Week 4 - Shock & MODS Flashcards

Question

Collaborative Care - Neurogenic Shock - __________ stability - Treatment of the hypotension and bradycardia with __________ and atropine - Fluids used cautiously as hypotension is generally not related to fluid loss - Monitor and treat hypothermia

Answer 1

- Spinal stability - Treatment of the hypotension and bradycardia with vasopressors and atropine - Fluids used cautiously as hypotension is generally not related to fluid loss - Monitor and treat hypothermia

Answer 2

- Initial Stage - Compensatory Stage - Progressive Stage - Refractory Stage

Answer 3

- Not clinically apparent - Metabolism changes from aerobic to anaerobic - Lactic acid accumulates & must be removed by blood & broken down by liver - Process requires O2 (unavailable)

Answer 4

- Clinically apparent - Attempts are aimed at overcoming consequences of anaerobic metabolism and maintaining homeostasis - SNS response - Decrease in organ and tissue perfusion (e.g. renal -- low UO, CNS -- confusion) - Correctable

Answer 5

- Begins when compensatory mechanisms fail - See S/S of organ failure - MUST implement aggressive interventions to prevent MODS

Answer 6

Refractory

Answer 7

- ...is the progressive dysfunction of two or more organ systems - ...is the result of the uncontrolled inflammatory response to severe illness or injury -Most common cause: Sepsis

Answer 8

- Pulmonary - Dysfunction: hypoxia needing MV (at least 3-5 days) - Failure: ARDS (high FiO2 and high PEEP) - Treatment: increase O2 delivery/decrease O2 consumption, protective lung modes, positioning

Answer 9

- Cardiovascular - Dysfunction: Decreased EF, arrhythmias, need for inotropic or vasopressor support, increase CVP & PAWP - Failure: response refractory to inotropic or vasopressor support - Treatment: Volume management, Vasopressors, IABP, VAD

Answer 10

- CNS - Dysfunction: Confusion, mild disorientation - Failure: Seizures, hepatic encephalopathy, failure to wean, progressive coma - Treatment: Maintain cerebral blood flow, decrease cerebral O2 requirements

Answer 11

- Renal - Dysfunction: Oliguria or rising creatinine - Failure: Fixed specific gravity, require dialysis - Treatment: Diuretics, Dopamine, CRRT

Answer 12

- Hepatic - Dysfunction: rise in bilirubin or liver enzymes - Failure: Clinical jaundice with bilirubin > 8-10 mg/dl, elevated ammonia levels (NH3), hepatic encephalopathy - Treatment: Maintain adequate tissue perfusion, provide nutritional support, cautious use of drugs metabolized by the liver

Answer 13

- Intestinal - Dysfunction: ileus with intolerance to TF (> 5 days) - Failure: Stress ulcers requiring transfusions - Treatment: Stress ulcer prophylaxis, enteral feedings

Answer 14

- Hematologic - Dysfunction: Prolonged PT, PTT (> 25%), low platelets (50,000-80,000), increase in FDP’s, increase D-Dimer - Failure: DIC - Treatment: observe for bleeding, replace factors as needed, minimize traumatic interventions

Answer 15

- Serious clotting and bleeding disorder - Always caused by an underlying disease process or condition - Shock (Sepsis) - Obstetric conditions (abrubtio placentae) - Malignancies - Tissue damage (burns, trauma)

Answer 16

1. Initiating event 2. SIRS—Inflammation 3. Clotting cascade 4. Fibrinogen—fibrin + platelet aggregation 5. Deposited in the capillaries—thrombosis 6. Organ ischemia, necrosis

Answer 17

1. Fibrinolytic system activated—breakdown clots 2. Create fibrin split (degradation) products 3. FDP’s: Anticoagulant properties, inhibit normal clotting, consume platelets 4. Clotting factors and platelets depleted— cannot form stable clots 5. Bleeding (increase risk of hemorrhage)

Answer 18

- Bleeding side (more obvious) - Bleeding - Oozing at IV site - Blood in urine or stool - Petechia or ecchymoses

Answer 19

Primary Goal - Treat underlying cause - Early detection of clotting and bleeding Secondary Goal - Heparin/Lovenox to stop clotting - Administration of Blood Products** › Platelets › Fresh frozen plasma (FFP) › Cryroprecipitates

Answer 20

MODS - Collaborative Care - Prognosis for MODS is poor - Goal: Prevent the progression of MODS - Early detection of signs of deterioration or organ dysfunction

Answer 21

B. Heart rate 45 beats/min Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be more consistent with other types of shock.

