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NRSG 327 Week 5 Exam Study Guide: Hypovolemic, Septic, and Anaphylactic Shock, Exams of Nursing

This study guide provides a comprehensive overview of hypovolemic, septic, and anaphylactic shock, covering key concepts, risk factors, treatment strategies, and assessment parameters. It includes questions and answers related to the pathophysiology, clinical manifestations, and management of these critical conditions. The guide is particularly useful for nursing students preparing for exams or seeking a deeper understanding of shock management.

Typology: Exams

2024/2025

Available from 03/14/2025

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NRSG 327 WEEK 5 EXAM STUDY GUIDE QUESTIONS WITH
100% ACCURATE ANSWERS
What is normal for labs post op -- Answer โœ”โœ” Slightly elevated WBC
What level of Hgb is worrying? -- Answer โœ”โœ” 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 โœ”โœ” Loss of Volume
o Always ends in decreased tissue perfusion and impaired cellular metabolism
Risk Factors of Hypovolemic Shock: -- Answer โœ”โœ” 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 โœ”โœ” Absolute and Relative
Absolute (obvious) Hypovolemia -- Answer โœ”โœ” Things we can measure
o External Blood Loss (i.e. Gunshot wound)
o Body Fluid Loss (i.e. Diuresis)
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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 โœ”โœ” Slightly elevated WBC What level of Hgb is worrying? -- Answer โœ”โœ” 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 โœ”โœ” Loss of Volume o Always ends in decreased tissue perfusion and impaired cellular metabolism Risk Factors of Hypovolemic Shock: -- Answer โœ”โœ” 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 โœ”โœ” Absolute and Relative Absolute (obvious) Hypovolemia -- Answer โœ”โœ” Things we can measure o External Blood Loss (i.e. Gunshot wound) o Body Fluid Loss (i.e. Diuresis)

Norwoc ยท Relative -- Answer โœ”โœ” Cannot measure o Third Spacing (i.e. Burns) o Internal Blood Loss (i.e. Ruptured spleen) High Risk Patients for Hypovolemic Shock: -- Answer โœ”โœ” o Burn victims o Post Hemorrhaging (childbirth)

  • Post partum o Trauma o Elderly/Peds-> Dehydrated Where can life-threatening hemorrhages occur? -- Answer โœ”โœ” More of your Trauma s
  1. Chest
  2. Thighs
  3. Abdomen/Pelvis
  4. Outside the body Blood loss from the chest -- Answer โœ”โœ” 3 - 4 L blood loss Blood loss from the thigh -- Answer โœ”โœ” 1 L blood loss Blood loss from the abdomen and pelvis -- Answer โœ”โœ” 3 - 4 L blood loss Overall Shock Steps -- Answer โœ”โœ” ยท Because Decreased CO->MODS - > DIC Complications of HEMORRHAGE: -- Answer โœ”โœ” o Hypoperfusion o Lethal triad (complication of shock in general) o Electrolyte imbalance Hypoperfusion -- Answer โœ”โœ” 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 โœ”โœ” o Colloids Blood derivative o Crystalloids IV solution Whole blood -- Answer โœ”โœ” 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 โœ”โœ” 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 โœ”โœ” 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 โœ”โœ” o Doesn't do a lot for preload Crystalloids -- Answer โœ”โœ” salts that dissolve readily into true solutions

Isotonic: osmolality matches plasma -- Answer โœ”โœ” 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 โœ”โœ” 3% NS, D10W, D Watch for intravascular overload, pulmonary edema More salt than fluids Hypotonic: lower concentration of electrolytes -- Answer โœ”โœ” 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 โœ”โœ” 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 โœ”โœ” Critical Care: Central venous pressure Arterial pressure

Who is at risk of septic shock? -- Answer โœ”โœ” 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 โœ”โœ” a. fever and flushed face Infection -- Answer โœ”โœ” 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 โœ”โœ” Serum Lactate > Lactic Acid -- Answer โœ”โœ” 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 โœ”โœ” 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 โœ”โœ” 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 โœ”โœ” 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 โœ”โœ” 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 โœ”โœ” 2 things Septic Shock S&S: -- Answer โœ”โœ” - 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 โœ”โœ” TREAT THE UNDERLYING CAUSE! o ANTIBIOTICS IMPROVE CARDIAC OUTPUT

DIC: Disseminated Intravascular Coagulation ARDS -- Answer โœ”โœ” acute respiratory distress syndrome DIC -- Answer โœ”โœ” disseminated intravascular coagulation Anaphylactic Shock: Treatment -- Answer โœ”โœ” -- Answer โœ”โœ” 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 โœ”โœ” Stop the vasodilation! o Epinephrine Stop the bronchoconstriction! o Epinephrine Stop the histamine! o Epinephrine Epinephrine (Alpha): -- Answer โœ”โœ” Vasoconstriction (leaky goes away), Decrease Edema Epinephrine (Beta 1/ Beta 2): -- Answer โœ”โœ” ยท Beta 1- Increase HR ยท Beta 2- Bronchodilate, open up airways

What might patients need when having anaphylactic shock? -- Answer โœ”โœ” steroids, and antihistamines to be helpful He then goes into anaphylactic shock and develops: -- Answer โœ”โœ” a) bronchoconstriction, hives or edema, and hypotension. Neurogenic shock -- Answer โœ”โœ” 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 โœ”โœ” o Bradycardia o Dry, warm skin o Can get very cold later on o **Again, think hypoperfusion!!! Neurogenic Shock: Treatment -- Answer โœ”โœ” 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 โœ”โœ” 1. S&S will all be very similar - think hypoperfusion (S/S are usually the same through all types except these 3)