1.

Lub sound : The "lub" is the first heart sound, commonly termed S1, and is caused by
turbulence caused by the closure of mitral and tricuspid valves at the start of systole
2. Dub sound : "dub" or S2, is caused by the closure of the aortic and pulmonic valves,
marking the end of systole
3. Whiring sound : there is the back flow from left ventricle to right ventricle through septal
defect.
4. Briana’s blood pressure is lower because of inadequate pumping of blood from the heart
to the body
5. Blood flows from the left ventricle through the ventricular septal defect to the right
ventricle and into the lungs, it will increase blood pressure in the lung (pulmonary
hypertension) then her lung will be congested
6.

Type of shock Possible cause Specific Cause of Reduced MAP

Septic Systemic Bacterial Infection Vasodilation and sometimes decreased

HR leads to reduced MAP
Cardiogenic Myocard Infarction, Severe Interfere with the function of the heart as
Heart Failure, severe a pump
cardiomyopathy
Anaphylactic Hypersensitivity (allergy) Releasing histamine, it can causes
dilation of blood vessel, resulting in
greatly reduced arterial pressure (MAP)
Plasma loss Gastroenteritis and Extensive Reduced blood volume results from loss
burns of plasma into the interstitial spaces
Hemoraghic Bleeding Reduced blood volume caused by either
external or internal bleeding
Neurogenic Cerebral trauma/injury, spinal Diameter of blood vessel increase
cord injury,deep general or (vasodilatation), the heart slows.
spinala anasthesia, or toxic
central nervous system
depression

7. In progressive shock, the compensatory mechanisms are not adequate to compensate for
the loss of blood volume. As a consequence, a positive-feedback cycle develops in which
the blood pressure regulatory mechanisms are not able to compensate for circulatory
shock. As circulatory shock becomes worse, regulatory mechanisms become even less
able to compensate for the increasing severity of the circulatory shock. The cycle
proceeds until the next stage of shock is reached or until medical treatment is applied that
assists the regulatory mechanisms in reestablishing adequate blood flow to tissues.
During progressive shock, the blood pressure declines to a very low level that is not
adequate to maintain blood flow to the cardiac muscle; thus the heart begins to
deteriorate. Substances that are toxic to the heart are released from tissues that suffer
from sever ischemia. When the blood pressure declines to a very low level, blood begins
to clot in the small vessels. Eventually blood vessel dilation begins as a result of
 decreased sympathetic activity and because of the lack of oxygen in capillary beds.
Capillary permeability increases under ischemic conditions, allowing fluid to to leave the
blood vessels and enter the interstitial spaces, and finally intense tissue deterioration
begins in response to inadequate blood flow.
 Vasoconstrictor : agent that can cause constriction of the blood vessels
a. ephinephrine
b. norepinephrine
c. phenylephrin
d. vasopressin
e. pseudoephedrin

 Vasodilator : agent that can cause dilatation of blood vessels

a.alpha blocker : prazosin, terazosin, doxazosin
b. Central alpha-adrenergic agonists : clonidine
c. Direct vasodilator : hydralazine, minoxidil.