Answer 22

D. Two 16-gauge IV catheters A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large-bore IV lines to administer normal saline. Lactated Ringer’s solution should be used cautiously and would not be prescribed until the patient has been assessed for liver abnormalities. Vasopressor infusion is not used as the initial therapy for hypovolemic shock. Patients in shock need to be kept warm not cool

Answer 23

C. Urine output 65 mL over the past hour. Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. Urine output should be equal to or more than 0.5 mL/kg/hr. The hemoglobin level and MAP are useful in determining the effects of fluid administration, but they are not as useful as data indicating good organ perfusion. The absence of hemorrhage helps to prevent further fluid loss but does not reflect fluid balance.

Answer 24

B. Monitor breath sounds frequently. Because pulmonary congestion and dyspnea are characteristics of cardiogenic shock, the nurse should assess the breath sounds frequently. The head of the bed is usually elevated to decrease dyspnea in patients with cardiogenic shock. Elevated temperature and flushing or itching of the skin are not typical of cardiogenic shock.

Answer 25

B. Skin is warm and pink Warm, pink, and dry skin indicates that perfusion to tissues is improved. Because nitroprusside is a vasodilator, the blood pressure may be low even if the drug is effective. Absence of a heart murmur and a decrease in troponin level are not indicators of improvement in shock.

Answer 26

D. Oxygen saturation Because the airway edema that is associated with anaphylaxis can affect airway and breathing, the O2 saturation is the most critical assessment. Improvements in the other assessments will also be expected with effective treatment of anaphylactic shock.

Answer 27

A. The patient’s serum creatinine level is high. The high serum creatinine level indicates that the patient has renal failure as well as heart failure. The crackles, chest pressure, and cool extremities are all symptoms consistent with the patient’s diagnosis of cardiogenic shock.

Answer 28

C. Maintaining a cool room temperature for a patient with neurogenic shock Patients with neurogenic shock have poikilothermia. The room temperature should be kept warm to avoid hypothermia. The other actions by the new RN are appropriate.

Answer 29

A. Skin cool and clammy Because patients in the early stage of septic shock have warm and dry skin, the patient’s cool and clammy skin indicates that shock is progressing. The other information will also be reported but does not indicate deterioration of the patient’s status.

Answer 30

A. New onset of confusion The changes in mental status are indicative that the patient is in the progressive stage of shock and that rapid intervention is needed to prevent further deterioration. The other information is consistent with compensatory shock.

Answer 31

B. Provide O2 at 100% per non-rebreather mask. The first priority in the initial management of shock is maintenance of the airway and ventilation. ECG monitoring, insertion of IV catheters, and obtaining blood for ransfusions should also be rapidly accomplished but only after actions to maximize O2 delivery have been implemented

Answer 32

B. Administer epinephrine. Epinephrine rapidly causes peripheral vasoconstriction, dilates the bronchi, and blocks the effects of histamine and reverses the vasodilation, bronchoconstriction, and histamine release that cause the symptoms of anaphylaxis. The other nterventions are also appropriate but would not be the first ones completed.

Answer 33

their level of consciousness, urine output, and blood pressure

Answer 34

CVP is a measure of the pressure in the superior vena cava or right atrium, with a normal range of 2-8 mmHg. It is used to monitor the patient's hemodynamic status and fluid status.

Answer 35

Elevated HR & RR decreased urine output

Answer 36

cool, clammy skin weak pulse delayed capillary refill

Answer 37

blood cultures

Answer 38

fluid replacement

Answer 39

hypotension cool extremities pulmonary edema.

Answer 40

aggressive fluid

Answer 41

whole-body allergic

Answer 42

retain water and maintain blood pressure.

Answer 43

CVP is a measure of the pressure in the thoracic vena cava, which reflects the volume status and cardiac function of the patient.

