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Shock, Sepsis, and Burn Management: Questions and Answers for Nursing Students, Exams of Nursing

A comprehensive q&a format covering key aspects of shock, sepsis, and burn management. it details various types of shock, their clinical manifestations, and management strategies. furthermore, it explores sepsis pathophysiology, clinical features, and treatment approaches, including the use of parkland's formula for fluid resuscitation in burn patients. The document also includes questions on the timing of organ failure in sepsis and the management of smoke inhalation.

Typology: Exams

2024/2025

Available from 04/19/2025

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NURS3101 Exam With Complete Solutions
Shock - ANSWER Inadequate delivery of O2 to cells
Patho of shock - ANSWER - Hypotension
- Circulatory failure
- Insufficient tissue perfusion
Compensatory Shock - ANSWER Early stage of shock
- Agitated
- Tachycardic
- Tachypnoea
- Vasoconstriction
- Oliguria <400mL U.O.
- Increased BGL
Progressive Shock - ANSWER Compensatory mechanisms begin failing to meet tissue
metabolic needs. S & S:
- Low LOC
- Tachyponea
- SOB
- Tachycardic
- Anuria
- Cold peripheries
- Low MAP
Refractory Shock - ANSWER Unresponsive to therapy as too much cell death
S&S:
- Unconscious
- Anuria
- Kidney failure
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NURS3101 Exam With Complete Solutions

Shock - ANSWER Inadequate delivery of O2 to cells Patho of shock - ANSWER - Hypotension

  • Circulatory failure
  • Insufficient tissue perfusion Compensatory Shock - ANSWER Early stage of shock
  • Agitated
  • Tachycardic
  • Tachypnoea
  • Vasoconstriction
  • Oliguria <400mL U.O.
  • Increased BGL Progressive Shock - ANSWER Compensatory mechanisms begin failing to meet tissue metabolic needs. S & S:
  • Low LOC
  • Tachyponea
  • SOB
  • Tachycardic
  • Anuria
  • Cold peripheries
  • Low MAP Refractory Shock - ANSWER Unresponsive to therapy as too much cell death S&S:
  • Unconscious
  • Anuria
  • Kidney failure
  • No Map > Hypovolemic Shock - ANSWER Severe blood & fluid loss. Caused by vomitting, diarrhoea and bleeding Cardiogenic Shock - ANSWER Pump failure due to decreased O2, less blood. Causes
  • MI -CHF
  • Coronary heart disease (CAD) Distributive shock - ANSWER Peripheral vessels get weak and leak into the tissues. E.G sepsis, anaphylatic & neurogenic shock Obstructive shock - ANSWER Impaired filling and or out flow of the heart due to the obstruction of the heart itself Clinical Manifestations of Hypovolemic Shock - ANSWER - Increased HR & PVR
  • Cool, pale and clammy
  • No oedema
  • JVP not raised Clinical Manifestations of Cardiogenic/Obstructive Shock - ANSWER - Rapid HR
  • Increased PVR
  • Cool and clammy
  • Increased JVP
  • Pulmonary oedema Clinical Manifestations of Distributive Shock - ANSWER - Increased HR
  • Decreased PVR
  • Flushed
  • JVP not raised
  • Decreased HR in neurogenic Potential Complications of Shock - ANSWER - Kidney failure
  • Respiratory failure

heart pump the blood

  1. Antibiotics: treat infections. E.g Vancomycin
  2. Urine output: circulates volume and renal function (Normal 0.5mL/kg/hr)
  3. Lactate measurement: progression of treatment. Lactate acidosis results from a deficit in tissue o2 availability
  4. ABG: to detect the bloodstream pathogens Multiple Organ Dysfunction Syndrome (MODS) - ANSWER 1. Continued auto amplifying massive inflammatory response
  5. Tissue hypoperfusion
  6. O2 supply/demand imbalance
  7. End organ dysfunction disseminated itravascular coagulation (DIC) - ANSWER serious condition that arises as a complication of another disorder, in which widespread, unrestricted microvascular blood clotting occurs; primary symptom is hemorrhage Lactate - ANSWER - Produced in excess by muscle cells, RBC's, brain & other tissues when there is sufficient o
  • Primary way of producing energy in the body's cells is disrupted When does the respiratory system start to fail - ANSWER 1-3 days When does the liver start to fail - ANSWER 5-7 days

