NR 464 - Exam IV With complete
verified solutions (Guaranteed Pass)
Shock Defined - answer §Syndrome characterized by decreased tissue
perfusion and impaired cellular metabolism
-Imbalance in supply/demand for O2 and nutrients
Classification of Shock - answer Hypovolemic, Cardiogenic,
Anaphylatctic, Septic (others, but we're only focusing on these)
Cardiogenic Shock: Causes - answer §Myocardial infarction
§Cardiomyopathy
§Blunt cardiac injury
§Severe systemic or pulmonary hypertension
§Cardiac tamponade
§Myocardial depression from metabolic problems
Cardiogenic Shock: Pathophysiology: Alterations in Contractility, Rate,
Afterload and Preload - answer
Cardiogenic Shock: Findings on Physical Exam - answer
,Cardiogenic Shock: Dysrhythmias - answer Top strip: PVC (QRS wide and
distorted, multi-focal since they look different)
Bottom strip: v tach
Cardiogenic Shock: Hemodynamics - answer ScvO2 only measures
venous blood returning from the upper half of the body, while SvO2
samples the true mixed venous blood leaving the right heart. Normal
SvO2 60-80%. Normal ScvO2 (from an internal jugular or subclavian
vein) is > 70%.
If SvO2 or ScvO2 decreases, it indicates that the tissues are extracting a
higher percentage of oxygen from the blood than normal. In other
words, a decreased SvO2 indicates that the cardiac output is not high
enough to meet tissue oxygen needs.
ScvO2 usually runs 7% higher than SvO2 in critically ill patients.
Low oximetry readings usually indicate either low oxygen delivery(DO2)
or an increase in consumption (VO2).
Significantly elevated levels (>80%) may indicate:
• Inability to use oxygen delivered to the tissues (sepsis)
• Significantly high cardiac output
,• Shunting of oxygenated blood past tissue
• Technical errors
Cardiogenic Shock Diagnostics - answer
Cardiogenic Shock: Goals of Care - answer §Overall Goal: Restore blood
flow to the myocardium by restoring the balance between O2 supply
and demand
§Angioplasty with stenting
§Emergency revascularization
§Valve replacement
Never position pt supine; best to sit up d/t WOB, can help preload by
lifting legs
Cardiogenic Shock: Collaborative Care - answer §Drug therapy
•Diuretics to reduce preload
•Vasodilators to reduce afterload (if SVR high...use very carefully)
(Nitroglycerin)
•Norepinephrine may be used if hypotensive with low SVR (systemic
vascular resistance)
•Inotropic drug (Dobutamine, Dopamine)
, •Antidysrhythmics (Amiodarone)
•Pain medications/anti-anxiety meds
•Stool softener
•Heparin
§Fluid and salt restriction
•Furosemide: will decrease preload and allow heart to optimize
contractility
Cardiogenic Shock: Patient Position: HOB Up, if not CI - answer
Hypovolemic Shock: Absolute Hypovolemia - answer §Loss of
intravascular fluid volume
•Hemorrhage
•GI loss (e.g., vomiting, diarrhea)
•Fistula drainage
•Diabetes insipidus
•Hyperglycemia
•Diuresis
Hypovolemic Shock: Relative Hypovolemia - answer §Results when fluid
volume moves out of vascular space into extravascular space (e.g.,
interstitial or intracavitary space)
verified solutions (Guaranteed Pass)
Shock Defined - answer §Syndrome characterized by decreased tissue
perfusion and impaired cellular metabolism
-Imbalance in supply/demand for O2 and nutrients
Classification of Shock - answer Hypovolemic, Cardiogenic,
Anaphylatctic, Septic (others, but we're only focusing on these)
Cardiogenic Shock: Causes - answer §Myocardial infarction
§Cardiomyopathy
§Blunt cardiac injury
§Severe systemic or pulmonary hypertension
§Cardiac tamponade
§Myocardial depression from metabolic problems
Cardiogenic Shock: Pathophysiology: Alterations in Contractility, Rate,
Afterload and Preload - answer
Cardiogenic Shock: Findings on Physical Exam - answer
,Cardiogenic Shock: Dysrhythmias - answer Top strip: PVC (QRS wide and
distorted, multi-focal since they look different)
Bottom strip: v tach
Cardiogenic Shock: Hemodynamics - answer ScvO2 only measures
venous blood returning from the upper half of the body, while SvO2
samples the true mixed venous blood leaving the right heart. Normal
SvO2 60-80%. Normal ScvO2 (from an internal jugular or subclavian
vein) is > 70%.
If SvO2 or ScvO2 decreases, it indicates that the tissues are extracting a
higher percentage of oxygen from the blood than normal. In other
words, a decreased SvO2 indicates that the cardiac output is not high
enough to meet tissue oxygen needs.
ScvO2 usually runs 7% higher than SvO2 in critically ill patients.
Low oximetry readings usually indicate either low oxygen delivery(DO2)
or an increase in consumption (VO2).
Significantly elevated levels (>80%) may indicate:
• Inability to use oxygen delivered to the tissues (sepsis)
• Significantly high cardiac output
,• Shunting of oxygenated blood past tissue
• Technical errors
Cardiogenic Shock Diagnostics - answer
Cardiogenic Shock: Goals of Care - answer §Overall Goal: Restore blood
flow to the myocardium by restoring the balance between O2 supply
and demand
§Angioplasty with stenting
§Emergency revascularization
§Valve replacement
Never position pt supine; best to sit up d/t WOB, can help preload by
lifting legs
Cardiogenic Shock: Collaborative Care - answer §Drug therapy
•Diuretics to reduce preload
•Vasodilators to reduce afterload (if SVR high...use very carefully)
(Nitroglycerin)
•Norepinephrine may be used if hypotensive with low SVR (systemic
vascular resistance)
•Inotropic drug (Dobutamine, Dopamine)
, •Antidysrhythmics (Amiodarone)
•Pain medications/anti-anxiety meds
•Stool softener
•Heparin
§Fluid and salt restriction
•Furosemide: will decrease preload and allow heart to optimize
contractility
Cardiogenic Shock: Patient Position: HOB Up, if not CI - answer
Hypovolemic Shock: Absolute Hypovolemia - answer §Loss of
intravascular fluid volume
•Hemorrhage
•GI loss (e.g., vomiting, diarrhea)
•Fistula drainage
•Diabetes insipidus
•Hyperglycemia
•Diuresis
Hypovolemic Shock: Relative Hypovolemia - answer §Results when fluid
volume moves out of vascular space into extravascular space (e.g.,
interstitial or intracavitary space)
