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Chapter 66 Shock, Sepsis, and Multiple
Organ Dysfunction Syndrome (Lewis)
Pages 1587 – 1604. Questions and
Verified Answers
____________ is the drug of choice to treat anaphylactic shock. - ANSEpinephrine Absolute hypovolemia results when - ANSfluid is lost through hemorrhage, gastrointestinal (GI) loss (e.g., vomiting, diarrhea), fistula drainage, diabetes insipidus, or diuresis. Anaphylactic shock is - ANSan acute and life-threatening hypersensitivity (allergic) reaction. ♣ The reaction is caused by a sensitizing substance (e.g., drug, chemical, vaccine, food, insect venom). Cardiogenic shock occurs when - ANSeither systolic or diastolic dysfunction of the pumping action of the heart results in reduced cardiac output (CO). Causes of cardiogenic shock include - ANSacute myocardial infarction (MI), cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary hypertension, and myocardial depression from metabolic problems.
Clinical manifestations of anaphylactic shock can include - ANSanxiety, confusion, dizziness, chest pain, incontinence, swelling of the lips and tongue, wheezing, stridor, flushing, pruritus, urticaria, and angioedema. Clinical manifestations of cardiogenic shock include - ANStachycardia, hypotension, a narrowed pulse pressure, tachypnea, pulmonary congestion, cyanosis, pallor, cool and clammy skin, diaphoresis, decreased capillary refill time, anxiety, confusion, and agitation. Clinical manifestations of hypovolemia depend on - ANSthe extent of injury or insult, age, and general state of health and may include anxiety; an increase in heart rate, CO, and respiratory rate and depth; and a decrease in stroke volume, pulmonary artery wedge pressure (PAWP), and urine output. Clinical manifestations of neurogenic shock include - ANShypotension, bradycardia, temperature dysregulation (resulting in heat loss), dry skin, and poikilothermia. Definitive measures for cardiogenic shock include - ANSthrombolytic therapy, angioplasty with stenting, emergency revascularization, and valve replacement. diagnosis for shock - ANSThere is no specific diagnostic study to determine shock. The diagnosis is established from a detailed history and physical examination findings.
Neurogenic shock is a - ANShemodynamic phenomenon that can occur within 30 minutes of a spinal cord injury at the fifth thoracic (T5) vertebra or above and last up to 6 weeks, or in response to spinal anesthesia. nursing care for cardiogenic shock involves - ANShemodynamic monitoring, drug therapy (e.g., diuretics to reduce preload), and use of circulatory assist devices (e.g., intraaortic balloon pump, ventricular assist device). Patients in septic shock require - ANSlarge amounts of fluid replacement. The goal is to achieve a targeted response based on CVP, ScvO2, cardiac ultrasound, a focused physical assessment, fluid responsiveness, or other measures. Use of a fluid challenge technique (crystalloids if associated with hemodynamic improvement [increased MAP and/or other measures]) is recommended. Patients with septic shock often have - ANShypotension, respiratory failure, alteration in neurologic status, acute kidney injury with decreased urine output, and GI dysfunction. Protein-calorie malnutrition is - ANSone of the main manifestations of hypermetabolism in shock. Early enteral nutrition is vital to decreasing morbidity from shock. Rehabilitation of the patient who is recovering from shock necessitates correction of - ANSthe precipitating cause, prevention or early treatment of
complications, and education focused on disease management and/or prevention of recurrence based on initial cause of shock Relative hypovolemia results when - ANSfluid volume moves out of the vascular space into extravascular space, such as with sepsis and burns. Sepsis is a - ANSsystemic inflammatory response to a documented or suspected infection. Severe sepsis is sepsis complicated by organ dysfunction. Septic shock has three major pathophysiologic effects: - ANSvasodilation, maldistribution of blood flow, and myocardial depression. Septic shock is the presence of - ANSsepsis with hypotension despite adequate fluid resuscitation along with the presence of inadequate tissue perfusion. septic shock/antibiotics - ANSAntibiotics are an important component of therapy for patients with septic shock. They should be started after cultures (e.g., blood, urine) are obtained and within the first hour of severe sepsis or septic shock. septic shock/iv corticosteroids - ANSIV corticosteroids are only recommended for patients who cannot maintain an adequate blood pressure (BP) with vasopressor therapy, despite fluid resuscitation.
The four main categories of shock are - ANScardiogenic, hypovolemic, distributive (includes septic, anaphylactic, and neurogenic shock), and obstructive. The initial assessment of shock focuses on - ANSassessing responsiveness and ABCs: airway, breathing, and circulation. The initial stage of shock that occurs at a cellular level is - ANSusually not clinically apparent. the nurses role in shock involves - ANS(1) monitoring the patient's ongoing physical and emotional status, (2) identifying trends to detect changes in the patient's condition, (3) planning and implementing nursing interventions and therapy, (4) evaluating the patient's response to therapy, (5) providing emotional support to the patient and caregiver, and (6) collaborating with other members of the health team to coordinate care. The overall goal of cardiogenic shock is to - ANSrestore blood flow to the myocardium by restoring the balance between O2 supply and demand The overall goals for a patient in shock include - ANS(1) evidence of adequate tissue perfusion, (2) restoration of normal BP, (3) return/recovery of organ function, and (4) avoidance of complications from prolonged states of hypoperfusion.
The patient in shock requires frequent assessment of - ANSheart rate/rhythm, BP, CVP, SvO2, and pulmonary artery (PA) pressures or arterial pressure wave-form analysis for cardiac output (APCO); neurologic status; respiratory status, urine output, and temperature; capillary refill; skin for temperature, pallor, flushing, cyanosis, diaphoresis, or piloerection; and bowel sounds and abdominal distention, as well as prevention of health care-associated infections. The primary goal of drug therapy for shock is - ANSthe correction of decreased tissue perfusion resulting in tissue hypoxia. Vasopressor or vasodilator therapy is used according to patient needs to maintain the mean arterial pressure at the appropriate level after adequate volume resuscitation. The primary strategy in treating obstructive shock is - ANSearly recognition and treatment to relieve or manage the obstruction. The progressive stage of shock begins as - ANScompensatory mechanisms fail and aggressive interventions are necessary to prevent the development of multiple organ dysfunction system (MODS). The treatment of neurogenic shock is dependent on - ANSthe cause. In spinal cord injury, general measures to promote spinal stability are initially used.
