MDC IV - Final Exam Notes | Complete Class Coverage

Final Exam Study Guide 1


Chapter 11: Shock, Sepsis & Multiple Organ Dysfunction Syndrome
• Overview of Shock
o Shock is a life-threatening condition of inadequate tissue perfusion, leading to
cellular dysfunction & organ failure.
§ Pathophysiology: Decreased oxygen delivery → anaerobic metabolism → lactic
acidosis → organ dysfunction.
§ General S/S: Hypotension, tachycardia, tachypnea, cool clammy skin (except
in distributive shock), altered mental status, oliguria.
• Types of Shock
o Hypovolemic Shock
§ Cause: Blood or fluid loss (hemorrhage, burns, vomiting, diarrhea,
dehydration).
§ Pathophysiology: ↓ circulating volume → ↓ preload → ↓ stroke volume → ↓
cardiac output → tissue hypoxia.
§ S/S: Tachycardia, hypotension, weak pulses, cool/clammy skin, pallor, thirst,
anxiety, oliguria.
§ Diagnostics: CBC (H/H may be low with blood loss), lactate ↑, urine output
<0.5 mL/kg/hr.
§ Nursing Interventions:
• Establish 2 large-bore IVs, start rapid fluid resuscitation.
• Monitor VS, oxygenation & urine output.
• Prepare blood products if hemorrhagic.
§ Treatment/Management:
• Correct underlying cause (stop bleeding, replace fluids).
• Vasopressors if fluids insufficient.
§ Complications: Shock progression → organ failure → MODS.
o Cardiogenic Shock
§ Cause: MI, HF, cardiomyopathy, arrhythmias.

,Final Exam Study Guide 2


§ Pathophysiology: Heart cannot pump effectively → ↓ cardiac output → tissue
hypoxia.
§ S/S: Hypotension, tachycardia, cool clammy skin, pulmonary edema, weak
peripheral pulses.
§ Diagnostics: ECG, troponin, BNP, echocardiography.
§ Nursing Interventions:
• Administer inotropes (e.g., dobutamine) as ordered.
• Monitor hemodynamics, urine output.
• O2 therapy, maintain airway.
§ Treatment/Management:
• Treat underlying cardiac cause (PCI, thrombolysis).
• Mechanical support (IABP, LVAD) if refractory.
§ Complications: Pulmonary edema, arrhythmias, multiorgan failure.
o Distributive Shock
§ Characterized by massive vasodilation, leading to relative hypovolemia.
• Septic Shock
o Cause: Severe infection (bacterial, fungal, viral).
o Pathophysiology: Infection triggers systemic inflammatory response
→ vasodilation → hypotension → organ dysfunction.
o S/S: Fever or hypothermia, tachycardia, hypotension, warm/flushed
skin early, cool/clammy later, confusion, ↓ urine output.
o Diagnostics: Blood cultures, lactate (>2 mmol/L), CBC (WBC ↑ or ↓),
CRP ↑
o Nursing Interventions:
§ Early recognition (qSOFA criteria).
§ Start broad-spectrum antibiotics within 1 hr.
§ IV fluids (crystalloids), monitor urine output.
§ Frequent VS & mental status checks.
o Treatment/Management:

,Final Exam Study Guide 3


§ Vasopressors (norepinephrine) if MAP <65 mmHg after fluids.
§ Treat source (drain abscess, remove infected line).
o Complications: MODS, DIC, ARDS
• Anaphylactic Shock
o Cause: Severe allergic reaction (food, medication, insect sting).
o Pathophysiology: Massive histamine release → vasodilation,
capillary leak, bronchospasm.
o S/S: Hypotension, tachycardia, angioedema, urticaria,
bronchospasm, stridor.
o Nursing Interventions:
§ Ensure airway patency, give epinephrine IM.
§ O2, IV fluids, monitor VS.
§ Antihistamines, corticosteroids as ordered.
o Complications: Airway obstruction, cardiac arrest.
• Neurogenic Shock
o Cause: Spinal cord injury (T5 or above).
o Pathophysiology: Loss of sympathetic tone → hypotension,
bradycardia, vasodilation.
o S/S: Hypotension, bradycardia, warm/dry skin, peripheral pooling,
hypothermia.
o Nursing Interventions:
§ Monitor hemodynamics, maintain spinal precautions.
§ Administer fluids cautiously, vasopressors (dopamine,
norepinephrine).
o Complications: Tissue hypoxia, organ failure.
• Multiple Organ Dysfunction Syndrome (MODS)
o Definition: Progressive organ failure after severe shock or systemic inflammation.
o Commonly Affected Organs: Lungs, kidneys, liver, heart, CNS, GI tract.

, Final Exam Study Guide 4


o Pathophysiology: Uncontrolled inflammatory response → microvascular
thrombosis → tissue ischemia → organ failure.
o S/S: Pulmonary (ARDS, hypoxia), renal (oliguria, ↑ BUN/Cr), liver (jaundice, ↑ LFTs),
cardiovascular (hypotension, tachycardia), CNS (confusion, delirium).
o Nursing Interventions:
§ Continuous monitoring of organ function (labs, VS, urine output, ABG).
§ Maintain perfusion with fluids, vasopressors.
§ Supportive care: mechanical ventilation, dialysis.
o Treatment/Management:
§ Treat underlying cause (infection, hemorrhage).
§ Nutritional support (high protein/calories).
§ Multidisciplinary team approach.
o Complications: Death if untreated, often occurs within 48–72 hrs. after initial
insult.
• Nursing Priorities in Shock
o Airway & oxygenation o Prevent organ failure
o Circulation – fluid resuscitation, o Frequent monitoring (VS, labs,
monitor perfusion LOC, urine output)
o Identify & treat underlying cause


Chapter 14: Preoperative Nursing Management
• Overview
o Preoperative nursing care focuses on preparing the patient physically and
psychologically for surgery, minimizing complications & promoting optimal
recovery.
o Goals:
§ Ensure patient safety § Reduce anxiety & stress
§ Optimize physiologic status
§ Educate patient/family about procedure & post-op expectations