Advanced Med surg exam 3 with correct answers

Advanced Med surg exam 3 with |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




correct answers |||\\\




compensatory stage of shock - correct answer✔✔-BP remains normal |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




-elevated glucose and sodium |||\\\ |||\\\ |||\\\




-lactic acid starts to build up causing metabolic acidosis, compensation leads to respiratory
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alkalosis

-heart rate above 100, increasing
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-RR above 22, PaCO2 less than 32
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-cold clammy skin, longer than 3 second refill
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-decreased urine output |||\\\ |||\\\




-confusion

-respiratory alkalosis |||\\\




Progressive stage of shock - correct answer✔✔-systolic BP less than 100, MAP less than 65
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-Needs fluid resuscitation |||\\\ |||\\\




-HR above 150
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-rapid, shallow breaths |||\\\ |||\\\




-crackles

-PaO2 less than 80, CO2 greater than 45
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-mottling skin, petechiae, long cap refill |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




-less than 0.5 ml/kg/h or urine
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-lethargy

-metabolic acidosis |||\\\

,Irreversible stage of shock - correct answer✔✔-needs mechanical or pharm support for BP |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




-HR is erratic
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-requires intubation and mechanical ventilation |||\\\ |||\\\ |||\\\ |||\\\




-jaundice skin |||\\\




-anuric, needs dialysis |||\\\ |||\\\




-unconscious

-profound acidosis |||\\\




nursing management for shock - correct answer✔✔-early intervention is key
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-fluids and oxygen, and obtaining labs early to rule out metabolic imbalances or infection
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-Clarify advance directives as shock can progress rapidly
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-can sedate patient to lower body demands, supplemental oxygen or mechanical ventilation
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-BP meds, PRBCs, monitor ScVO2
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notify provider if 2 of these 3 signs occur for suspected sepsis - correct answer✔✔- RR above
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22

- altered mentation
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-systolic BP less than or equal to 100 mmHg/ decreasing pulse pressure
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normal pulse pressure - correct answer✔✔30-40 mmHg
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ScvO2 (continuous central venous oximetry) - correct answer✔✔-monitors venous blood
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oxygen saturation and severity of hypoperfusion states
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-goes into superior vena cava|||\\\ |||\\\ |||\\\ |||\\\




-normal value is 70%, this lowers in shock as more O2 is consumed
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, passive leg raising is used for? - correct answer✔✔-to determine which patient will respond to
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IV fluid bolus
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-raise patients legs to 30-45 degree angle to increase venous return and CO
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**If BP does improve- Pt will respond to more fluids
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**If BP does not improve- Pt will not respond to more fluids and can cause fluid overload
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monitor Hemodynamic status by - correct answer✔✔Central venous pressure (CVP)
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Pulmonary artery |||\\\




all management of shock includes - correct answer✔✔-supplemental oxygen/ventilation
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-fluid replacement |||\\\




-vasoactive medications |||\\\




-nutritional support for metabolic needs |||\\\ |||\\\ |||\\\ |||\\\




what is used for fluid replacement - correct answer✔✔-Lactated ringers!!!
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-other crystalloid solutions like 0.9% sodium chloride
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what can result from over administrations of lactate ringers? - correct answer✔✔- pulmonary
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edema

-abdominal compartment syndrome |||\\\ |||\\\




vasopressors do what - correct answer✔✔-increase myocardial contractility, regulate HR, |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




reduce myocardial resistance and initiate vasoconstriction|||\\\ |||\\\ |||\\\ |||\\\ |||\\\




**Beta 1 adrenergic receptors stimulated cause HR and myocardial contraction increase
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**For beta 2 adrenergic receptors--vasodilation occurs in heart and skeletal muscles &
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bronchioles relax |||\\\