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NUR 2016: SHOCK, SIRS/SEPSIS, MODS, DIC: TEST QUESTIONS WITH COMPLETE SOLUTIONS, Exams of Nursing

Aims Community CollegeNursing

NUR 2016: SHOCK, SIRS/SEPSIS, MODS, DIC: TEST QUESTIONS WITH COMPLETE SOLUTIONS

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NUR 2016: SHOCK, SIRS/SEPSIS, MODS, DIC: TEST
QUESTIONS WITH COMPLETE SOLUTIONS
1) What is does MODs stand for? -- Answer โœ”โœ” multiple organ dysfunction syndrome
2) What are the two pathways of MODs? -- Answer โœ”โœ” Primary is a direct result of
well-defined event (i.e., hypoxia event resulting in lack of perfusion) Secondary is a
result of SIRs.
3) The primary pathway of MODs usually occurs within ___ hours. -- Answer โœ”โœ” 72
4) The secondary pathway of MODs may occur... -- Answer โœ”โœ” Much later in the
course of illness compared to the primary pathway
5) What are the pathological changes of MODs? -- Answer โœ”โœ” Uncontrolled systemic
inflammation, tissue hypoxia, unregulated apoptosis
6) What is the Sequential Organ Failure Assessment (SOFA) criteria? -- Answer โœ”โœ” An
assessment tool that predicts the progression of sepsis.
7) What is on the SOFA criteria? -- Answer โœ”โœ” Respiratory function (PaO2/FiO2
ratio), cardiovascular function (MAP & vasopressors), coagulation (platelet count),
renal function (Urine output, Cr), CNS function (GSC), liver function (bili)
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NUR 2016: SHOCK, SIRS/SEPSIS, MODS, DIC: TEST

