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Certified Emergency Nurse (CEN) Exam Review SHOCK

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At the completion of this section, the learner will be able to:  Define shock  Differentiate the signs of compensatory shock from decompensatory shock  List the three forms of distributive shock The CEN exam contains nine questions on shock which involve the following topics:  Cardiogenic shock  Distributive shock (e.g. anaphylactic, septic, neurogenic shock)  Hypovolemic  Obstructive (e.g. pericardial tamponade, tension pneumothorax)  Shock (not specific)  Shock (lack of oxygen to the tissues) o Hypovolemic shock – Decreased cellular perfusion secondary to lack of circulating volume o Cardiogenic shock – Decreased cellular perfusion secondary to failure of the central pump o Distributive shock – Decreased cellular perfusion secondary to maldistribution of the oxygen to the periphery o Obstructive shock – Decreased cellular perfusion secondary to obstruction of blood into or out of the ventricles (e.g. pulmonary embolism, pericardial tamponade, tension pneumothorax)  Obstructive shock Type of obstruction Treatment Pregnancy Roll the patient to her side Tension pneumothorax Chest tube/needle decompression Cardiac tamponade Pericardiocentesis Pulmonary embolism Thrombolytics Aortic aneurysm Surgical intervention Aortic stenosis Surgical intervention Excessive positive end expiratory pressure (PEEP) Readjust ventilator settings  Hypovolemic shock o Early (compensatory) shock Sympathetic nervous system (adrenergic system) Parasympathetic nervous system (cholinergic system) Alpha receptors  Vasoconstriction  Glucogeonolysis  Diaphoresis  Vasodilation  Gluconeogenesis  Dry skin Beta-one receptors   heart rate   contractility   automaticity   heart rate   contractility   automaticity Beta-two receptors   respiratory rate  Bronchodilation   respiratory rate  Bronchoconstriction Certified Emergency Nurse (CEN) Exam Review Jeff Solheim 2 | P a g e Definition: Agonist – St imulates a system Antagonist – Diminishes the response of a system  Late (decompensatory shock  Inflammatory mediators are released in response to either foreign invasion of tissue or tissue damage. They have three main courses of action:  Vasodilation  Increased capillary permeability  Increased coagulation

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