock PLUS pulses paradoxus (a decrease of
10mmHg or more in SBP during inspiration) and JVD
• Interventions are specific to cause: cardiac tamponade~immediate
pericardiocentesis, tension pneumothorax~needle thoracotomy, PE:
thrombolysis or surgical embolectomy
• If no intervention performed 100% mortality rate
o SNS Body compensation:
o
▪ Decreased circulating blood volume to the right atrium, carotid arteries,
and aorta stimulate the SNS for body compensation
You are responsible for reading the chapters assigned for this module. For all concepts,
please review: Management of Care, Safety and Infection Control, Health Promotion and
Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral
Therapies, Reduction of Risk Potential, Physiological Adaptation. ADPIE, Priority,
Complications, Patient and Family Education and Self-Management, Ethics, Delegation,
Cultural/Spiritual Considerations, red flags/alerts.
Pay special attention to the following concepts:
● Shock:
o Distributive (Septic, Neurogenic, Anaphylactic), Hypovolemic, Cardiogenic,
Obstructive
▪ Distributive (Septic/Neurogenic/Anaphylactic):
• Neurogenic: Decresaed sympathetic tone (nerval impulses)/loss of
autonomic and motor reflexes, vasodilation is widespread; very
uncommon; occurs due to expensive spinal cord injury above T5
• Presentation: flaccid paralysis, bradycardia, hypothermia
• Treatment: treat hypovolemia/prevent hypoxemia, promote normal
body temperature, monitor for dysrhythmias, and inotropic and
vasoconstrictor drugs
• Anaphylactic shock (WE KNOW THIS) push EPI!!!!
• Septic Shock: A widespread infection that triggers whole-body
inflammation. It leads to distributive shock when infectious
microorganisms are present in the blood.
• Stages: SIRS—>Sepsis—>Severe sepsis—>septic shock->MODS;
identify and treat as early as possible
▪ Hypovolemic: Lack of circulating blood volume
• Treatment~FLUIDS=aggressive fluid replacement with close
monitoring, colloids or crystalloids; colloids and fluids help pull
from the interstitum back into interstitial space; ex) mannitol,
albumin
• Blood transfusion may include PRBCs, whole blood, FFP, PLTs
and cryoprecipitate
• Fluid restrictions may be in place: Monitor for fluid overload, lung
sounds, JVD, increased pulmonary artery pressure, arterial wedge
pressure, and R atrial pressures
, MDC 4 Exam #2 Concept Guide
▪ Cardiogenic: Direct Pump Failure~Fluid volume not affected
• Most difficult to treat and has the highest mortality rate
• Causes: MI, ventricular dysrhythmias, cardiac arrest,
cardiomyopathy, myocardial degeneration
• Signs and Symptoms: hypotension/tachy, cool and clammy skin,
crackles/SOB/dyspnea, anxiety/restlessness
• AGGRESSIVELY TREAT THE UNDERLYING CAUSE:
vasodilators (nitro), fluids, vasopressors (dopamine)
▪ Obstructive: Mechanical obstruction to cardiac filling or ventricular
outflow
• Results from: Cardiac tamponade, constrictive pericarditis,
tension pneumothorax, and massive pulmonary embolism
• Presentation of shock PLUS pulses paradoxus (a decrease of
10mmHg or more in SBP during inspiration) and JVD
• Interventions are specific to cause: cardiac tamponade~immediate
pericardiocentesis, tension pneumothorax~needle thoracotomy, PE:
thrombolysis or surgical embolectomy
• If no intervention performed 100% mortality rate
o SNS Body compensation:
o
▪ Decreased circulating blood volume to the right atrium, carotid arteries,
and aorta stimulate the SNS for body compensation