QUESTIONS WITH COMPLETE SOLUTIONS

  1. What is does MODs stand for? -- Answer โœ”โœ” multiple organ dysfunction syndrome
  2. What are the two pathways of MODs? -- Answer โœ”โœ” Primary is a direct result of well-defined event (i.e., hypoxia event resulting in lack of perfusion) Secondary is a result of SIRs.
  3. The primary pathway of MODs usually occurs within ___ hours. -- Answer โœ”โœ” 72
  4. The secondary pathway of MODs may occur... -- Answer โœ”โœ” Much later in the course of illness compared to the primary pathway
  5. What are the pathological changes of MODs? -- Answer โœ”โœ” Uncontrolled systemic inflammation, tissue hypoxia, unregulated apoptosis
  6. What is the Sequential Organ Failure Assessment (SOFA) criteria? -- Answer โœ”โœ” An assessment tool that predicts the progression of sepsis.
  7. What is on the SOFA criteria? -- Answer โœ”โœ” Respiratory function (PaO2/FiO ratio), cardiovascular function (MAP & vasopressors), coagulation (platelet count), renal function (Urine output, Cr), CNS function (GSC), liver function (bili)
  1. What is qSOFA? -- Answer โœ”โœ” Revised SOFA screening tool that eliminates invasive data. A positive score is defined as two or more points. (Altered mental status, SBP < 100, RR >22)
  2. What pulmonary systemic changes are seen with MODs? -- Answer โœ”โœ” ARDs, increased RR, may need vent support, high oxygen demands
  3. What cardiovascular systemic changes are seen with MODs? -- Answer โœ”โœ” Decreased coronary artery perfusion and contractility, s/s of poor perfusion
  4. What renal systemic changes are seen with MODs? -- Answer โœ”โœ” Decreased urinary output, may need dialysis
  5. What neurological changes are seen with MODs? -- Answer โœ”โœ” Loss of consciousness, altered mental status
  6. What liver changes are seen with MODs? -- Answer โœ”โœ” Decrease in clotting factors, higher instances of hemorrhage
  7. What GI changes are seen with MODs? -- Answer โœ”โœ” Decreased or no peristalsis, distention, necrosis
  8. What hematologic changes are seen with MODs? -- Answer โœ”โœ” Hypercoagulable (DVT prophylaxis), increased vessel permeability
  9. What is disseminated intravascular coagulation (DIC)? -- Answer โœ”โœ” Serious bleeding disorder initiated by widespread, microvascular clotting creating tissue hypoxia (You clot clot clot, and because you don't have any clotting factor left you are at risk of hemorrhaging)
  1. What is the job of the cardiovascular system? -- Answer โœ”โœ” Supply tissues with oxygen and nutrient rich blood and remove wastes
  2. What are the stages of shock? -- Answer โœ”โœ” Initial, compensatory, progressive, refractory
  3. What happens during the initial stage of shock? -- Answer โœ”โœ” Decreased CO, decreased perfusion, cells switch to anaerobic metabolism, leads to increased lactic acid (metabolic acidosis)
  4. True or False: During the initial stage of shock, changes are difficult to detect as changes are primarily at the cellular level. -- Answer โœ”โœ” True
  5. What happens during the compensatory stage of shock? -- Answer โœ”โœ” Increased HR, increased RR, increased glycolysis, decreased urine output, decreased blood flow to the liver/kidneys, decreased peristalsis, cool skin, diaphoresis (the body is trying to increase cardiac output to restore tissue perfusion and improve oxygenation)
  6. What happens during the progressive stage of shock? -- Answer โœ”โœ” Compensatory mechanisms cannot restore hemostasis, major dysfunction of many organs (mechanisms begin to fail)
  7. What happens during the refractory stage of shock? -- Answer โœ”โœ” Death is inevitable, profound hypotension, unresponsive to treatment
  8. How will vital signs change in shock? -- Answer โœ”โœ” Tachycardia, tachypnea, hypoxia
  9. What will ABGs show during shock? -- Answer โœ”โœ” PH will decrease, PaO2 will decrease, PaCo2 will increase
  1. What are the types of shock? -- Answer โœ”โœ” Cardiogenic, hypovolemic, obstructive, distributive
  2. What is cardiogenic shock? -- Answer โœ”โœ” Pump failure due to direct cardiac cause
  3. What can cause cardiogenic shock? -- Answer โœ”โœ” MI, CHF, cardiomyopathy, dysrhythmias, and valvular stenosis or rupture
  4. What are the clinical manifestations of cardiogenic shock? -- Answer โœ”โœ” Increased CVP, increased SVR, hypotension, tachycardia, delayed cap refill, cool/mottled extremities, JVD, dyspnea and crackles if pulmonary edema is present, altered mental status, oliguria, concentrated urine.
  5. What is Beck's Triad? -- Answer โœ”โœ” JVD, muffled heart sounds, and hypotension. Indicates cardiac tamponade.
  6. What is pulsus paradoxus? -- Answer โœ”โœ” Drop in BP during inhalation due to the right and left sides of the heart competing for limited space.
