N432 - Med/Surg III - Final Exam Content

What is the main result of the progressive stage of shock? - Major organ dysfunction/MODS Clinical manifestations of moderate hypovolemic shock (30% loss or 1.5L) - Anxiety Tachypnea Mild tachycardia Clinical manifestations of severe hypovolemic shock (40%+ or 1.5-2 L) - HR 110 Hypotension (SBP 100) Confusion Low UO Cool, clammy skin Faint or absent peripheral pulses Clinical manifestations of cardiogenic shock - SBP 90 for 30+ mins Chest pain Pulmonary congestion Dyspnea Hypovolemia Tachycardia Confusion Cool skin DiaphoresisWhen do pts in anaphylactic shock require intubation? - If/when respiratory distress occurs What is spinal shock? - Temporary loss of reflex activity below level of injury S/S of PE - Dyspnea Tachypnea Pleuritic pain Cough Resp distress Tachycardia Evidence of DVT What is lactate? - The result of anaerobic metabolism What does lactate measure? - Indirect measure of impaired oxygenation and shock Normal lactate - 2 mmol/L What is lactic acidosis? - Lactate 5 with pH 7.35 T/F: All individuals who experience an injury will develop SIRS - FALSE Healthy individuals with strong immunity will not have a systemic reaction What is the criteria for SIRS? - 2+ of the following:-Core temp 100.9 or 96.8 -HR 90 -RR 20 -WBC 12 or 4 T/F: MODS can develop into SIRS if gone untreated - FALSE Severe SIRS can progress to MODS What differentiates SIRS from MODS? - Progressive dysfunction of 2+ organ systems, persisting for 24+ hrs Which organ system typically fails first with MODS? - Lungs -- ARDS What is sepsis? - When the underlying cause of SIRS is an infection T/F: an infection causing sepsis can be limited to one part of the body, but the effects can ravage whole body - TRUE Risk factors for SIRS/sepsis - Age (young and old) Transplant Treatment with chemo/radiation Comorbidities Medications Nutrition Portal of entryWhich of the following should occur within 3 hrs for the sepsis bundle? A) 2 sets of blood cultures B) Broad spectrum abx C) Vasopressors D) Crystalloid admin E) Colloid admin - A) 2 sets of blood cultures B) Broad spectrum abx D) Crystalloid admin