Shock Flashcard 1

C. Rationale: Shock is a medical condition in which poor tissue perfusion causes organs, especially the brain, heart, liver, and kidneys, to fail due to inadequate oxygenation and failure to sustain their metabolic demands. Tissue hypoxia, anaerobic metabolism, and the accumulation of lactic acid and carbon dioxide may cause irreversible cell damage and organ failure.

B. Rationale: For septic shock, the best intervention to increase the oxygen content in the blood is to give 100% oxygen through a non-rebreather mask. A blood transfusion would be necessary for a patient with hypovolemic shock secondary to blood loss in cases such as trauma. Endotracheal intubation may be performed in patients with some forms of obstructive shock, such as a massive pulmonary thromboembolism, to correct the ventilation-perfusion mismatch. Hemodialysis is not used in the treatment of shock.

A. Rationale: In patients showing signs of heart failure or pulmonary edema, it is recommended to reduce the volume of IV infusion of an isotonic crystalloid solution to 5 to 10 mL/kg of body weight.

C. Rationale: The cause of shock, in this case, is massive hypovolemia from a severe hemorrhage. Transfusing packed RBCs will increase hemoglobin (and volume), leading to increased oxygen-carrying capacity of the blood. If blood is lacking, no amount of oxygen supplementation can improve the patient’s oxygen-carrying capacity for tissue perfusion.

C. Rationale: Decreasing systemic vascular resistance is necessary for cardiogenic shock to improve stroke volume effectively and, ultimately cardiac output. To decrease systemic vascular resistance, vasodilators, and diuretics such as furosemide are recommended. Diuretics can also improve pulmonary edema and systemic venous congestion, usually seen in this condition.

A. Rationale: Female patients, in the absence of adequately typed and cross-matched blood, may only be given type O negative blood to prevent blood incompatibility between mother and child manifesting as hemolytic disease of the newborn in the future. Male patients can be transfused with either type O negative or type O positive blood.

A. Rationale: The health care provider must be alert for the following clinical signs and symptoms that indicate a patient is deteriorating from shock: increasing heart rate, diminishing peripheral and central pulses, narrowing pulse pressure, prolonged capillary refill time, cold extremities, altered sensorium, and hypotension. The patient presents with hypotension and a narrow pulse pressure, increased heart rate, and altered sensorium, indicating that their condition is worsening due to shock.

D. Rationale: A patient is said to be in compensated shock when they present with signs and symptoms of poor peripheral perfusion with a normal systolic blood pressure. The perfusion of oxygen and nutrients to peripheral tissues is compromised in this situation because the body has compensated by increasing systemic vascular resistance, favoring blood flow to the vital organs. These patients will present with tachycardia, poor capillary refill time, cool extremities, and decreased urine output.

A. Rationale: Increased oxygen demand of cells is caused by pain, anxiety, fever, and increased breathing effort. In this case, the patient’s fever is the cause of increased oxygen demand. It is imperative to use an antipyretic medication or other cooling methods to improve shock in this patient.

D. Rationale: Fat embolism from larger fractured bones such as the pelvis or the femur can cause ventilation-perfusion mismatch if the embolus travels to the pulmonary vasculature. In this case, to relieve the ensuing obstructive shock, endotracheal intubation with mechanical ventilation would correct the ventilation-perfusion mismatch and increase the oxygen content of the blood to improve the obstructive shock in this patient.