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Chapter 20: Heart Failure and Circulatory Shock PATHO TAKEN FROM http://thepoint.lww.com/Book/Show

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A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?



a) Distributive
b) Cardiogenic
c) Hypovolemic
d) Obstructive
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A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?



a) Distributive
b) Cardiogenic
c) Hypovolemic
d) Obstructive
Hypovolemic

Hypovolemic shock occurs when there has been extensive blood or body fluid loss. Cardiogenic shock occurs when the heart loses its ability to pump sufficient blood to meet oxygenation needs of body tissues. Distributive shock is loss of blood vessel tone, resulting in expansion of the vascular compartment. Obstructive shock is an inability of the heart to fill or empty properly.
A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following?


a) Infective endocarditis
b) Pericardial effusion
c) Valvular stenosis
d) Valvular regurgitation
Valvular regurgitation

When cardiac valves such as the aortic or mitral fail to close properly, blood does not efficiently exit from the left ventricle. This condition is valvular regurgitation. Valvular stenosis is a narrowing of the lumen of the valve. Pericardial effusion, an accumulation of fluid in the pericardial sac causes obstructive shock, as it impedes ventricular filling. Infective endocarditis could trigger septic shock
Epinephrine (Adrenalin).

Treatment includes immediate discontinuation of the inciting agent; close monitoring of CV and respiratory function; and, maintenance of respiratory gas exchange, cardiac output and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles.
The diagnosis is left-sided heart failure. The nurse knows that the most common causes of left-sided failure include which of the following? Select all that apply.

a) Hypertension
b) Acute myocardial infarction
c) Tricuspid valve dysfunction
d) Impaired renal blood flow
e) Chronic pulmonary disease
• Hypertension
• Acute myocardial infarction

The most common causes of left-sided failure are acute myocardial infarction and hypertension. Chronic pulmonary disease and tricuspid valve regurgitation can cause right-sided failure. Impaired renal blood flow can be a consequence rather than a cause of heart failure.