When does the GIT system start to fail? - ANSWER 10-15 days

When do the kidneys begin to fail? - ANSWER 11-17 days

Sepsis patho - ANSWER Ineffective material that enters systemic circulation leading to decreased tissue perfusion and o2 from WBC's

Characteristics of burns - ANSWER Injury resulting from exposure to heat, chemicals, radiation, cold injuries and electric current

Thermal burns - ANSWER Exposure to dry heat (flames) or moist heat (steam or hot liquids)

Chemical burns - ANSWER Direct skin contact with acids, alkaline agents, toxic compounds

Electrical burns - ANSWER Contact with an electric current lower than <1000v or >

Radiation burns - ANSWER Mediated by energy transferrence

Cold burns - ANSWER Decreased blood flow causes tissue necrosis

Patho of burns - ANSWER Inflammatory reaction leading to rapid oedema formation due to increased microvascular permeability, vasodilation & increased extravascular osmotic activity. Earliest stage of vasodilation and increased venous permeability is due to histamine release

Parkland's formula - ANSWER 3ml Hartmann's x body weight x %TBSA

  • 1/2 given in first 8hrs
  • 1/2 given in the next 16hrs

Rule of Nine's - ANSWER - Arms, head and neck = 9% each

  • Legs, front of torso & back of torso = 18%
  • Perineum & palms = 1% each

Airway management of burns - ANSWER Maintain patent airway. Inspect for foreign material. Insert guedel if compromised

Breathing management of burns - ANSWER Administer 100% o2. Expose chest for bilateral and adequate chest movement. Consider CO2 poisoning

  • Hypothermia
  • Permanent scarring
  • Breathing problems (smoke inhalation)

Background pain - ANSWER Constant burning or throbbing sensation. Treat with NSAID's & paracetamol or PCA w/ morphine

Breakthrough pain - ANSWER Sudden increase in pain. Treat with ket, morphine, fetanyl or IV opioid

Procedural pain - ANSWER Prior to commencing a procedure

Epidermal burns - ANSWER Dry, red blances w/ pressure, no blisters. Heals with no scarring

Superficial dermal - ANSWER Pale pink, extremely painful, low risk of scarring

Mid-dermal - ANSWER Dark pink, large blisters, cap refill sluggish. Painful, Mod risk of scarring

Deep-dermal - ANSWER Blotchy red, may blister, no cap refill, increased risk of scarrin

Full-thick burn - ANSWER No blisters, no cap refill. Will scar

Smoke Inhalation - ANSWER Airway or pulmonary injury resulting from the inhalation of toxic products

Patho of smoke inhalation - ANSWER Thermal injury, chemical irritation of the respiratory tract, systemic toxicity due to CO and cyanide = inflammatory response = increased fluid resus volumes, progressive pulmonary dysfunction, prolonged ventilator

days, risk of pneumonia and acute respiratory syndrome

Risk factors for smoke inhalation - ANSWER - Being in an enclosed space for more than 5 minutes

  • Experiencing prolonged exposure (bushfire)
  • Asthma
  • Young children
  • Elderly

V:Q mismatch - ANSWER An imbalance in the amount of oxygen received in the alveoli and the amount of blood flowing through the alveolar capillaries

Intubation - ANSWER insertion of a tube into the trachea

Mechanical ventilator - ANSWER a machine used to inflate and deflate the lungs when a person cannot breathe on his own

carbon monoxide poisoning - ANSWER a toxic condition that results from inhaling and absorbing carbon monoxide gas. CO molecules with replace the O

Symptoms of smoke inhalation - ANSWER - Increased RR, worsening hypoxia

  • Headache, coma, dec. LOC, vision loss
  • Increased HR, C.O. Cardiac failure, arrhythmia, chest pain

