Exam 2- Med Surg Blueprint Questions with correct
answers
What is shock? Correct Answer.-A life-threatening conditions where body
is not getting enough flow which causes poor tissue perfusion and organ
system failure
Shock= Hypoperfusion!
What are the stages of shock? Correct Answer.-Initial/early
-Anxiety, restless, hypoxia, rapid pulse, BP is normal, MAP of
10mmHg, cool/clammy skin, normal skin color, increase rate and depth
of breath
Compensatory
-Body works well because its trying to compensate
-Notice a decrease in urine output because blood to organs like kidneys
stops to get to oragsnt hat need it like heart, lungs, brain
Progressive
-When comp. mechanisms fail
-Profound hypotension, weak and rapid pulse, confusion, AMS
-THE BIGGEST CHANGE IS IN NEURO
Refractory
,-Cell death and MSOF, Full shock
Overall assessment of generalized shock Correct Answer.-Process:
Move close to nurses station, put on monitor, get IV access, full
cardiac/respiratory exam, get lab work, give treatment
CNS: Restless, confusion, irritable
CV: VITALS every 15 min!!! Put on monitor!
-Measure BP to see fluid status, narrow pulse pressure less than 20 is
bad, will see tachycardia first then brady, pt may appear cool, pale,
modeled (modeled= no blood to extremities so become purple & veiny,
these pts often code or die)
-In worse stages of shock, fluids cant fix
Respiratory: Need ABGs, fix with oxygen, tachy at first
-Give NC first, if breathing doesn't improve give rebreather mask
Renal: Oliguria or anuria
-ENSURE pt is urinating
GI: N/V, hypoactive bowels
Labs for Shock Correct Answer.-Lactate Acid
,-Tests for tissue hypo perfusion when muscles start dying
ABG/VBG
CBC, BMP, INR
-CBC for hemoglobin, BMP for electrolyte, INR for clotting
Liver profile- BUN, Cr
-Liver is very vascular
Blood cultures
-Not always, wouldn't in neuro shock
Hypovolemic Shock Correct Answer.-Loss of fluids/blood which
decreases tissue perfusion
Early s/s: Normal BP, High HR, restless, confused, cool/clammy,
hyperglycemia
Late s/s: non-manageable BP, lethargy, hypotension, acidosis
Assessment: Full cardiac and respiratory, renal
Dx: Ct scan or ultrasound
, Management:
-Oxygenate first!
-Replace fluids (4L isotonic NS/LR) ASAP
-Treat the cause (antiemetics)
-Vasopressors as last resort
Obstructive shock Correct Answer.-Obstruction of bf blocks pump
causing poor perfusion of tissue/organs
-Ex: Pulmonary embolism (Blood clot in arteries to lungs) or cardiac
tamponade (Fluid in sac of heart)
S/S: Depends on the cause, but general like poor pulses, cool skin, SOB,
N/V, lethargy
-In PE: Chest pain, SOB
-In CT: Muffled heart sounds, JVD, hypotension
Assessment: CV and respiratory
Management
-Oxygenation
-Fix the cause!!!
(If PE give heparin, if CT tap heart with paracentesis)
-Vasopressors last
answers
What is shock? Correct Answer.-A life-threatening conditions where body
is not getting enough flow which causes poor tissue perfusion and organ
system failure
Shock= Hypoperfusion!
What are the stages of shock? Correct Answer.-Initial/early
-Anxiety, restless, hypoxia, rapid pulse, BP is normal, MAP of
10mmHg, cool/clammy skin, normal skin color, increase rate and depth
of breath
Compensatory
-Body works well because its trying to compensate
-Notice a decrease in urine output because blood to organs like kidneys
stops to get to oragsnt hat need it like heart, lungs, brain
Progressive
-When comp. mechanisms fail
-Profound hypotension, weak and rapid pulse, confusion, AMS
-THE BIGGEST CHANGE IS IN NEURO
Refractory
,-Cell death and MSOF, Full shock
Overall assessment of generalized shock Correct Answer.-Process:
Move close to nurses station, put on monitor, get IV access, full
cardiac/respiratory exam, get lab work, give treatment
CNS: Restless, confusion, irritable
CV: VITALS every 15 min!!! Put on monitor!
-Measure BP to see fluid status, narrow pulse pressure less than 20 is
bad, will see tachycardia first then brady, pt may appear cool, pale,
modeled (modeled= no blood to extremities so become purple & veiny,
these pts often code or die)
-In worse stages of shock, fluids cant fix
Respiratory: Need ABGs, fix with oxygen, tachy at first
-Give NC first, if breathing doesn't improve give rebreather mask
Renal: Oliguria or anuria
-ENSURE pt is urinating
GI: N/V, hypoactive bowels
Labs for Shock Correct Answer.-Lactate Acid
,-Tests for tissue hypo perfusion when muscles start dying
ABG/VBG
CBC, BMP, INR
-CBC for hemoglobin, BMP for electrolyte, INR for clotting
Liver profile- BUN, Cr
-Liver is very vascular
Blood cultures
-Not always, wouldn't in neuro shock
Hypovolemic Shock Correct Answer.-Loss of fluids/blood which
decreases tissue perfusion
Early s/s: Normal BP, High HR, restless, confused, cool/clammy,
hyperglycemia
Late s/s: non-manageable BP, lethargy, hypotension, acidosis
Assessment: Full cardiac and respiratory, renal
Dx: Ct scan or ultrasound
, Management:
-Oxygenate first!
-Replace fluids (4L isotonic NS/LR) ASAP
-Treat the cause (antiemetics)
-Vasopressors as last resort
Obstructive shock Correct Answer.-Obstruction of bf blocks pump
causing poor perfusion of tissue/organs
-Ex: Pulmonary embolism (Blood clot in arteries to lungs) or cardiac
tamponade (Fluid in sac of heart)
S/S: Depends on the cause, but general like poor pulses, cool skin, SOB,
N/V, lethargy
-In PE: Chest pain, SOB
-In CT: Muffled heart sounds, JVD, hypotension
Assessment: CV and respiratory
Management
-Oxygenation
-Fix the cause!!!
(If PE give heparin, if CT tap heart with paracentesis)
-Vasopressors last
