shock, CS, HS

Question 1

What is shock?

Answer 1

A syndrome characterized by decreased tissue perfusion and impaired cellular metabolism, causing an imbalance between oxygen/nutrient supply and demand.

Question 2

What happens during shock at the cellular level?

Answer 2

Hypoperfusion → increased O₂/nutrient demand → ischemia → cell injury → cell death.

Question 3

What are the main classifications of shock?

Answer 3

Cardiogenic, Hypovolemic, Distributive (Anaphylactic, Septic, Neurogenic), and Obstructive.

Question 4

What is the pathophysiology of cardiogenic shock?

Answer 4

Systolic or diastolic dysfunction of the heart → decreased cardiac output (CO), stroke volume (SV), and BP → poor tissue perfusion.

Question 5

What is the leading cause of cardiogenic shock?

Answer 5

Myocardial infarction (MI).

Question 6

What are causes of cardiogenic shock?

Answer 6

Cardiac tamponade, ventricular hypertrophy, cardiomyopathy, dysrhythmias (brady/tachy), valvular stenosis or regurgitation, ventricular septal rupture, tension pneumothorax, MI.

Question 7

What are key patient presentations in cardiogenic shock?

Answer 7

Tachycardia, hypotension, narrow pulse pressure, delayed cap refill.

Question 8

What are assessment findings in cardiogenic shock?

Answer 8

Tachypnea, crackles, cyanosis, pallor, weak pulses, cool/clammy skin, decreased urine output, anxiety, confusion, agitation.

Question 9

What is the goal of treatment in cardiogenic shock?

Answer 9

Restore heart function and balance oxygen supply and demand.

Question 10

What are key treatments for cardiogenic shock?

Answer 10

Revascularization (angioplasty/stent), valve replacement, intra-aortic balloon pump, ventricular assist device (VAD).

Question 11

What are the main drug therapies used for cardiogenic shock?

Answer 11

• Nitroglycerin: decreases workload, dilates coronary arteries
• Vasodilators (Nitroprusside): reduce preload/afterload
• Epinephrine (low dose): cardiac stimulation, bronchodilation, vasodilation
• Norepinephrine (Levophed): main vasopressor post-MI, increases CO and perfusion.

Question 12

What is the definition of hypovolemic shock?

Answer 12

Inadequate intravascular fluid volume to support perfusion.

Question 13

What is absolute hypovolemia?

Answer 13

Actual fluid loss from the body (e.g., hemorrhage, vomiting, diarrhea, fistula drainage, diabetes insipidus, diuresis).

Question 14

What is relative hypovolemia?

Answer 14

Fluid shifting out of the vascular space (e.g., third spacing, internal bleeding, bowel obstruction, massive vasodilation).

Question 15

What are causes of hypovolemic shock?

Answer 15

External blood/fluid loss, internal bleeding, third spacing, massive vasodilation, fluid shifts.

Question 16

How much blood loss can the body compensate for before showing signs of shock?

Answer 16

Up to 750 mL (≈15% of total volume).

Question 17

What are early patient presentations in hypovolemic shock?

Answer 17

Tachycardia, cool/clammy/pale skin, decreased cap refill, absent bowel sounds, anxiety, confusion, agitation, decreased urine output.

Question 18

What are late signs of hypovolemic shock?

Answer 18

Bradycardia and severe hypotension.

Question 19

Why are bowel sounds absent in hypovolemic shock?

Answer 19

Because of shunting of blood to vital organs, reducing GI perfusion.

Question 20

What lab studies are important in hypovolemic shock?

Answer 20

Hemoglobin, hematocrit, electrolytes, lactate, blood gases, urine output.

Question 21

What does an elevated lactate level indicate?

Answer 21

Poor tissue perfusion and anaerobic metabolism.

Question 22

What is the goal of hypovolemic shock treatment?

Answer 22

Restore tissue perfusion.

Question 23

What type of IV access is used for rapid fluid replacement?

Answer 23

1–2 large-bore IVs, intraosseous device, or central venous catheter.

Question 24

What fluids are commonly used initially for resuscitation?

Answer 24

Normal Saline (NS) or Lactated Ringers (LR).

Question 25

When are PRBCs (packed red blood cells) indicated?

Answer 25

In hypovolemic shock due to blood loss.

Question 26

Which crystalloid is commonly used in the Emergency Department (ED)?

Answer 26

Normal Saline (NS).

Question 27

Which crystalloid is often used in the Operating Room (OR) or Obstetrics (OB)?

Answer 27

Lactated Ringers (LR).

Question 28

What determines how a patient responds to hypovolemic shock?

Answer 28

Extent of injury, age, and overall health.

Question 29

What nursing priorities exist during hypovolemic shock?

Answer 29

Monitor VS, urine output, mental status, perfusion, and response to fluids; maintain airway and oxygenation; control fluid loss source.