Airway management of S.I - ANSWER Maintain patent airway. Look for airway obstructions and listen for upper airway noises. Use a guedel airway to open the airway and remove secretions

Breathing management of S.I. - ANSWER Listen for rapid breathing, shallow breaths, wheezing. Administer 100% O2 via a NRBM

Unintelligble sounds

Motor (GCS) - ANSWER Obeys= Localizing pain= Withdrawal form pain= Flexion to pain= Extension to pain= None=

Cerebral Perfusion Pressure (CPP) - ANSWER MAP-ICP

intra cranial pressure - ANSWER 0-15 mmHg. Growing pressure inside the skull

Taking a hx (neuro assessment) - ANSWER - MOI

  • Injury sustained
  • S&S
  • Treatment provided

Subjective data (Neuro assess) - ANSWER - When it occured?

  • Headache?
  • Sensation?

Objective data (Neuro assess) - ANSWER - Memory

  • Gait
  • Tremors
  • Speech

Vital Signs (Neuro assessment) - ANSWER - BGL <10mmOL (brain perfusion requires normal BGL level)

  • BP (widening pulse pressure = cushings triad)
  • T <37.5 (prevent fever)
  • HR (bradycardia)
  • RR (irregular breathing - pressure on brain stem)

Assess LOC (neuro assessment) - ANSWER GCS, AVPU

Cushing's triad - ANSWER -Increase in systolic BP -Increase in pulse pressure (systolic and diastolic numbers get further apart) -Decrease in HR -Late sign -Seen with increased ICP -Adverse effect of prednisone

  • Irregular respirations

Compensating for raised ICP (Stage 1) - ANSWER Cerebral arteriole autoregulation (vasoconstriction)

Compensating for raised ICP (Stage 2) - ANSWER Monroe-Kellie Doctrine

Monroe-Kellie Doctrine - ANSWER when one content in the skull increases, another must decrease to compensate and maintain normal ICP

Clincal manifestations of ICP - ANSWER - Change in LOC, behavioural changes

  • Headache, nausea & vomitting
  • Pressure increases when you cough or sneeze
  • IDC: understand input and output

Impaired cerebral perfsuion pressure - ANSWER -CT scan

  • Check pupillary response every 5 minutes
  • GCS every hour

Hypothermic related to drowning - ANSWER - Remove wet clothes

  • Warm blankets
  • Increase 1 degree per hour (vessels will dilate quickly if increased too much)`

Acute Spinal Injury - ANSWER Degenerative loss of motor, sensory and autonomic function

Spinal Cord A&P - ANSWER - 31 pairs of spinal (8C, 12T, 5L, 5S, 1C)

  • Sensory/afferent via dorsal root, motor/efferent via ventral root
  • Grey matter (cell body) vs white matter (myelinated axons)
  • Meninges

Classification of a SCI - ANSWER - Vertebral level of injury

  • Degree - complete/incomplete
  • Overall severity - considers level, degree & mechanism

A (Impairment scale) - ANSWER Complete. Non-sensory or motor function is preserved in the sacral segments s4-

B (Impairment scale) - ANSWER Sensory incomplete. Sensory but no motor function is preserved below the neurological level

C (impairment scale) - ANSWER Motor incomplete. Motor function is preserved @ most caudal sacral segments (anal contraction)

D (impairment scale) - ANSWER Motor incomplete. 1/2 of key muscle functions below the lesion having muscle functions >

E (impairment scale) - ANSWER Normal

Functions affected by SCI - ANSWER Reflexes, ventilation, communication, autonomic control, sensorimotor function, skin integrity, bladder/bowel control and sexual function

Can the SC regenerate? - ANSWER No, neurons cannot undergo mitotic division to replace/renew themselves. Some capacity for axonal regrowth in PNS, some in CNS, but much slower and more inefficient

Primary SCI - ANSWER Irreversible damage sustained @ the time of injury. (Direct trauma, compression)

