Shock Flashcard 3

A. Rationale: A decrease in venous oxygen saturation means that the oxygen supply to the organs and tissues has been depleted, and this means that shock has ensued, leaving less oxygen in the central venous system. If the venous oxygen concentration is normal, then we can conclude that the oxygen delivery to the tissues is adequate.

C. Rationale: Early in the disease, clinicians treat shock by concentrating on delivering oxygen to the tissues. Interventions that improve the oxygen-carrying capacity of the blood, increase oxygen saturation, improve blood volume, improve cardiac output, decrease oxygen demand, and correct metabolic imbalances all enhance oxygen delivery to the tissues.

D. Rationale: Intravenous dextrose solution can be given at a dose of 0.5 to 1.0 g/kg. IV dextrose can be in the form of D25W (2 to 4 mL/kg) or D10W (5 to 10 mL/kg). After dextrose administration, it is recommended to monitor blood glucose concentration closely. Continuous glucose infusion can be given if needed to prevent recurrent hypoglycemia.

B. Rationale: The most common and effective treatment intervention to improve cardiac output is resuscitation with a bolus of intravenous isotonic crystalloid fluids such as normal saline solution. Medical therapies, such as vasopressors, are also used to improve cardiac output if fluid therapy alone does not improve the patient’s condition.

A. Rationale: Patients in early shock will present with a prolonged capillary refill time, diminished peripheral pulses, tachypnea, and tachycardia. These signs and symptoms should alert the clinician that the patient is potentially in shock.

B. Rationale: Metabolic acidosis is caused by the accumulation of lactic acid in the serum as a result of poor tissue perfusion and anaerobic metabolism. Concentrate interventions on finding and treating the primary cause.

A. Rationale: Two factors influence blood pressure, namely cardiac output, and systemic vascular resistance. The primary compensatory mechanisms for hypotension are to increase cardiac output and systemic vascular resistance. Also, patients in shock will have a narrow pulse pressure if the compensatory increase in systemic vascular resistance causes the systolic blood pressure and diastolic blood pressure to be closer to each other.

C. Rationale: The main components of cardiac output are stroke volume and heart rate. Stroke volume is influenced by preload, afterload, and myocardial contractility. The most common cause of reduced stroke volume in pediatric patients is decreased preload due to dehydration, vasodilatation, or hemorrhage.

A. Rationale: Hemoglobin is a protein located in red blood cells that allows oxygen to bind to it. The hemoglobin concentration can estimate the amount of oxygen in red blood cells.

A. Rationale: Using inotropes and inodilators is the management of choice for optimizing contractility. Intravenous fluid therapy optimizes preload. Vasopressors and vasodilators optimize the afterload (systemic vascular resistance), and chronotropes such as epinephrine optimize the heart rate.