NUR 417 FINAL EXAM STUDY GUIDE CRITICAL CARE INTERVENTIONS &
ASSESSMENTS COMPLETE ICU, SEPSIS, ARDS & CARDIAC PREP| LATEST 2026
UPDATE
Module 1
- Factors that influence stroke volume
• The volume ejected with each heartbeat is the SV
• Stroke volume: HR x 1000 / cardiac output
• CO: SV x HR; Normal is 4-8 L/min
• Preload, afterload, and contractility affect stroke volume and cardiac output
- Evaluating preload status
• Preload is the volume in the ventricle at the end of diastole.
• S/S: JVD, edema, crackles or rales, high/low BP
• CVP is a measurement of right ventricular preload and reflects fluid volume status; will tell
you how much volume is in the body
- Normal: 2–8 mmHg.
- Elevated CVP = increased preload; low CVP = decreased preload.
• Pulmonary Artery Wedge Pressure (PAWP):
- Reflects left ventricular preload.
- Normal: 6–12 mmHg.
- Increased PAWP can indicate fluid overload or left heart failure.
- Afterload: measure to decrease
• Afterload refers to the forces opposing ventricular ejection of blood. These forces include
systemic arterial pressure, aortic valve resistance, and the blood volume and density. •
Vasodilators, ACE inhibitors, calcium channel blockers, beta-blockers, intra-aortic balloon
pump
• Treating underlying causes, like hypertension management or aortic stenosis treatments
- Ejection Fraction: interpretation of results
• Normal is 55-70%
• Decreased EF indicates heart dysfunction
• Heart failure with reduced EF indicates systolic heart failure
• Someone can still have heart failure with a preserved EF
- Usually die to diastolic dysfunction (impaired filling)
- Preload and afterload: evaluation of medication response
• Medications that decrease preload are vasodilators and diuretics
- ↓ JVD, ↓ peripheral edema
- Clear lung sounds
- Improved oxygenation
- Stable BP and HR
- ↑ urine output
• Medications that decrease afterload are vasodilators, ACE inhibitors, calcium channel
blockers, beta-blockers
- ↓ BP
- ↓ SVR (if monitored)
- Improved EF (long-term)
- ↓ heart workload, ↓ chest pain
,- Effect of preload on cardiac output
• CO depends
, • Preload = volume of blood in ventricles at end of diastole
• ↑ Preload → ↑ Stroke Volume → ↑ Cardiac Output
• CVP is a measurement of right ventricular preload and reflects fluid volume status; will tell
you how much volume is in the body, the normal is 2-8 mmHg
• PAWP is a measurement of left ventricular preload and assesses fluid status and left-sided
heart function; normal is 6-12 mmHg
Module 2
- Common manifestations of DKA
• DKA: profound deficiency of insulin, patient has high glucose levels
• s/sx: dehydration, polyuria, polydipsia, osmotic diuresis bc too much sugar, fruity breath,
n/v, flushed dry skin, abdominal pain, dry mouth, eyes appear sunken, fever, ketonuria,
glycosuria, labored breathing (Kussmaul respirations), nausea/vomiting, serum glucose
>300 mg/dl, potassium imbalances,
• labs: BMP, CMP, ABG’s, urinalysis, blood glucose levels
• metabolic acidosis: pt will have kussmaul breathing → deep, rapid breathing
- Blood transfusion reactions
• Acute hemolytic reaction: Infusion of ABO-incompatible whole blood, RBCs, or
components containing as little as 10 mL of RBCs, Antibodies in the recipient’s plasma
attach to antigens on transfused RBCs, causing RBC destruction.
- Reactions usually develop in first 15 min. May occur up to 2 hr after.
- Fever with or without chills; back, abdominal, chest, or flank pain; infusion site pain, ↑
HR, dyspnea, tachypnea, ↓ BP, hemoglobinuria, acute jaundice, dark urine, bleeding,
acute kidney injury, shock, cardiac arrest, DIC, death.
- Management is to monitor and maintain BP with IV fluids as ordered, Treat shock and
DIC if present, Draw blood samples for serologic testing slowly to avoid hemolysis from
the procedure. Send other specimens as ordered, Give diuretics as prescribed to
maintain urine flow, Insert indwelling urinary catheter or measure voided amounts to
monitor hourly urine output. Dialysis may be needed if renal failure occurs, Do not
transfuse more RBC-containing components until blood bank has provided newly
crossmatched units, Verify and document patient identification from sample collection
to component infusion (e.g., visually compare label on sample collection and blood
component with patient identification).
• Delayed hemolytic reaction: Fever, mild jaundice, decreased hemoglobin. Occurs as early
as 3 days or as late as several months posttransfusion as the result of destruction of
transfused RBCs by alloantibodies not detected during crossmatch; Monitor patients with
supportive care. Hemolysis may be severe enough to warrant further transfusions with
antigen-negative RBCs. Eculizumab may be beneficial.