Answer 44

hemodynamic

Answer 45

Elevated CVP can indicate fluid overload or heart failure low CVP can suggest hypovolemic shock

Answer 46

CVP is measured through a central venous catheter inserted into the superior vena cava or right atrium, and it is monitored along with other vital signs to assess the patient's overall hemodynamic status.

Answer 47

* Definition of PAWP * PAOP and PAWP are both terms for pulmonary artery occlusion pressure, which is a measurement of blood pressure in the pulmonary artery. PAOP is also known as pulmonary artery wedge pressure (PAWP).

Answer 48

Elevated Heart Rate Hypovolemic shock causes the heart to beat faster to maintain cardiac output and perfusion. Elevated Respiratory Rate The body tries to compensate for decreased oxygen delivery by increasing the respiratory rate. Decreased Urine Output The kidneys prioritize blood flow to vital organs, leading to reduced urine production. Recognizing the classic signs of hypovolemic shock, including elevated heart rate, elevated respiratory rate, and decreased urine output, is crucial for early identification and prompt treatment to prevent further deterioration.

Answer 49

Cool, clammy skin Indicating poor peripheral perfusion due to decreased blood flow to the extremities. Weak peripheral pulses. Decreased cardiac output leads to reduced pulsation in the peripheral arteries. Decreased urine output Reduced renal perfusion due to low cardiac output results in decreased urine production. Altered mental status Decreased blood flow to the brain can lead to confusion, lethargy, or agitation. The key signs of low cardiac output are related to the body's attempt to prioritize blood flow to vital organs, resulting in reduced perfusion to the extremities, kidneys, and brain.

Answer 50

* Obtain Blood Cultures Obtain blood cultures before starting antibiotics to identify the causative organism and guide appropriate antibiotic therapy * Measure Input and Output Measure fluid intake and urine output every 1-2 hours to monitor tissue perfusion and detect signs of hypovolemia or fluid overload. * Monitor Respiratory Status Monitor the patient's respiratory rate, effort, and oxygen saturation every 2 hours to detect signs of respiratory distress or impending respiratory failure.

Answer 51

adequate fluid replacement

Answer 52

Tachycardia Elevated heart rate, often greater than 100 beats per minute, as the body tries to compensate for decreased blood volume. Tachypnea Rapid and shallow breathing, often greater than 20 breaths per minute, as the body tries to increase oxygen delivery to tissues. Decreased Urine Output Reduced urine output, often less than 0.5 mL/kg/hour, as the body prioritizes blood flow to vital organs over the kidneys. These classic signs of hypovolemic shock are the body's attempt to maintain perfusion to vital organs in the face of decreased blood volume.

Answer 53

* Initiate Crystalloid Solution Begin fluid resuscitation with crystalloid solutions (e.g., normal saline, Ringer's lactate) at a rate of 20 ml/kg over the first 60 minutes. * Monitor Patient Response Closely monitor the patient's vital signs, urine output, and other clinical indicators to assess the efficacy of the fluid resuscitation. * Adjust Fluid Rate Based on the patient's response, further adjust the fluid administration rate to maintain adequate perfusion and organ function. * Titrate to Hemodynamic Goals The goal is to titrate fluid administration to maintain a mean arterial pressure (MAP) of at least 65 mmHg and urine output of at least 0.5 ml/kg/hour. * Avoid Fluid Overload Monitor for signs of fluid overload, such as pulmonary edema, and adjust the fluid rate accordingly to prevent complications.

Answer 54

* Decreased Cardiac Output Cardiogenic shock is characterized by a decrease in cardiac output due to impaired myocardial function. * Tissue Hypoperfusion The decreased cardiac output leads to tissue hypoperfusion (low renal perfusion and decrease in urine output), which is a hallmark of cardiogenic shock. * Hypotension One of the key signs of cardiogenic shock is hypotension, or low blood pressure. * Cool Extremities As a result of the decreased perfusion, the patient's extremities may feel cool (clammy) to the touch. * Pulmonary Edema Cardiogenic shock can also lead to the development of pulmonary edema, or fluid buildup in the lungs. * Neuro Changes Anxiety, confusion, agitation

Answer 55

vasodilation

Answer 56

Anaphylactic shock S&S - urticaria, angioedema, hypotension, and respiratory distress Common triggers include foods, medications, insect stings/bites, and latex. Individuals with a history of allergies or asthma are at higher risk

Answer 57

Management Immediate administration of epinephrine, fluid resuscitation, and supportive care are essential. Airway management may be necessary in severe cases. Prevention Identifying and avoiding known triggers, carrying epinephrine auto- injectors, and prompt treatment of reactions are crucial for prevention.

