Shock Flashcard 5
Rationale
A. Rationale: Patients in shock will potentially have metabolic imbalances such as hypoglycemia, hypocalcemia, hyperkalemia, and lactic acidosis that can compromise cardiac contractility and decrease cardiac output.
Question
Which of the following medical conditions is a possible outcome of shock and causes metabolic imbalances that further worsen the patient’s condition?
a. Hyperkalemia
b. Hyperglycemia
c. Thyroid storm
d. Respiratory acidosis
Answer
a. Hyperkalemia
Rationale
A. Rationale: Cardiac output and systemic vascular resistance are determinants of blood pressure. Early in the disease, children with shock may present with elevated blood pressure as a compensatory mechanism as the body aims to improve cardiac output and increase systemic vascular resistance.
Question
Which of the following physiologic parameters are determinants of blood pressure?
a. Cardiac output
b. Blood volume
c. Hemoglobin concentration
d. Size of the heart
Answer
a. Cardiac output
Rationale
A. Rationale: Septic shock is a result of the body’s mechanisms of fighting infections by releasing cellular factors that promote inflammatory stimulus.
Question
Which of the following types of shock is secondary to severe infection?
a. Septic
b. Anaphylactic
c. Hypovolemic
d. Cardiogenic
Answer
a. Septic
Rationale
C. Rationale: Distributive shock is seen in patients with reduced systemic vascular resistance that causes a maldistribution of blood volume and blood flow. This can be due to septic shock or anaphylactic shock, where there is increased capillary permeability, and in neurogenic shock (seen in spinal injury), which causes severe vasodilation and hypotension due to the loss of vascular tone.
Question
Which of the following types of shock presents with reduced systemic vascular resistance and extravasation of intravascular fluid into the third space?
a. Cardiogenic shock
b. Anaphylactic shock
c. Distributive shock
d. Obstructive shock
Answer
c. Distributive shock
Rationale
A. Rationale: To improve cardiac output, patients with shock should be treated initially with intravenous infusion therapy. Vasodilators and vasopressors may be considered in patients who have a persistent low BP after IV infusions.
Question
Which pharmacologic treatment improves cardiac output in a pediatric patient with shock?
a. Vasodilators
b. Antihypertensives
c. Thyroid hormone replacement
d. Corticosteroids
Answer
a. Vasodilators
Rationale
D. Rationale: When providing volume expanders for the treatment of shock, pediatric patients must be closely monitored because they are prone to complications such as pulmonary congestion from too much fluid administration. Initial signs and symptoms of pulmonary congestion include difficulty breathing and crackles on auscultation.
Question
While providing fluid resuscitation therapy on an afebrile 4-year-old girl in septic shock, she develops difficulty breathing and crackles in the left lower lung fields. What is the likely cause of the patient’s signs and symptoms?
a. Pneumonia
b. Congestive heart disease
c. Cardiac arrhythmia
d. Pulmonary congestion
Answer
d. Pulmonary congestion
Rationale
B. Rationale: The pediatric patient in shock may maintain a normal blood pressure initially by compensating for decreased stroke volume with an increased heart rate. During compensated shock, the blood pressure remains normal, but tissue perfusion may still be inadequate because there is also an increase in systemic vascular resistance as the body attempts to target blood volume and oxygen to the vital organs. Therefore, even though a patient in compensated shock has a normal to slightly elevated blood pressure, they may still have lactic acidosis and end-organ dysfunction.
Question
Why do pediatric patients in shock with a normal blood pressure sometimes still present with poor tissue perfusion?
a. The metabolic demands of tissues during shock increases
b. Cardiac output is depressed and there is increased systemic vascular resistance
c. Due to increased lactate dehydrogenase production
d. Due to the increased renal excretion of water and salt
Answer
b. Cardiac output is depressed and there is increased systemic vascular resistance