Nur220 - Exam 2 - Shock & Acute Neurological Problems /ATI MEDSURG 2 NUR 265/ ER/SHOCK/ DISASTER DETAILED ANSWER KEY NEURO -SHOCK & BURNS PRACTICE EXAM What is shock? - ANSWER -Tissue perfusion inadequate to deliver nutrients and O2 to support vital organs and cellular function *lack of oxygen to tissues/cells* drop in oxygenated blood that gets to tissues What does shock result in? - ANSWER -Decrease in t he amount of oxygenated blood that is getting to cells/organs and failure in cardiovascular system What are the functions of the Cardiovascular system? - ANSWER -- Maintain homeostasis = regulate blood volume/pressure, transport nutrients and oxygen to res t of body and removes waste and CO2, maintains intact membranes - well functioning heart (pump is working correctly), -adequate blood volume - good vascular tone - good peripheral resistance to maintain blood pressure at an effective rate - to maintain car diac output - ensure all cells are getting oxygen Define homeostasis - ANSWER -Making sure we have enough blood supply, oxygenation going to cells and enough removal of waste products, such as CO2 out of the cells When it comes to homeostasis and shock, h ow will the body always respond? - ANSWER -The body will always respond to shock with compensatory mechanisms: how effective and duration of mechanism depends on many factors What are more functions of the cardiovascular (CV) system? - ANSWER -- Delivery ox ygen and nutrients to cells - remove waste products that result from cellular destruction - regulation of blood volume - constrict or dilate to regulate blood flow What does cardiac output measure? - ANSWER -indicates how well our tissues/cells are perfusing *blood pumped in L/min usually 4 -6 - blood pumping in 1 minute* What does Systemic Vascular Resistance (SVR) measure? - ANSWER -resistance to blood flowing out o f the ventricles - our blood pressure, blood flow to and from our tissues/organs - ability of blood vessels to dilate/constrict and regulate blood volume/pressure True or False: Duration and effectiveness of compensatory mechanisms depends on many factors - ANSWER -True What is the pathophysiology of Compensatory Mechanisms? - ANSWER -- Baroreceptors stimulate Catecholamine (flight or fight) response (sympathetic impulse) resulting in... - sympathetic nerve impulses that increase HR/RR & vasoconstriction bl ood vessels - Decreased renal perfusion leads to Renin/angiotensin/aldosterone syndrome causing... - Glucocorticoid release What do compensatory mechanisms attempt to prevent? How? - ANSWER -Deterioration of circulation by trying to return CO2 and arterial pressure to normal limits What triggers a Baroreceptor reflex? - ANSWER -Decrease in MAP (mean arterial pressure) How is MAP calculated? - ANSWER -2x the diastolic + systolic divided by 3 What is the goal range for MAP? - ANSWER -Greater than 60 - to main tain adequate organ perfusion When is the Catecholamine response triggered? - ANSWER -When BP drops and fight or flight occurs What happens when Catecholamine is triggered? - ANSWER -Epi and nor epi are release, which increases force and rate of cardiac contraction and results in increased RR, BP, selective vasoconstriction and decreased gastric motility Where does blood shunt fro m in the Catecholamine phase? - ANSWER -From the skin/kidneys/GI to brain/heart What occurs with Renin/angiotensin/aldosterone syndrome? - ANSWER -Holds onto blood volume, hold more fluid and this results in decreased urinary output *the body is trying to hold onto as much blood circulating volume as it can* What does decreased renal perfusion result in? - ANSWER -Results in decreased urine output and increase in sodium retention decreased urine output = early sign of shock, means pt is compensating (trying to return to normal) What does the activation of renin -angiotensin system result in? - ANSWER -Results in increased renal absorption of sodium and water Why are Glucocorticoid's released? - ANSWER -to increase availability of glucose for cellular metaboli sm (energy, to get energy to cells) What are glucocorticoids? - ANSWER -act as anti -inflammatory agents and reduce edema of the airways - control metabolism in muscle, fat, liver and bone ex.) corticosteroids (steroids) When may we see an increase in gluc ose levels? - ANSWER -in the early stages of shock After falling from a 10 foot ladder, a patient is brought to the ED. Alert, c/o back pain and difficulty moving LEs. Which observation indicates the patient may be experiencing neurogenic shock? A. Cool p ale skin B. Decreased systolic BP C. Tachycardia D. Bradycardia - ANSWER -D. Bradycardia Neurogenic shock is the only type that causes bradycardia because of the interruption in sympathetic response. Strategy: question is asking you to select the sign which specifically points you to neurogenic, vs other types of shock. Pt admitted after MVA with abdominal injuries and a fractured femur. VS: T98, P130, RR34, BP50/40. You suspect what type of shock?
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