  7. What is an intra-aortic balloon pump (IABP)? -- Answer โœ”โœ” A balloon placed in the aorta that shrinks and pulls blood forward from a vaccuum effect during systole, and inflates during diastole to cause retroflow into the coronary arteries and increase coronary circulation.
  8. What is the purpose of an intra-aortic balloon bump (IABP)? -- Answer โœ”โœ” Support the function of the failing heart without increasing the metabolic demand on the myocardial tissue.
  9. What is an impella? -- Answer โœ”โœ” A pump with a propeller that is placed via a catheter into the left ventricle and pulls blood into the aorta. Helps increase CO & coronary artery perfusion.
  1. What are the primary interventions when a patient is in hypovolemic shock secondary to blood loss? -- Answer โœ”โœ” Tourniquet or direct pressure! IV access/get pt ready for surgery ASAP
  2. What is obstructive shock? -- Answer โœ”โœ” impairment of the heart to pump effectively as a result of a noncardiac factor
  3. What can cause obstructive shock? -- Answer โœ”โœ” Blockage of great vessels, pulmonary artery stenosis, pulmonary embolism, cardiac tamponade, tension pneumothorax, aortic dissection
  4. What are the clinical manifestations of obstructive shock? -- Answer โœ”โœ” Hypotension, pulsus paradoxus, tachycardia, muffled heart tones (d/2 cardiac tamponade), reduced capillary refill, tachypnea
  5. How is obstructive shock managed? -- Answer โœ”โœ” Remove the obstruction as quickly as possible.
  6. What is the treatment for cardiac tamponade? -- Answer โœ”โœ” pericardiocentesis - puncturing the pericardial sac to aspirate the excess fluid
  7. What is the treatment for a tension pneumothorax? -- Answer โœ”โœ” needle decompression or chest tube
  8. What are the types of distributive shock? -- Answer โœ”โœ” neurogenic, anaphylactic, septic
  9. What is neurogenic shock? -- Answer โœ”โœ” Loss of sympathetic tone causing massive vasodilation and increased capillary permeability
  1. What are the causes of neurogenic shock? -- Answer โœ”โœ” Head trauma, spinal cord injury, epidural anesthesia
  2. What are the clinical manifestations of neurogenic shock? -- Answer โœ”โœ” Hypotension without compensatory tachycardia, bradycardia, warm and dry skin, flaccid paralysis below the level of the injury
  3. What is the management for neurogenic shock? -- Answer โœ”โœ” Maintain spinal immobilization, administer crystalloids, maintain SBP over 90, administer vasopressors or norepinephrine, administer dopamine
  4. How will dopamine help treat neurogenic shock? -- Answer โœ”โœ” Increase HR and contractility
  5. What is anaphylactic shock? -- Answer โœ”โœ” Allergen exposure results in an antigen- antibody reaction causing massive vasodilation.
  6. What are common triggers for anaphylactic shock? -- Answer โœ”โœ” Antibiotics, latex, bee stings, foods (peanuts, shellfish)
  7. What are the clinical manifestations of anaphylactic shock? -- Answer โœ”โœ” System vasodilation, increased capillary permeability, generalized erythema, bronchoconstriction, wheezing, stridor, coronary vasoconstriction, urticaria, itching, anxiety, restlessness
  8. What is the treatment for anaphylactic shock? -- Answer โœ”โœ” Removal of causing antigen, for a mild reaction the treatment is oxygen and antihistamine. If there is airway or circulation involvement the treatment is epinephrine, IV fluids, corticosteroids, bronchodilators, vasoconstrictors, inotropes
  1. According to the sepsis bundle, within 1 HOUR of presenting symptoms you must: -- Answer โœ”โœ” Draw lactate, obtain blood culture, administer broad-spectrum antibiotics, initiate fluid resuscitation.
  2. If the initial measures of the sepsis bundle are insufficient to support return of perfusion, you must next administer: -- Answer โœ”โœ” Vasopressors, additional fluids, oxygen
  3. What do you want to maintain your mean arterial pressure at? -- Answer โœ”โœ” Greater than 65
  4. What is a normal lactate level? -- Answer โœ”โœ” <2 mmol/L
  5. What fluids should be used for fluid resuscitation for sepsis? -- Answer โœ”โœ” 30 mL/kg of crystalloids
  6. Examples of crystalloid fluids? -- Answer โœ”โœ” NS, LR
  7. The longer the lactate level is high, the higher the ____. -- Answer โœ”โœ” Morality
  8. Common causes of sepsis? -- Answer โœ”โœ” VAP, CAUTI, CLABSI, lack of hand hygiene, lack of assessments
  9. What is VAP? -- Answer โœ”โœ” ventilator associated pneumonia
  10. What is a CAUTI? -- Answer โœ”โœ” catheter associated urinary tract infection
  11. What is a CLABSI? -- Answer โœ”โœ” central line associated blood stream infection