NUR 440 - Exam 3 Practice Questions with Answers

Causes of cardiogenic shock MI, Myocardial contusion, cardiomyopathy, myocarditis, severe HF, dysrhythmias, valvular dysfunction, ventricular septal rupture Assessment of cardiogenic shock Increased HR, Dysrhythmias, decreased BP, chest pain, tachypnea, oliguria, cool and pale skin, decreased mentation, left ventricular failure, right ventricular failure, decreased cardiac output and cardiac index Causes of hypovolemic shock External loss of blood, external loss of fluid, internal sequestration of blood/fluid Assessment of hypovolemic shock Increased HR, decreased BP, tachypnea, oliguria, decreased mentation, cool and pale skin, flat neck veins, increased hct if from dehydration, decreased hct if from blood loss What is SIRS? Systemic Inflammatory Response Syndrome Precipitation factors for SIRS Infection, ischemia, trauma, hemorrhage, pancreatitis SIRS demonstrates at least 2 of these: Temp: 36 or 38 HR 90 RR 20 or PaCO2 32 WBC 12,000 or 4,000 Shock causes Decrease in cardiac function, blood volume, vascular tone Stage 1: Initial stage of shock No obvious signs/symptoms. Decrease in CO Alteration in tissue perfusion Aerobic to anaerobic metabolism Stage 2: Compensatory stage of shock S+S are noticeable. HR and RR happen first. Mental status changes like anxiety and restlessness. Neural, endocrine, and chemical responses Stage 2: Neural Response BP decreases. Baro/chemoreceptors sense change. Message to medulla. Release epi and norepi (catecholamines). Then, increase HR and contractility, dilate coronary arteries, and systemic vasoconstriction Stage 2: Endocrine Response Release of ACTH and ADH. Activation of RAA response. Stage 2: Endocrine Response Symptoms Decreased urine output. Retained sodium and water. Increased urine specific gravity. Decreased creatinine clearance. Hyperglycemia. Stage 2: Chemical Response Changes in CO2 concentration due to altered perfusion causes increased RR to compensate. Respiratory alkalosis causes cerebral vasoconstriction. Stage 2: Chemical Response Symptoms Increased RR. Respiratory alkalosis early on. Changes in mental status like restlessness and confusion. Stage 3: Progressive Stage Compensatory mechanisms start to fail. Continued anaerobic metabolism. Decrease in BP. Capillary pooling. Lack of ATP = Cellular edema Stage 4: Refractory Stage Shock is irreversible. Organs begin to die (MODS). Death occurs in response to lack of organ perfusion. Multiple Organ Dysfunction Syndrome (MODS) 2 or more organ systems fail Mortality for MODS with 2 failed organs ~54%