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NURS 425 Final Exam Sepsis, Shock, SIRS, MODS fully solved & verified for accuracy.
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NURS 425 Final Exam Sepsis, Shock, SIRS, MODS fully solved & verified for accuracy.
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NURS 425 Final Exam:Sepsis, Shock, SIRS, MODS
fully solved & verified for
accuracy
What is hypovolemic shock? - answer a shoc What is hypovolemic
shock? - answer a shock state that results from inadequate
circulating volume in the intravascular space
What are the risk factors for hypovolemic shock? - answer
excessive fluid loss, which can occur with: diuresis, GI losses, blood
loss, burns, DKA
What population is at higher risk for hypovolemic shock? - answer
older adults, because of decreased fluid intake and medications that
cause dehydration (they do not have as much reserve)
Explain the pathophysiology of hypovolemic shock. - answer when
there is less volume, a person will not perfuse as well. SV decreases
which decreases CO. MAP begins to decrease and this results in a
decrease in oxygen delivery to the tissues. then, the switch from
aerobic to anaerobic metabolism begins. lactic acid builds up and
necrosis begins as vasoconstriction and tachycardia occur to
compensate. as things progress, the compensation starts to fail.
What are the subjective manifestations of hypovolemic shock? -
answer lethargy, confusion/altered LOC, dizziness, somnolence,
restlessness, anxiety, dyspnea, thirst, weakness, nausea,
constipation
,What are the objective manifestations of hypovolemic shock? -
answer hypoxia, hemorrhage, tachypnea, cool/mottled skin,
hypotension, tachycardia, weak/thready pulse, decreased CO,
decreased MAP, decreased CVP, decreased UOP
Explain what lab values are expected for a patient in hypovolemic
shock. - answer ABGs will show metabolic acidosis. lactate will be
high. electrolytes will be high because the patient is losing volume,
but not losing electrolytes. renal labs will be elevated because the
kidneys are being hypoperfused. for CBC, if the patient is
dehydrated, we would see a high H&H because the patient would be
hemoconcentrated. if the patient is hemorrhaging, H&H would be
low. the specific gravity will likely be elevated because urine is
concentrated as the patient will be holding onto fluids.
What are the pharmacological treatments for a patient in
hypovolemic shock? - answer replacement of volume is crucial,
fluids are the treatment of choice. if a patient is hemorrhaging,
would give blood products. must be careful with vasopressors
because of the vasoconstriction that is already occurring. if the
patient is acidotic, give bicarbonate. if the patient is hyperglycemic,
give insulin. should also increase oxygen availability.
Explain the nursing care of a patient who is in hypovolemic shock. -
answer look for trends in labs and VS and report to the provider.
plan and implement nursing interventions like fluids, blood, and
oxygen. monitor pt. VS, they will be on a cardiac monitor and
possible arterial line. evaluate intervention effectiveness.
communicate with interprofessional team.
What is cardiogenic shock? - answer dysfunction of the heart's
pumping action resulting in decreased CO, SV, and BP; the issue is
that the heart is not efficient enough to perfuse everything
What are the risk factors for cardiogenic shock? - answer
cardiomyopathy, dysrhythmias, valvular stenosis or regurgitation,
prior MI, severe heart failure, and myocardial ischemia
, Explain the pathophysiology of cardiogenic shock. - answer
something has happened to the heart to make it too weak for it to
be able to perfuse. SV will be decreased because the heart/the left
ventricle is now severely weakened and cannot put the volume out.
because of this, we will have hypoperfusion to tissues and the
switch from aerobic to anaerobic metabolism.
What are the subjective manifestations of cardiogenic shock? -
answer chest pain, diaphoresis, dyspnea, altered LOC, anxiety
What are the objective manifestations of cardiogenic shock? -
answer cool/mottled skin, crackles, tachycardia, hypotension,
decreased CO, decreased MAP, increased CVP, decreased UOP
What will a patient with cardiogenic shock look like? - answer this
patient will be fluid overloaded; they will have edema, crackles, and
jugular vein distention
Explain what lab values are expected for a patient in cardiogenic
shock. - answer cardiac enzymes are expected to be elevated.
ABGs will show metabolic acidosis. lactate will be high. electrolytes
will be low because the patient will be fluid volume overloaded and
therefore everything will be hemodiluted. BNP will be elevated
because the patient is fluid volume overloaded. specific gravity is
expected to be elevated as the patient will be very concentrated
because their urine output will be low.
What pharmacological treatments can be used for a patient in
cardiogenic shock? - answer positive inotropic agents, such as
dobutamine and dopamine, cause the heart to beat stronger and
more efficiently, therefore increasing SV and MAP and perfusion to
tissues. vasodilators, such as nitroglycerine, will increase the
perfusion to the heart and make the heart more efficient. diuretics,
such as furosemide, will reduce fluid load and decrease the pressure
on the heart, making the heart more efficient.
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