Upgrade to remove ads
McCance Patho Chapter 48 quick study
Terms in this set (22)
Shock occurs when the cardiovascular system fails to perfuse tissue, cells, and organs adequately, causing a widespread impairment of cellular metabolism and tissue function. It is a downward physiologic spiral that if not reversed, can lead to MODS.
Types of shock
End result of shock
The final common pathway in all types of shock is impaired cellular metabolism; cells switch from an aerobic to anaerobic metabolism. Energy stores drop, and cellular mechanisms relative to membrane permeability, action potentials, and lysozyme release fail.
Anaerobic metabolism and
Impaired cellular metabolism
Anaerobic metabolism results in activation of the inflammatory response, decreased circulatory volume, and decreasing pH.
Impaired cellular metabolism results in cellular inability to use glucose because of impaired glucose delivery or impaired glucose intake, resulting in a shift of glycogenolysis, gluconeogenesis, and lipolysis for fuel generation.
Glycogenolysis and Gluconeogenesis in shock
Glycogenolysis is affected for up to 10 hours.
Gluconeogenesis results in the use of proteins necessary for structure, function, repair, and replication that leads to more impaired cellular metabolism. Lipolysis is ineffective because of a lack of transport serum proteins.
Gluconeogenesis contributes to lactic acid, uric acid, and ammonia buildup, interstitial edema, and impairment of the immune system, as well as general muscle weakness leading to decreased respiratory function and cardiac output.
results from persistent hypotension and tissue hypoperfusion caused by cardiac dysfunction in the presence of adequate intravascular volume and left ventricular filling pressure.
caused by the loss of whole blood, plasma, or interstitial fluid in large amounts. The use of compensatory mechanisms may be vigorous, but tissue perfusion ultimately decreases and results in impaired cellular metabolism.
Neurogenic (vasogenic) shock
results from massive vasodilation caused by an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. It causes a relative hypovolemia (even though cardiac output may be high), and results in impaired cellular metabolism.
the outcome of a widespread hypersensitivity to an allergen that triggers anaphylaxis. The inflammatory response is triggered, and a massive vasodilation with fluid shift into the interstitium follows. The relative hypovolemia leads to impaired cellular metabolism.
begins with impaired cellular metabolism caused by uncontrolled septicemia. The infecting agent triggers the inflammatory and immune responses. It is part of a continuum known as SIRS. Mortality for septic shock is very high.
he progressive dysfunction of two or more organ systems resulting from a systemic inflammatory response after a severe illness or injury. The inflammatory response can be triggered by sepsis, necrotic tissue, trauma, burns, ARDS, acute pancreatitis, major surgery, circulatory shock, DIC, acute renal failure, blood transfusion, heat stroke, liver failure, mesenteric ischemia, propofol infusion syndrome, persistent inflammatory foci, and other severe injuries.
Primary MODS is the immediate local or mild systemic response to the triggering event or illness. It primes the inflammatory system.
Which type of shock is not related to low systemic vascular resistance?
Cardiogenic shock has decreased cardiac output; therefore adequate oxygen is not delivered to the cells. Septic, neurogenic, and anaphylactic forms have low perfusion as a result of low systemic vascular resistance.
Which is a true statement regarding cardiogenic shock?
A -The most common cause of cardiogenic shock is infection.
B -Cardiogenic shock responds well to multiple treatments.
C -Mortality improves with revascularization strategies.
D-Compensatory adaptive responses result in hypotension.
C. Mortality is improved with revascularization strategies.
The most common cause of cardiogenic shock is myocardial infarction or surgery requiring bypass. Any form of heart failure may cause cardiogenic shock. Cardiogenic shock is often unresponsive to treatment, with in-hospital mortality ranging from 50% to 80%.
Compensatory adaptive responses include the maintenance of blood pressure through vasoconstriction.
At which level of fluid loss does hypovolemic shock develop?
Hypovolemic shock begins to develop when the intravascular volume has decreased by about 15%.
What is the cause of neurogenic shock?
a- Decreased volume
b- Massive vasodilation
c- Sympathetic overstimulation
d- Increased systemic vascular resistance
B. Neurogenic shock is due to massive vasodilation that may be caused by an overstimulation of the parasympathetic system or an understimulation of the sympathetic system.
Decreased systemic vascular resistance occurs, as well as relative hypovolemia. The amount of blood has not changed, but the space that carries blood has increased.
What is the appropriate first-line treatment for shock?
a. Large amounts of fluid volume
b. Medications to increase systemic vascular resistance
c. Identification and treatment of the underlying cause
d. Enhancement of cardiac output
C. The most important first-line treatment for shock is to identify and treat the underlying cause. After the underlying cause is detected, treatment is supportive.
Which statement is true regarding multiple organ dysfunction syndrome (MODS)?
a. MODS is the progressive dysfunction of one organ system.
b. An uncontrolled inflammatory response can trigger MODS.
c. MODS is another term for sepsis.
d. The mortality rate for MODS is generally low.
B. MODS is the progressive dysfunction of two or more organ systems, resulting from uncontrolled inflammatory response, and may occur during sepsis. However, these two terms are not synonymous. The mortality rate for MODS is high.
What percentage of the total body surface area has been burned when the area is the size of the patient's palm?
A. The surface area of the palm averages 1% of the body surface area over a wide range of ages.
is associated with maldistribution of blood flow, hypermetabolism, myocardial depression, and supply-dependent oxygen consumption. The progressive organ dysfunction of secondary MODS is the result of an excessive inflammatory reaction.
The three essential elements of survival after a major burn:
(1) meticulous wound management
(2) adequate fluids and nutrition
(3) early surgical excision and grafting
Which of the following are results of gluconeogenesis in shock?
A- Increased lactic acid
B- Increased uric acid
C- Impairment of the immune system
D -Interstitial edema
E- Increased heart rate
All but E.
Gluconeogenesis causes proteins to be used for fuel. The breakdown of proteins can result in increased lactic acid, uric acid, interstitial edema, and ammonia, as well as impairment of the immune system. Tachycardia is a compensatory shock mechanism focused on oxygen delivery.
Alterations in clotting factors create a ______ state after a burn. Bacteria translocation across the gut wall increases, evaporative water loss increases, and white blood cell function is impaired.
This set is often in folders with...
McCance Ch 48 Shock, MODS & Burns in Adults
McCance Patho Chapter 47 quick study
McCance Patho Chapter 49 quick study
Advanced Pathophysiology and Physiology:…
You might also like...
Module 11 - Shock and Multiple Organ Dysfunction S…
Patho - Shock
Other sets by this creator
McCance Patho Chapter 46 quick study
McCance Patho Chapter 45 quick study
McCance Patho Chapter 44 quick study
McCance Patho Chapter 43 quick study
Other Quizlet sets
Government and Economy of Asia Review
Bio psych audition