NSB236 Questions and Correct Answers the Latest Update

Situation Mr. Johnson Butterworth is a 72-year-old man who was initially admitted 3 days ago for the conservative managed of a small bowel obstruction, which has now required surgical intervention. Mr Butterworth is being admitted to your ward post-operatively and has undergone a left hemicolectomy with approximately 15cm of necrotic small bowel resected and a double-barreled ileostomy brought out, a peritoneal washout performed, times two Redivacs in situ to drain the pericolic gutter (Right side 100mls, Left side 80mls of haemoserous fluid) and mid-line abdominal closure performed. Intra-operatively, Mr. Butternut received 4 units of blood and an additional 2 litres of Hartman's solution. A quad (4) lumen central venous line, a Salem sump nasogastric tube (NGT) and an indwelling urinary catheter (IDC) were inserted. On admission at 16:15 hours he has Hartman's solution running at 125mls/hour, and an urinary output Key points: Decreased urinary out indicator of decreased organ perfusion as evidenced by decreased blood pressure. Hypotension - related to the inflammatory process associated with sepsis and vasodilatory effects of the inflammatory mediators. Tachycardia - compensatory response to decreased blood pressure and the bodies attempt to improve cardiac output (stroke volume x heart rate) secondary to the decreased blood pressure and organ perfusion. Tachypnea - an incresed respiratory effort to improve oxygenation secondary to #Examify | #OnlineExams | #TestPrep | #StudyResources | #AcademicSuccess | #ExamPreparation | #QuizTime | #LearningTools | #Education | #StudentSupport Examify | Smart Grades | Latest update compromise organ perfusion and decreased Oxygenation (supplemented via Hudson mask) Mr. Johnson Butterworth is a 72-year-old man who was initially admitted 3 days ago for the conservative managed of a small bowel obstruction, which has now required surgical intervention. Mr Butterworth is being admitted to your ward post-operatively and has undergone a left hemicolectomy with approximately 15cm of necrotic small bowel resected and a double-barreled ileostomy brought out, a peritoneal washout performed, times two Redivacs in situ to drain the pericolic gutter (Right side 100mls, Left side 80mls of haemoserous fluid) and mid-line abdominal closure performed. Intra-operatively, Mr. Butternut received 4 units of blood and an additional 2 litres of Hartman's solution. A quad (4) lumen central venous line, a Salem sump nasogastric tube (NGT) and an indwelling urinary catheter (IDC) were inserted. On admission at 16:15 hours he has Hartman's solution running at 125mls/hour, and an urinary output of 70- 90ml Elevated white cell count: indication of increased white cell activity in response to a systemic infection, in order to fight the invading bacteria. Increased creatinine - indication of decreased renal function secondary to decreased blood pressure and renal perfusion, that has occurred secondary to the vasodilatory effects of sepsis and evidenced by decreased urinary output. Increased Alanine Aminotransferase (ALT) - liver enzyme: increased levels secondary to decreased organ perfusion as a result of hypotension and decreased end-organ perfusion, as a result of the vasodilatory effects of sepsis. In low blood pressure states, blood is shunted to support critical organs such as the heart, respiratory system and brain. #Examify | #OnlineExams | #TestPrep | #StudyResources | #AcademicSuccess | #ExamPreparation | #QuizTime | #LearningTools | #Education | #StudentSupport Examify | Smart Grades | Latest update Mr Williams is day 2 postoperatively (appendectomy) on assessment this morning, he is reporting abdominal discomfort with a pain score of 5/10, is has hypoactive bowel sounds, you note his urinary output has decreased from an acceptable 40mls/hr to 20ml/hr. You perform a set of vital signs which reveal the following: HR 122 beats/min, BP 95/65mmHg, RR 28 breaths/min, Temp: 38.8, SpO2 95% on 4L/min Based on the above assessment findings outline the compensatory processes that have been initiated. Heart rate has increased as a compensatory process to improve cardiac output and in turn blood pressures (CO = HRX SV) Increase respiratory rate to compensate for decreased oxygenation as a result of decreasing blood pressure and oxygenation Decreased blood pressure and perfusion to the kidney results in decreased urinary out which would trigger the renin-angiotensin aldosterone system resulting in fluid retention as a means to try and improve circulating volume and blood pressure. Which two underlying shock-related factors cause the majority of clinical manifestations associated with shock? Activation of compensatory mechanisms Inadequate oxygen delivery #Examify | #OnlineExams | #TestPrep | #StudyResources | #AcademicSuccess | #ExamPreparation | #QuizTime | #LearningTools | #Education | #StudentSupport Examify | Smart Grades | Latest update Which clinical situation could result in a relative fluid volume deficit? Acites Which condition characterises cardiogenic shock? Impaired cardiac contractility and cardiac output The various forms of distr