NSG 456 Exam IV With Complete Solution

NSG 456 Exam IV With C omp lete Solution Extrinsic Stress response - ANSWER *endorphins and stress hormones released *pupils dilate *arterioles dilate *heart and BP increase *blood sugar increases (as a result of increased cortisol) *blood to flow to skeletal muscles increases *breathing rate increases *digestion stops *urine output decreases Systemic Inflammatory Response Syndrome (SIRS) - ANSWER *protective (intrinsic) inflammatory response *characterized by a robust systemic inflammatory response *usually induced by major body insult (injury) -infectious (sepsis) -noninfectious (anaphylaxis, SLE) Criteria to Identify SIRS - ANSWER two or more of the following *temp >101 or <96.8 *tachycardia (HR >90) *tachypnea (RR >20 or PaCO2 <32 mmHg) *WBC count ->12k cells -<4000 cells >10% immature WBC (aka "bands", neutrophils) NOT HELPFUL IN DIAGNOSIS SEPSIS Shock definition - ANSWER a clinical syndrome that results from inadequate tissue perfusion, creating an imbalance between the delivery of oxygen and nutrients needed to support cellular function Shock - ANSWER *shock is initially reversible, but must be recognized and treated immediately to prevent irreversible organ dysfunction *all body systems are affected *hypoperfusion of the tissues *hypermetabolism *SIRS Does shock mean low blood pressure? - ANSWER It can depend on the type of shock. Most shock is hypotensive, but it can be hypertensive (cardiogenic). Steps of Shock - ANSWER 1. Inadequate perfusion - not enough oxygen gets to cells 2. Cells forced to switch to anaerobic respiration 3. Lactic acid builds up -> metabolic acidosis 4. Vasoconstriction -> venous pooling 5. endothelial damage -cell membrane dysfunction and loss of sodium-potassium pump -decrease in vascular oncotic pressure -increased 3rd spacing from intravascular space -efflux of potassium -influx of sodium and water many organ cells die = ORGAN DEATH Compensatory Mechanisms of Shock - ANSWER Clinical Findings in Stages of Shock - ANSWER Compensatory Stage of Shock - ANSWER *SNS stimulation *body shunts blood to only core organs *tissue perfusion becomes inadequate *acidosis occurs due to anaerobic metabolism *RR increases due to acidosis *confusion may occur Progressive Stage of Shock - ANSWER *BP and MAP decrease *all organs suffer from hypoperfusion *vasoconstriction continues *mental status further deteriorate s *decrease in pulmonary blood flow causes further hypoxemia *inadequate perfusion of heart leads to dysrhythmias and ischemia *MAP falls below 70 *GFR cannot be maintained *function of liver, GI, and blood all impaired *disseminated intravascular coagulation (DIC) may occur as cause or complication of shock