Download NRSG 327 Week 5 Exam Study Guide: Hypovolemic, Septic, and Anaphylactic Shock and more Exams Nursing in PDF only on Docsity!
NRSG 327 WEEK 5 EXAM STUDY GUIDE QUESTIONS WITH
100% ACCURATE ANSWERS
What is normal for labs post op -- Answer โโ Slightly elevated WBC What level of Hgb is worrying? -- Answer โโ o Anything below 80 is concerning Is the patient symptomatic (dizzy, fainty, pale, weak, white/greyish, look at the mucous membranes- eyelids, mouth, palm of hand, increase RR, low energy ยท Most MRP will not treat unless extremely low or symptomatic Hypovolemic Shock- Pathology -- Answer โโ Loss of Volume o Always ends in decreased tissue perfusion and impaired cellular metabolism Risk Factors of Hypovolemic Shock: -- Answer โโ o Surgery/ Trauma o Low BMI o N/V (extreme) o Very young, Very old o Not good at regulating fluids in the body o Diseases
- Cardiac issue->Heart failure
- Acute Kidney Injury (AKI) Types of Hypovolemia -- Answer โโ Absolute and Relative Absolute (obvious) Hypovolemia -- Answer โโ Things we can measure o External Blood Loss (i.e. Gunshot wound) o Body Fluid Loss (i.e. Diuresis)
Norwoc ยท Relative -- Answer โโ Cannot measure o Third Spacing (i.e. Burns) o Internal Blood Loss (i.e. Ruptured spleen) High Risk Patients for Hypovolemic Shock: -- Answer โโ o Burn victims o Post Hemorrhaging (childbirth)
- Post partum o Trauma o Elderly/Peds-> Dehydrated Where can life-threatening hemorrhages occur? -- Answer โโ More of your Trauma s
- Chest
- Thighs
- Abdomen/Pelvis
- Outside the body Blood loss from the chest -- Answer โโ 3 - 4 L blood loss Blood loss from the thigh -- Answer โโ 1 L blood loss Blood loss from the abdomen and pelvis -- Answer โโ 3 - 4 L blood loss Overall Shock Steps -- Answer โโ ยท Because Decreased CO->MODS - > DIC Complications of HEMORRHAGE: -- Answer โโ o Hypoperfusion o Lethal triad (complication of shock in general) o Electrolyte imbalance Hypoperfusion -- Answer โโ o Think of S&S you already know for shock!
ยท Helps to clot the blood Given if relay bad Treatment of Non-Hemorrhage -- Answer โโ o Colloids Blood derivative o Crystalloids IV solution Whole blood -- Answer โโ 2023 study showed that whole blood reduced tissue injury 4 units RBC, 4 units plasma, 1 adult dose platelets (1:1:1 ratio) ยท ONE adult platelet dose is a pool of FOUR whole blood donor platelets o Platelets itself is counted as 4 Colloids -- Answer โโ Contains large molecules o Can give a small amount of fluid for a big job ยท Remain in the intravascular compartment ยท Expand plasma by drawing fld from the extravascular space (oncotic pressure) ยท Require less volume than crystalloids ยท Examples: FFP (fresh frozen plasm), Albumin, Hetastarch, Pentastarch ยท Watch for: fld volume overload Who is colloids given to mostly? -- Answer โโ GIVEN MOSTLY POST-CARDIAC SURGERY OR HF (Their preload is normal) o Shifts fluid volume, pt. may be on fluid restriction Pulls fluid from the extracellular space back into the vascular space to increase BP What is colloids not great for? -- Answer โโ o Doesn't do a lot for preload Crystalloids -- Answer โโ salts that dissolve readily into true solutions
Isotonic: osmolality matches plasma -- Answer โโ 0.9% NS, Ringer's Lactate (preferred as it is the closest electrolyte solution to the blood- more expensive that is why NS is used more), D5NS ยท REMEMBER that ringers lactate does not affect the lactic acid Watch for hypervolemia Equal balance of salt and fluids Hypertonic: higher concentration of electrolytes -- Answer โโ 3% NS, D10W, D Watch for intravascular overload, pulmonary edema More salt than fluids Hypotonic: lower concentration of electrolytes -- Answer โโ 0.45% NS, D5W (once dextrose has been metabolized) Watch for changes in LOC/Shock Less salt than fluids How will we know if our interventions are working?- Easily Measured -- Answer โโ o What will we be assessing for? Blood Work ยท CBC ยท Lytes ยท Coags ยท ABGs, Lactate, Renal panel, Liver panel o Done later Figure out the cause ยท Either give blood or IV solutions How will we know if our interventions are working?- Not so easily measured -- Answer โโ Critical Care: Central venous pressure Arterial pressure