Answer 58

antidiuretic hormone (ADH)

Answer 59

Loss of Sympathetic Tone Neurogenic shock is characterized by a loss of sympathetic tone, leading to vasodilation and decreased peripheral vascular resistance. Spinal Cord Injuries Neurogenic shock is often seen in spinal cord injuries, where the disruption of the spinal cord impairs the body's ability to maintain normal blood pressure and heart rate. Vasodilation and Hypotension The loss of sympathetic tone results in vasodilation, leading to decreased peripheral vascular resistance and hypotension, which are the hallmarks of neurogenic shock. Bradycardia In addition to hypotension, neurogenic shock is also characterized by bradycardia, as the parasympathetic nervous system becomes dominant in the absence of sympathetic tone.

Answer 60

Neurogenic

Answer 61

vasodilation

Answer 62

Septic Shock Sepsis: systemic inflammatory response to documented or suspected infection Severe sepsis: sepsis complicated by organ dysfunction

Answer 63

Presence of sepsis with hypotension despite fluid resuscitation Presence of inadequate tissue perfusion resulting in hypoxia

Answer 64

3 major pathophysiologic effects - Vasodilation - Maldistribution of blood flow - Myocardial dysfunction * Decreased ejection fraction * Ventricular dilation

Answer 65

-Increased coagulation and inflammation -Decreased fibrinolysis -Formation of microthrombi -Obstruction of microvasculature -Hyperdynamic state: increased CO and decreased SVR -Decreased urine output

Answer 66

Tachypnea/hyperventilation Results in respiratory alkalosis Respiratory failure develops in 85% of patients Altered neurologic status GI dysfunction, GI bleeding, paralytic ileus

Answer 67

Thorough history and physical examination - No single study to determine shock - Blood studies * Elevation of lactate * Base deficit - 12-lead ECG, continuous ECG monitoring - Chest x-ray - Continuous pulse oximetry - Hemodynamic monitoring

Answer 68

coagulation

Answer 69

The pathophysiologic mechanisms of DIC involve an underlying condition that activates the coagulation system, leading to excessive thrombin generation, consumption of clotting factors, and ultimately, impaired hemostasis DIC can be triggered by various underlying conditions, such as sepsis, trauma, obstetric complications, malignancies, and severe liver disease

Answer 70

Signs of DIC include bleeding, bruising, petechiae, and organ dysfunction due to microvascular thrombosis. Patients may also present with laboratory findings of prolonged clotting times, low platelet count, andelevated D-dimer levels. Treatment of DIC involves addressing the underlying cause and providing supportive care, which may include the administration of blood products, anticoagulants, and treatment of the primary condition.

Answer 71

c. Septic.

Answer 72

a. Decorticate posturing.

Answer 73

b. Disturbed body image related to postoperative change in appearance.

Answer 74

d.“When the patient’s urine output is too high, they are at risk for hypotension.”

Answer 75

b.Oculomotor (III). c. Trochlear (IV). e.Abducens (VI).

Answer 76

a. Urine output of 0.5 ml/kg/hr.

Answer 77

c. The patient has an elevated ammonia level and confusion.

Answer 78

c. Ventricular depolarization.

Answer 79

B. "I feel dizzy and light-headed.”

Answer 80

Anaphylactic Shock Signs: wheezing, chest pain, stridor. Cardiogenic Shock Low cardiac output signs.

Answer 81

Neurogenic Shock Bradycardia, warm and dry skin. Septic Shock Early stage: decreased systemic vascular resistance (SVR).

Answer 82

Key Indicators Level of consciousness (LOC), urine output, and blood pressure are crucial. Hypovolemic Shock Signs Elevated heart and respiratory rates, decrease urine output.

Answer 83

hemodynamic

Answer 84

CVP measures the pressure within the right atrium, reflecting venous return to the heart. The typical range is 2-8 mmHg, but it can vary based on factors like age and volume status

Week 4 - Shock & MODS Flashcards

(129 cards)