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Summary NUR 445 - Comprehensive Exam 4 Study Guide

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2023/2024 Written for academic year
Institution Arizona College Of Allied Health
Course NUR 445
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This is a comprehensive and detailed exam 4 study guide/review with major emphasis on; Shock & Trauma Management for Nur 445. An Essential Study resource just for you

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NUR 445 - Exam 4 Study Guide
SHOCK

,Hypovolemic Shock
-Common cause
oblood loss d/t trauma, GI bleeds, surgery
ointernal bleeding
ofluid loss d/t vomiting, diarrhea, urination, burns
othird-space fluid loss
-Clinical manifestations
oEarly
Tachycardia
Restless, confused
UO decreased d/t reabsorption of sodium and water
Pale, cool, clammy skin
Pulses weak, sluggish cap refill
Hyperventilation (respiratory alkalosis)
Hypoactive bowel sounds
Hyperglycemia
oLate
Lethargy
Hypotension
Metabolic and respiratory acidosis
Anuria
Cold, cyanotic skin with weak/absent pulses
Dysrhythmias
oRefractory (ineffective treatment)
Coma
Severe hypotension
Ischemic and necrotic cold extremities
Renal and hepatic failure
-Hemodynamic parameters
oDecreased CVP, PaOP, SvO2/ScvO2, CO
oINCREASED systemic vascular resistance (SVR)
-Assess
oNeuro status
oVS
oHemodynamic readings
oUO
oSkin color and temperature
-Labs
oABGs
Initial: Respiratory alkalosis
Late: Metabolic acidosis
oSvO2/ScvO2
Decreased  inadequate oxygen delivery
oH&H
Decreased if cause is bleeding
oMetabolic profile
Renal failure and liver failure  INCREASED BUN & Creatinine
oLactate/base deficit
Increased lactate, negative base  poor perfusion
-Nursing actions

, o100% NRB
oAnticipate and prepare for intubation
Positive-pressure mechanical ventilation needed to improve oxygenation
oLarge-bore IVs  Fluid replacement
NS
LR
Blood products (PRBCs, FFP, Platelets)
-Patient Education
oInstruct patient and family on the cause of hypovolemia
oAllow family members visitation during hospital treatment

Cardiogenic shock
-Causes
oMI
oSevere valvular dysfunction
oSevere HF
-RF
oAMI
oEnd-stage CHF
oCardiomyopathy
oHTN
oDM
oCAD
oAcute vascular disease
-Clinical manifestations
oInitial
Chest pain
Diaphoresis
N/V
Decreased CO  increased lactate
Hypotension
Decreased LOC
Decreased UO
Poor pulses
Pale, cool skin
Hypoactive BS
Pulmonary edema  SOB, crackles, decreased SpO2
oLate
Profound hypotension and bradycardia
Coma
Cyanotic, mottled skin
Absent BS
Anuria
oAs shock progresses  severe hypotension and bradycardia
-Labs
oABGs
Initial: respiratory alkalosis
Late: metabolic acidosis
oHemodynamic parameters (PA catheter)
Increased CVP and PAOP

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