2022 READ AHEAD EXAM SOLUTION FOR PHARMACOLOGY II
(SHOCK) COMPLETE DOCS
what is shock? - 1. a syndrome characterized by decreased cellular perfusion and
impaired cellular metabolism with a resulting imbalance of the supply and demand of o2
and nutrients
-imbalance of oxygen supply and demand leads to decreased tissue perfusion and
impaired cellular metabolism
-caused by low circulating volume or cardiogenic pump failure
name the types of shock? - 1. cardiogenic--> heart issues
2. hypovolemic--> too little blood volume
3. anaphylactic--> allergic reaction
4. septic--> infection
5. neurogenic--> damage to ns
6. obstructive--> obstruction leading to decreased co
what is the bottom line of shock? - shock= decreased tissue/cellular perfusion
what triggers shock? - drop in map
what is map? - 1. average pressure in arteries during one cardiac cycle
-indicator of perfusion to vital organs
-obtained via an arterial line or hand calculation
what is a goal map? - > or = 70 mmhg
what is sirs? - 1. inflammatory state affecting the whole body
-triggers clotting cascade--> mods
,what is mods? - 1. progressive damage in 2 or more organs or organ systems
-can be induced by a variety of acute insults
-is a process rather than single event
name the stages of schock? - 1. compensatory or early reversible
2. progressive or intermediate
3. refractory or irreversible
4. death
what is the compensatory stage of shock? - 1. sns trying to maintain homeostasis
2. bp: wnl, but...
-early sign of shock: narrowing pulse pressure
3. increased hr and rr
4. pale, clammy, confused
5. map still "ok": 65-70
what is pulse pressure? - the difference b/w systolic and diastolic bps
what is the nurse management for the compensatory stage? - 1. manage underlying
issue
2. freq vs
-report sbp <90 mmhg, drop of 40 mmhg, map <65
-fluids to maintain bp
-meds to maintain bp/manage tachycardia
3. resp support-o2/ventilation
4. labs: electrolytes, bg, abgs
5. pt safety--> contusion and fall risk
what is the progressive stage of shock? - 1. body unable to maintain homeostasis
, -map drops 20 mmhg or more
-fluid loss of 35-50%
2. persistent drop in bp--> more sns stimulation --> further vasoconstriction in more
areas of body--> tissue hypoxia
3. clinical signs:
-decreased bp
-increased hr (compensating mechansisms failing! map <65)
-increased rr, shallow
-petechia, mottling--> decreased circulation and clotting cascade
what is the respiratory response during progressive shock? - 1. decreased in blood flow
to lungs and vasoconstriction of arterioles
2. fluid movement into interstitum
3. pulmonary edema
4. increased sob, crackles, and need for o2 support
what is the cardiac response during progressive shock? - 1. decreased co, decreased
bp and coronary artery perfusion
2. peripheral hypoperfusion
-pallor
-cool, clammy skin
-decreased cap refill
-weak, thready pulse
-cyanosis
what is the renal response during progressive shock? - 1. decreased renal blood flow
-acute tubular necrosis
2. inability to process wastes
-metabolic acidosis
(SHOCK) COMPLETE DOCS
what is shock? - 1. a syndrome characterized by decreased cellular perfusion and
impaired cellular metabolism with a resulting imbalance of the supply and demand of o2
and nutrients
-imbalance of oxygen supply and demand leads to decreased tissue perfusion and
impaired cellular metabolism
-caused by low circulating volume or cardiogenic pump failure
name the types of shock? - 1. cardiogenic--> heart issues
2. hypovolemic--> too little blood volume
3. anaphylactic--> allergic reaction
4. septic--> infection
5. neurogenic--> damage to ns
6. obstructive--> obstruction leading to decreased co
what is the bottom line of shock? - shock= decreased tissue/cellular perfusion
what triggers shock? - drop in map
what is map? - 1. average pressure in arteries during one cardiac cycle
-indicator of perfusion to vital organs
-obtained via an arterial line or hand calculation
what is a goal map? - > or = 70 mmhg
what is sirs? - 1. inflammatory state affecting the whole body
-triggers clotting cascade--> mods
,what is mods? - 1. progressive damage in 2 or more organs or organ systems
-can be induced by a variety of acute insults
-is a process rather than single event
name the stages of schock? - 1. compensatory or early reversible
2. progressive or intermediate
3. refractory or irreversible
4. death
what is the compensatory stage of shock? - 1. sns trying to maintain homeostasis
2. bp: wnl, but...
-early sign of shock: narrowing pulse pressure
3. increased hr and rr
4. pale, clammy, confused
5. map still "ok": 65-70
what is pulse pressure? - the difference b/w systolic and diastolic bps
what is the nurse management for the compensatory stage? - 1. manage underlying
issue
2. freq vs
-report sbp <90 mmhg, drop of 40 mmhg, map <65
-fluids to maintain bp
-meds to maintain bp/manage tachycardia
3. resp support-o2/ventilation
4. labs: electrolytes, bg, abgs
5. pt safety--> contusion and fall risk
what is the progressive stage of shock? - 1. body unable to maintain homeostasis
, -map drops 20 mmhg or more
-fluid loss of 35-50%
2. persistent drop in bp--> more sns stimulation --> further vasoconstriction in more
areas of body--> tissue hypoxia
3. clinical signs:
-decreased bp
-increased hr (compensating mechansisms failing! map <65)
-increased rr, shallow
-petechia, mottling--> decreased circulation and clotting cascade
what is the respiratory response during progressive shock? - 1. decreased in blood flow
to lungs and vasoconstriction of arterioles
2. fluid movement into interstitum
3. pulmonary edema
4. increased sob, crackles, and need for o2 support
what is the cardiac response during progressive shock? - 1. decreased co, decreased
bp and coronary artery perfusion
2. peripheral hypoperfusion
-pallor
-cool, clammy skin
-decreased cap refill
-weak, thready pulse
-cyanosis
what is the renal response during progressive shock? - 1. decreased renal blood flow
-acute tubular necrosis
2. inability to process wastes
-metabolic acidosis
