TNCC Notes for Written Exam LATEST
2025 LATEST A+
TNCC Notes for Written Exam
other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities.
What is vascular response? -
✅ As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of
baroreceptors. Arterioles constrict to increase TPR and BP.
What is renal response? -
✅ Renal ischemia activates release of renin.
Kidneys do not receive adequate blood supply, renin is release into circulation.
Renin causes angiotensinogen, normal plasma protein, to release angiotensin I.
Angiotensin-converting enzyme from the lungs converts into angiotensin II.
Angiotensin II causes:
- Vasoconstriction of arterioles and some veins
- Stimulation of sympathetic nervous system
- Retention of water by kidneys
- Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone)
*Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion.
Explain adrenal gland response. -
✅ When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal
medulla will increase.
Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive
chronotropy) to improve cardiac output, BP and tissue perfusion.
Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that
stimulates adrenal gland to release cortisol.
Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to
produce more sugar.
Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water.
Explain Hepatic Response. -
✅ Liver can store excess glucose as glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose.
In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas.
Explain Pulmonary Response. -
✅Tachypnea happens for 2 reasons:
1. Maintain acid-base balance
2. Maintain increased supply of oxygen
* Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is
an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli.
Explain Irreversible Shock. -
✅ Shock uncompensated or irreversible stages will cause compromises to most body systems.
- Inadequate venous return
- inadequate cardiac filling
- decreased coronary artery perfusion
- Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage.
How would you assess someone in hypovolemic shock? -
✅ (Use Initial Assessment) and then:
Inspect:
- LOC
- Rate and quality of respirations
- External bleeding?
- Skin color and moisture
- Assess jugular veins and peripheral veins
, TNCC Notes for Written Exam LATEST
2025 LATEST A+
Auscultate:
- BP
- Pulse pressure
- Breath sounds
- Heart sounds
- Bowel sounds
Percuss:
- Chest and abdomen
Palpate:
- Central pulse (carotid or femoral)
- Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
- Palpate peripheral pulses
- Palpate skin temp and moisture
Diagnostic Procedures:
- Xrays and other studies
- Labs
Planning and Implementation
- Oxygen
- IV's with warmed replacement fluids
- Control external bleeding with direct pressure
- Elevate LE's
- NGT
- Foley
- Monitor and pulse oximeter
- Monitor for development of coagulopathies
- Surgery?
ICP is a reflection of what three volumes? What happens when one increases? -
✅ 1. Brain
2. CSF
3. Blood within the nonexpansible cranial vault
As volume of one increases, the volume of another decreases to maintain ICP within normal range.
As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive
pt w/marginally elevated ICP can be harmful.
Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased
concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase
blood volume and ICP.
What are the early signs and symptoms of increased ICP? -
✅ - Headache
- N/V
- Amnesia regarding events around the injury
- Altered LOC
- Restlessness, drowsiness, changes in speech, or loss of judgement
What are the late observable signs of symptoms of increased ICP? -
✅ - Dilated, nonreactive pupil
- Unresponsiveness to verbal or painful stimuli
- Abnormal motor posturing patterns
- Widening pulse pressure
- Increased systolic blood pressure
- Changes in RR and pattern
- Bradycardia
What is Cushing's phenomenon or Cushing's Reflex? -
✅ Triad of progressive HTN, bradycardia and diminished respiratory effort.
What are the two types of herniation that occurs with ICP? -
✅ 1. Uncal herniation
2. Central or transtentorial herniation
Why does herniation occur? What are the symptoms? -
✅ Because of uncontrolled increases in ICP.
S/E's
- Unilateral or bilateral pupillary dilation
- AsyDimmetric pupillary reactivity
- Abnormal motor posturing
2025 LATEST A+
TNCC Notes for Written Exam
other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities.
What is vascular response? -
✅ As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of
baroreceptors. Arterioles constrict to increase TPR and BP.
What is renal response? -
✅ Renal ischemia activates release of renin.
Kidneys do not receive adequate blood supply, renin is release into circulation.
Renin causes angiotensinogen, normal plasma protein, to release angiotensin I.
Angiotensin-converting enzyme from the lungs converts into angiotensin II.
Angiotensin II causes:
- Vasoconstriction of arterioles and some veins
- Stimulation of sympathetic nervous system
- Retention of water by kidneys
- Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone)
*Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion.
Explain adrenal gland response. -
✅ When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal
medulla will increase.
Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive
chronotropy) to improve cardiac output, BP and tissue perfusion.
Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that
stimulates adrenal gland to release cortisol.
Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to
produce more sugar.
Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water.
Explain Hepatic Response. -
✅ Liver can store excess glucose as glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose.
In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas.
Explain Pulmonary Response. -
✅Tachypnea happens for 2 reasons:
1. Maintain acid-base balance
2. Maintain increased supply of oxygen
* Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is
an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli.
Explain Irreversible Shock. -
✅ Shock uncompensated or irreversible stages will cause compromises to most body systems.
- Inadequate venous return
- inadequate cardiac filling
- decreased coronary artery perfusion
- Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage.
How would you assess someone in hypovolemic shock? -
✅ (Use Initial Assessment) and then:
Inspect:
- LOC
- Rate and quality of respirations
- External bleeding?
- Skin color and moisture
- Assess jugular veins and peripheral veins
, TNCC Notes for Written Exam LATEST
2025 LATEST A+
Auscultate:
- BP
- Pulse pressure
- Breath sounds
- Heart sounds
- Bowel sounds
Percuss:
- Chest and abdomen
Palpate:
- Central pulse (carotid or femoral)
- Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
- Palpate peripheral pulses
- Palpate skin temp and moisture
Diagnostic Procedures:
- Xrays and other studies
- Labs
Planning and Implementation
- Oxygen
- IV's with warmed replacement fluids
- Control external bleeding with direct pressure
- Elevate LE's
- NGT
- Foley
- Monitor and pulse oximeter
- Monitor for development of coagulopathies
- Surgery?
ICP is a reflection of what three volumes? What happens when one increases? -
✅ 1. Brain
2. CSF
3. Blood within the nonexpansible cranial vault
As volume of one increases, the volume of another decreases to maintain ICP within normal range.
As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive
pt w/marginally elevated ICP can be harmful.
Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased
concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase
blood volume and ICP.
What are the early signs and symptoms of increased ICP? -
✅ - Headache
- N/V
- Amnesia regarding events around the injury
- Altered LOC
- Restlessness, drowsiness, changes in speech, or loss of judgement
What are the late observable signs of symptoms of increased ICP? -
✅ - Dilated, nonreactive pupil
- Unresponsiveness to verbal or painful stimuli
- Abnormal motor posturing patterns
- Widening pulse pressure
- Increased systolic blood pressure
- Changes in RR and pattern
- Bradycardia
What is Cushing's phenomenon or Cushing's Reflex? -
✅ Triad of progressive HTN, bradycardia and diminished respiratory effort.
What are the two types of herniation that occurs with ICP? -
✅ 1. Uncal herniation
2. Central or transtentorial herniation
Why does herniation occur? What are the symptoms? -
✅ Because of uncontrolled increases in ICP.
S/E's
- Unilateral or bilateral pupillary dilation
- AsyDimmetric pupillary reactivity
- Abnormal motor posturing