- First action for blood transfusion reaction.
• 1. Stop the transfusion and stay with the patient.
• 2. Maintain a patent IV line with saline solution.
• 3. Notify the blood bank and the HCP.
• 4. Recheck identifying tags and numbers.
• 5. Monitor vital signs and urine output.
• 6. Treat symptoms per HCP order.
• 7. Save the blood bag and tubing and send them to the blood bank.
• 8. Collect required blood and other specimens as ordered to evaluate for the reaction.
, • 9. Document according to agency policy.
- S/S impending shock
• shock happens when there is a decrease in tissue perfusion which causes the body to
have inadequate oxygen that impairs cellular function and can lead to organ failure -
every type of shock has two things in common: impaired tissue perfusion & impaired
cellular metabolism → lactate build-up
• Any condition that compromises oxygen delivery to organs and tissues can lead to shock
• Tachycardia, decreased BP, decrease in pulse pressure, anxiety, confusion, agitation,
decreased urine output, tachypnea, pallor, cool, clammy skin
- Important assessments for clients receiving TPN
• Weigh patient daily as a measure of the patient’s hydration status.
• Maintain accurate intake and output record.
• Determine the cause of any weight changes (e.g., fluid gained from edema, actual increase
or decrease in tissue weight).
• Assess blood levels of glucose, electrolytes, and urea nitrogen.
• Carefully assess the catheter site for signs of inflammation and infection. Phlebitis can
readily occur because of the hypertonic infusion. Catheter-related infection and septicemia
can occur
• Complications associated with TPN administration
- Metabolic Complications:
• Altered renal function
• Essential fatty acid deficiency
• Hyperglycemia/hypoglycemia
• Hyperlipidemia
• Liver dysfunction
• Refeeding syndrome (potentially fatal shifts in fluids and electrolytes- occurs in
malnourished patients receiving artificial feeding)
• Fluid/electrolyte imbalances: hypophosphatemia, hypokalemia, hypomagnesemia
- Catheter Associated Complicated:
• Infection
• Air embolism
• Catheter-related sepsis
• Dislodgement
• Hemorrhage
• Occlusion
• Phlebitis
• Pneumothorax, hemothorax, and hydrothorax
• Thrombosis of vein
- PE: Priority actions
• Position patient in semi-Fowler’s to ease breathing
• Administer oxygen as prescribed
• Assess ABCs (airway, breathing, circulation)
• Monitor vital signs, cardiac rhythm, pulse ox, and lung sounds
• Check ABGs for gas exchange status
ASSESSMENTS COMPLETE ICU, SEPSIS, ARDS & CARDIAC PREP| LATEST 2026
UPDATE
Module 1
- Factors that influence stroke volume
• The volume ejected with each heartbeat is the SV
• Stroke volume: HR x 1000 / cardiac output
• CO: SV x HR; Normal is 4-8 L/min
• Preload, afterload, and contractility affect stroke volume and cardiac output
- Evaluating preload status
• Preload is the volume in the ventricle at the end of diastole.
• S/S: JVD, edema, crackles or rales, high/low BP
• CVP is a measurement of right ventricular preload and reflects fluid volume status; will tell
you how much volume is in the body
- Normal: 2–8 mmHg.
- Elevated CVP = increased preload; low CVP = decreased preload.
• Pulmonary Artery Wedge Pressure (PAWP):
- Reflects left ventricular preload.
- Normal: 6–12 mmHg.
- Increased PAWP can indicate fluid overload or left heart failure.
- Afterload: measure to decrease
• Afterload refers to the forces opposing ventricular ejection of blood. These forces include
systemic arterial pressure, aortic valve resistance, and the blood volume and density. •
Vasodilators, ACE inhibitors, calcium channel blockers, beta-blockers, intra-aortic balloon
pump
• Treating underlying causes, like hypertension management or aortic stenosis treatments
- Ejection Fraction: interpretation of results
• Normal is 55-70%
• Decreased EF indicates heart dysfunction
• Heart failure with reduced EF indicates systolic heart failure
• Someone can still have heart failure with a preserved EF
- Usually die to diastolic dysfunction (impaired filling)
- Preload and afterload: evaluation of medication response
• Medications that decrease preload are vasodilators and diuretics
- ↓ JVD, ↓ peripheral edema
- Clear lung sounds
- Improved oxygenation
- Stable BP and HR
- ↑ urine output
• Medications that decrease afterload are vasodilators, ACE inhibitors, calcium channel
blockers, beta-blockers
- ↓ BP
- ↓ SVR (if monitored)
- Improved EF (long-term)
- ↓ heart workload, ↓ chest pain
,- Effect of preload on cardiac output
• CO depends
, • Preload = volume of blood in ventricles at end of diastole
• ↑ Preload → ↑ Stroke Volume → ↑ Cardiac Output
• CVP is a measurement of right ventricular preload and reflects fluid volume status; will tell
you how much volume is in the body, the normal is 2-8 mmHg
• PAWP is a measurement of left ventricular preload and assesses fluid status and left-sided
heart function; normal is 6-12 mmHg
Module 2
- Common manifestations of DKA
• DKA: profound deficiency of insulin, patient has high glucose levels
• s/sx: dehydration, polyuria, polydipsia, osmotic diuresis bc too much sugar, fruity breath,
n/v, flushed dry skin, abdominal pain, dry mouth, eyes appear sunken, fever, ketonuria,
glycosuria, labored breathing (Kussmaul respirations), nausea/vomiting, serum glucose
>300 mg/dl, potassium imbalances,
• labs: BMP, CMP, ABG’s, urinalysis, blood glucose levels
• metabolic acidosis: pt will have kussmaul breathing → deep, rapid breathing
- Blood transfusion reactions
• Acute hemolytic reaction: Infusion of ABO-incompatible whole blood, RBCs, or
components containing as little as 10 mL of RBCs, Antibodies in the recipient’s plasma
attach to antigens on transfused RBCs, causing RBC destruction.
