CCRN Multisystem Questions and Answers well Explained Latest 2024/2025 Update 100% Correct.

What patients should not receive NS for fluid replacement? - Hypernatremic Renal failure (R/t risk of hyperchloremic acidosis) What are the goals of fluid resuscitation for patients in shock? - MAP >65 CVP ~6 mmHg Urine output 0.5 ml/kg/hr Hgb >7 Symptoms of hypovolemic shock - Decreased BP Decreased cardiac output Tachycardia Increased SVR What are the 3 stages of shock? - 1. Compensatory 2. Progressive 3. Refractory/Irreversible Compensatory stage of shock - Shock symptoms start to set in, but blood pressure is MAINTAINED through the sympathetic nervous system response Symptoms of compensatory shock - Tachycardia Tachypnea Pale, cool skin AnxietyNORMAL BLOOD PRESSURE How is blood pressure maintained during the compensatory stage of shock? - The sympathetic nervous system is stimulated, causing diffuse vasoconstriction and increasing heart rate/contractility. This temporarily keeps blood pressure WDL. Progressive stage of shock - Hypotension starts to set in as sympathetic stimulation and compensatory mechanisms are not enough to maintain homeostasis. Refractory stage of shock - Shock that is unresponsive to interventions as multisystem organ failure starts to kick in Symptoms of Refractory shock - Organ failure (Kidney failure r/t tubular necrosis, encephalopathy, liver failure, etc...) End-stage hypotension 6 types of shock - Hypovolemic Septic Anaphylaxis Neurogenic (not on test) Obstructive Cardiogenic Treatment of hypovolemic shock - Fix the problem Replace blood/fluid as soon as possible (2 large bore IVs) Fluids should be warmed if the patient has received more that ___ ml in an hour - 2000What patients should not receive LR as fluid replacement? - Hyperkalemic patients (it contains potassium) Class 1 Hemorrhagic Shock - Blood loss of 750 ml or less Urine output is normal, HR is normal, patient may have no or only slight anxiety/ change in LOC Class II Hemorrhagic Shock - Blood loss of 750-1500 ml Heart rate >100, urine output is moderately low, patient is mildly anxious Class III Hemorrhagic Shock - Blood loss of mL Heart rate is >120, urine output is very low, patient is noticeably confused or anxious BP starts to drop Class IV Hemorrhagic Shock - Blood loss >2000 mL HR >140, patient is not making urine, is noticeably confused or lethargic, blood pressure is significantly decreased At what stage of hemorrhagic shock does blood pressure start to drop? - Stage III AT what stage of hemorrhagic shock do we start giving blood in addition to fluid replacement? - Stage III and IV How does hypothermia affect blood? - Platelet dysfunction, increased affinity of hemoglobin to O2What electrolyte abnormalities can occur with blood product administration? - Hypocalcemia Hypomagensemia Massive Transfusion - 10 or more units of PRBCs in 24 hours or 5 units in less than 3 hours What are some risks of blood transfusion? - Transfusion reaction TRALI Viral infection (Ex: Hep C) HYPOTHERMIA What is the trauma triad of death? - Hypothermia Acidosis Coagulopathy What is the impact of inadequate 2,3 DPG in banked blood? - Oxyhemoglobin dissociation curve shifts to the left, meaning hemoglobin holds on to oxygen SIRS (systemic inflammatory response syndrome) - SIRS is a general term for a systemic response to any kind of clinical insult (Ex: Sepsis, burns, trauma) SIRS criteria - Patient meets 2 or more of the following Temp <38 C or <36 C HR > 90 BPM Resp rate >20 or PaCO2 <32 mmHg WBC >12,000 or <4,000Sepsis - SIRS caused by a documented infection. Qualifying criteria is meeting SIRS criteria PLUS having a known infection, positive culture, pulmonary infiltrates etc... Severe Sepsis - Sepsis with evidence of corresponding or impending organ failure (ex: drop in urine output, lactic >2, hypotension aka patients we get to the ICU) Septic Shock - Severe sepsis plus a MAP <65 mmHg without pressors