Secondary SCI - ANSWER Evolving injury vascular dysfunction and spreading wave of inflammation = ischemia & oedema

Spinal Shock - ANSWER Transient concussion of SC. "Physiological" rather than anatomical dysfunction. It lasts hours-weeks. Absence of all sensorimotor, autonomic and reflex neurologic activity below level of injury

Neurogenic shocK - ANSWER Haemodynamic changes resulting from a loss of autonomic tone due to SCI. Seen when SCI is above T

Autonomic Dysreflexia - ANSWER - SCI @T6 or above

  • Imbalance of the autonomic NS
  • Initiated @ the bladder

Pathologic Fracture - ANSWER A break in the bone that is caused by a disease. E.G osteoporosis or cancer

Longitudinal Fracture - ANSWER Occurs parallel to the long axis of the bone. E.G. direct or high impact injury or stress overuse

Spiral Fracture - ANSWER Twisted shaped break that extends around the long axis of the bone. MOI: football injury

Greenstick Fracture - ANSWER One side of the bone is broken, while the other side remains intact. MOI: falling from a height

Simple Fracture - ANSWER The broken bone does not break through the skin

Compound Fracture - ANSWER Broken bone breaks through to the skin. MOI: significant trauma

Oblique Fracture - ANSWER Diagonal or angle break across the bone. MOI: twisting forces

comminuted fracture - ANSWER Bone breaking into 3 or more fragments

Transverse fracture - ANSWER Bone breaks into 2 separate fragments

The healing process - ANSWER 1. Fracture

  1. Hematoma
  2. Osteoclasts
  3. Angiogenesis
  4. Osteoblasts
  1. Soft Callous
  2. Bony (hard)
  3. Callous
  4. Reunion/remodelling

Priority managements of open and closed fractures - ANSWER - Splinting: Align the bone and improve blood flow

  • Stop the bleeding with a torniquet or possible manual pressure with a pad
  • Cover with sterile dressing soaked in saline
  • Immunisation - tetanus
  • Saline irrigation
  • Antibiotics asap <3hrs
  • <8hrs to surgery for a better functional outcome - debridement and wound closure

Early complications of fractures - ANSWER - Arterial injury

  • Nerve injury
  • Compartment syndrome
  • DVT
  • Fat embolism

Late complications of fractures - ANSWER - Osteomyelitis (infection in the bone)

  • Stiffness
  • PTSD
  • Arthritis

Compartment syndrome - ANSWER High pressure built up in a group of muscles

  • Listen
  • Colour and cap refill
  • Temp

6 P's of neurovascular assessment - ANSWER Pain Pulse Paralysis Pallor Paresthesia Pressure

Category 1 (Red) - ANSWER - Immediate

  • Life threatening conditions
  • Cardiac arrrest, <10 RR or GCS <

Category 2 (Orange) - ANSWER - 10 mins

  • Time sensitive treatment
  • Stridor, HR <50>150, sepsis

Category 3 (Green) - ANSWER - 30 mins

  • Potentially life threatening
  • Severe pain, mod blood loss, head injury with LOC

Category 4 (Blue) - ANSWER - 60 mins

  • Potentially serious
  • Mild haemorrhage or swollen joint

Category 5 (White) - ANSWER - 2hrs

  • Less urgent
  • Minimal pain
  • Abrasions
  • Lacerations

Mass Disaster Triage (MIMMS) - Command - ANSWER One service has control @ the scene

Safety (MIMMS) - ANSWER Self, scene, survivors

Communication (MIMMS) - ANSWER Early arrangements

Assessment (MIMMS) - ANSWER - Estimate the number and severity of the injured

  • Determines the initial health service response to the scene

Triage (MIMMS) - ANSWER - Casualties prioritised

  • Repeated @ every stage of evacuation chain

Treatment (MIMMS) - ANSWER Do the most for the most

Transport (MIMMS) - ANSWER - Ambulance

  • Commanders responsibility

Acute Behavioural Disturbance - ANSWER Abnormal physiology behaviour E.G. delirium