- Reactions usually develop in first 15 min. May occur up to 2 hr after.
- Fever with or without chills; back, abdominal, chest, or flank pain; infusion site pain, ↑
HR, dyspnea, tachypnea, ↓ BP, hemoglobinuria, acute jaundice, dark urine, bleeding,
acute kidney injury, shock, cardiac arrest, DIC, death.
- Management is to monitor and maintain BP with IV fluids as ordered, Treat shock and
DIC if present, Draw blood samples for serologic testing slowly to avoid hemolysis from
the procedure. Send other specimens as ordered, Give diuretics as prescribed to
maintain urine flow, Insert indwelling urinary catheter or measure voided amounts to
monitor hourly urine output. Dialysis may be needed if renal failure occurs, Do not
transfuse more RBC-containing components until blood bank has provided newly
crossmatched units, Verify and document patient identification from sample collection
to component infusion (e.g., visually compare label on sample collection and blood
component with patient identification).
• Delayed hemolytic reaction: Fever, mild jaundice, decreased hemoglobin. Occurs as early
as 3 days or as late as several months posttransfusion as the result of destruction of
transfused RBCs by alloantibodies not detected during crossmatch; Monitor patients with
supportive care. Hemolysis may be severe enough to warrant further transfusions with
antigen-negative RBCs. Eculizumab may be beneficial.
- First action for blood transfusion reaction.
• 1. Stop the transfusion and stay with the patient.
• 2. Maintain a patent IV line with saline solution.
• 3. Notify the blood bank and the HCP.
• 4. Recheck identifying tags and numbers.
• 5. Monitor vital signs and urine output.
• 6. Treat symptoms per HCP order.
• 7. Save the blood bag and tubing and send them to the blood bank.
• 8. Collect required blood and other specimens as ordered to evaluate for the reaction.
, • 9. Document according to agency policy.
- S/S impending shock
• shock happens when there is a decrease in tissue perfusion which causes the body to
have inadequate oxygen that impairs cellular function and can lead to organ failure -
every type of shock has two things in common: impaired tissue perfusion & impaired
cellular metabolism → lactate build-up
• Any condition that compromises oxygen delivery to organs and tissues can lead to shock
• Tachycardia, decreased BP, decrease in pulse pressure, anxiety, confusion, agitation,
decreased urine output, tachypnea, pallor, cool, clammy skin
- Important assessments for clients receiving TPN
• Weigh patient daily as a measure of the patient’s hydration status.
• Maintain accurate intake and output record.
• Determine the cause of any weight changes (e.g., fluid gained from edema, actual increase
or decrease in tissue weight).
• Assess blood levels of glucose, electrolytes, and urea nitrogen.
• Carefully assess the catheter site for signs of inflammation and infection. Phlebitis can
readily occur because of the hypertonic infusion. Catheter-related infection and septicemia
can occur
• Complications associated with TPN administration
- Metabolic Complications:
• Altered renal function
• Essential fatty acid deficiency
• Hyperglycemia/hypoglycemia
• Hyperlipidemia
• Liver dysfunction
• Refeeding syndrome (potentially fatal shifts in fluids and electrolytes- occurs in
malnourished patients receiving artificial feeding)
• Fluid/electrolyte imbalances: hypophosphatemia, hypokalemia, hypomagnesemia
- Catheter Associated Complicated:
• Infection
• Air embolism
• Catheter-related sepsis
• Dislodgement
• Hemorrhage
• Occlusion
• Phlebitis
• Pneumothorax, hemothorax, and hydrothorax
• Thrombosis of vein
- PE: Priority actions
• Position patient in semi-Fowler’s to ease breathing
• Administer oxygen as prescribed
• Assess ABCs (airway, breathing, circulation)
• Monitor vital signs, cardiac rhythm, pulse ox, and lung sounds
• Check ABGs for gas exchange status
