426 Complex Nursing Test 2 (Shock & MODS) Questions and Correct Answers
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Course
NUR 426
Institution
NUR 426
Shock Life-threatening condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support cellular function -Imbalance in supply and demand for O2 and nutrients -Affects all body systems -May develop rapidly or slowly
What are three things good CO should have? Effective p...
426 Complex Nursing Test 2 (Shock &
MODS) Questions and Correct Answers
Shock ✅Life-threatening condition in which tissue perfusion is inadequate to deliver
oxygen and nutrients to support cellular function
-Imbalance in supply and demand for O2 and nutrients
-Affects all body systems
-May develop rapidly or slowly
What are three things good CO should have? ✅Effective pump, adequate vasculature,
sufficient blood volume
What is the normal level of CO? ✅4-8 L/min
Equation for CO: ✅CO = SV x HR
SV is composed of...: ✅-preload
-afterload
-contractility
Cardiacs index equation: ✅Cardiac Index (CI) = CO / BSA
*body surface area
Normal Cardiacs Index (CI) is ✅2.2 - 4 L/min/m (squared)
Strove Volume is ✅How much blood you eject in a single beat
Preload ✅deals w/ management of your blood volume
Afterload ✅Reflects adequate vasculature
-how much work it takes to eject blood out of the aorta
-also looks at systemic vascular resistance
What is the normal level of Central Venous Pressure (CVP)? ✅4 - 12
Central Venous Pressure (CVP) ✅-measures the volume or pressure on the right
atrium
-the lower your CVP, the lower the volume
-the higher the CVP, the more volume of blood you have pushing on the aortic wall
causing a higher pressure reading
-CVP really gives you information about the right side
,What is the normal level for Peripheral Arterial Wedge Pressure (PAWP)? ✅6 - 12
Peripheral Arterial Wedge Pressure (PAWP) ✅-when the balloon at the tip of the
catheter is inflated its reading
-the wedge pressure is reading the volume status of the left atrial pressure
-helps in differentiating different types of problems: if elevated then too much
volume/fluid overload in left ventricle so it might be possible cariogenic shock
-too low a PAWP means you will need more fluid
PA pressure will be elevates w/ a___________ problem. ✅pulmonary
What are the normal pressure ranges for a PA pressure? ✅Normal systolic: 20-30
mmHg
Normal diastolic: 8-15 mmHg
SvO2 or ScvO2 Monitoring: ✅-Normal: 60-80%
-normal levels indicate a normal O2 supply and demand
-this looks at cardiac output and tissue status
You can draw from a ___________________ and get a BVG (blood draw). ✅central
line
Deeper into SvO2 (mixed venous O2): ✅-Normally utilize 25-30% of oxygen in arterial
blood to supply the needs of all organ (aka 25-30% is the normal amount of oxygen the
organs extract from the oxygenated blood)
-If ScvO2 is low, Cardiac output is not high enough to meet tissue oxygen needs
-low SvO2--> low CO---> heart isn't pumping as it should
-if the number is already low, the organs extract more oxygen bc they're oxygen hungry
, and then the blood that goes back to the atria is even lower meaning the SvO2 will be
low low
What are the STAGES OF SHOCK? ✅1) Compensatory Stage
2) Progressive Stage
3) Refractory Stage
Compensatory Stage
(1st Stage / Early stage) ✅*Blood flow directed to most essential organs*;
Your body is trying to keep your BP normal and everything else in normal parameters
Clinical Manifestations:
-Neuro: Confusion or agitation (act differently, subtle things you can detect)
-CV: HR > 100, ↑ contractility
-Narrowed pulse pressure
-MAP (should be greater than 65), *BP is normal* (systolic should not be less than 90),
and SVo2 will be decreased
, -Pulm: RR > 22, PaCO2 < 32 with respiratory alkalosis (hyperventilating and blowing off
too much CO2)
Blood is shunted away from organs below
-GI: decreased flow, risk of ileus (absent bowel sounds)
-Renal: decreased flow activates RAAS, decreased U/O
-Skin- cool and clammy *(septic - warm/flushed)*
-Lactic acid slightly elevated (aerobic metabolism —> produces lactate—> lactate
accumulates and can result in lactic acidosis)
Progressive Stage of Shock overview ✅Compensatory mechanisms start to fail
-All organs suffer from hypoperfusion
-Vasoconstriction continues further compromising cellular perfusion
-Anaerobic metabolism ensues
-Chances of survival depend on patients' general health before shock state and time to
restore tissue perfusion
(deeper look in) Progressive Stage of Shock- Compensatory Mechanisms Fail
✅*Ischemia to all organs with increased capillary permeability*
-Neuro: decreased responsiveness/lethargy
-CV: HR > 150, ↓ pedal pulses, prolonged cap refill, ↓ coronary perfusion, dysrhythmias,
Systolic BP < 90, MAP < 65, SvO2 < 60%
-****Pulm*: rapid shallow respirations, crackles,
PaO2 < 80, PaCO2 > 45 (Now there's an elevation in CO2 and a drop in O2 —>
hypoxia & respiratory acidosis), respiratory acidosis, atelectasis and decreased
surfactant
-Renal: AKI, decreased U/O (Less than 0.5 mL/kg/hour), ↑ BUN/Creat.
-GI - risk of bleed
-Hepatic - ↑ Lactate, NH3, ↑ enzymes, metabolic acidosis
-Hematologic - Petechiae (Bruising occurs bc the liver makes clotting factors and its not
working correctly)
-Temperature: cool
-Skin - mottled, anasarca
Refractory/Irreversible Stage ✅*In spite of active therapy - shock continues*
*Multiple Organ Dysfunction Syndrome*
-Neuro: unresponsive
-CV: requires pharmacologic or mechanical support
-Pulm - requires ventilator - ARDS
-GI - Ischemic gut
-Renal - anuria (not making urine at all), ATN requiring dialysis
-Hepatic - profound acidosis
-Hematologic - DIC
-Temp - hypothermia
-Skin - jaundiced
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