Who is at risk of septic shock? -- Answer โโ immunocompromised patients Diabetics o Post-Op We just cut into them - gave them a source of an infection Normal inflammatory response post-op (slightly high WBC) mask early signs of septic shock o Children Get sick very fast compared to adults o Elderly o Malnutrition Septic shock differs from hypovolemia shock in that it is frequently manifested by: -- Answer โโ a. fever and flushed face Infection -- Answer โโ ยท "Life-threatening organ dysfunction caused by a dysregulated host response to infection" ยท "A subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone" Key features here are the signs/symptoms PLUS the infection signs - > once we have this then we wat to check SBP (<90) and _____. -- Answer โโ Serum Lactate > Lactic Acid -- Answer โโ o is a natural byproduct of cellular metabolism and is produced when the body breaks down carbohydrates for energy in low-oxygen conditions (i.e. IMPAIRED CELLULAR METABOLISM) Lactic Acid in the body -- Answer โโ Is immediately split into lactate and hydrogen after it's produced. The body produces and uses lactate, not lactic acid. Ringers Lactate will not do what? -- Answer โโ Increase serum lactate levels as RL is sodium lactate & will not breakdown in the body like serum lactate
alone...although...there are some conflicting studies out there so often times you will just see NS being used as IV fluid instead of RL for patients at risk of septic shock. Sepsis Treatment -- Answer โโ o ABX - > High dose (#1 treatment) o IV fluids (Isotonic solution) o Monitoring VS, lab trends, GCS, LOC (Neuro mental status monitoring) ยท We are now in MODS with this patient Really important things about sepsis -- Answer โโ o Screening tools - o Lab testing - Lactate, CBC(figure out what else is happening in the blood), electrolytes, ABGs o Effective communication How many things do you need to meet the sepsis criteria -- Answer โโ 2 things Septic Shock S&S: -- Answer โโ - Temperature dysregulation
- Increased WBC ยท **Again, think hypoperfusion!!!
- Tachycardia - Tachypnea/hyperventilation o Hypotension o โ urine output o Altered neurological status o GI dysfunction o ARDS: Acute respiratory distress syndrome o DIC: Disseminated Intravascular Coagulation Treatment: Septic Shock -- Answer โโ TREAT THE UNDERLYING CAUSE! o ANTIBIOTICS IMPROVE CARDIAC OUTPUT
DIC: Disseminated Intravascular Coagulation ARDS -- Answer โโ acute respiratory distress syndrome DIC -- Answer โโ disseminated intravascular coagulation Anaphylactic Shock: Treatment -- Answer โโ -- Answer โโ Remove the cause!!! o Take away the peanuts TREAT THE CAUSE ยท Improve cardiac output o Increase O2 Supply Afterload Preload Contractility Decrease O2 Demand o O2/Intubation How do we treat THE CAUSE??? -- Answer โโ Stop the vasodilation! o Epinephrine Stop the bronchoconstriction! o Epinephrine Stop the histamine! o Epinephrine Epinephrine (Alpha): -- Answer โโ Vasoconstriction (leaky goes away), Decrease Edema Epinephrine (Beta 1/ Beta 2): -- Answer โโ ยท Beta 1- Increase HR ยท Beta 2- Bronchodilate, open up airways
What might patients need when having anaphylactic shock? -- Answer โโ steroids, and antihistamines to be helpful He then goes into anaphylactic shock and develops: -- Answer โโ a) bronchoconstriction, hives or edema, and hypotension. Neurogenic shock -- Answer โโ o Result of loss or suppression of sympathetic tone o Rare o Trauma: Spinal Cord Injury o Loos the Sympathetic response Think BP, RR, temp. etc... Neurogenic Shock S&S: -- Answer โโ o Bradycardia o Dry, warm skin o Can get very cold later on o **Again, think hypoperfusion!!! Neurogenic Shock: Treatment -- Answer โโ TREAT THE CAUSE - Try and save the spinal cord o What if we can't do that?! Atropine Maintain normal HR o MAINTAIN NORMAL HEART RATE .... ATROPINE!!! o Maintain normothermia - temperature regulation O2 Supply o Afterload o Preload o Contractility O2 Demand o O2/Intubation (depending on how bad spinal cord damage is) Key Takeaways for ALL TYPES OF SHOCK!!! -- Answer โโ 1. S&S will all be very similar - think hypoperfusion (S/S are usually the same through all types except these 3)
