WVU NSG 460 Exam 3 Shock and GI Content Questions And Answers Graded A+ Solutions

Cellular Perfusion -adequate cellular perfusion means... 1.) adequate circulation 2.) adequate cardiac output 3.) adequate vasomotor tone -these allow us to meet the cellular demands and simultaneously remove waste products efficiently Another term for shock is inadequate delivery of oxygen to the cells. Mean Arterial Pressure (MAP) -the MAP is what drives cellular perfusion -a normal MAP is 70 to 100 -ideally, we want a MAP that is >60 in order to adequately perfuse Hypoperfusion/Shock -without adequate perfusion, cells shift to anaerobic metabolism ^only 5% of energy is actually produced (1/18) -the anaerobic metabolism leads to the production of lactic acid, leading to lactic acidosis Causes of Hypoperfusion/Shock 1. lactic acid is the most common cause of metabolic acidosis 2. DKA (due to profound diuresis) 3. uremia (development of sepsis)Heart's Relation to Shock 1. The Fluid (hypovolemic) 2. The Pump (cardiogenic) 3. The Pipes (distributive) Hypovolemic Shock -the most common cause of shock -inadequate circulating volume ^can be caused by GI bleed, dehydration, etc. -can also be a shift of fluid to the interstitial space (burn shock) -can shift into the peritoneal space ^can see ascites ^we can see it in regard to liver failure, or blood can pool within the pelvic cavity after a pelvic fracture -it can also be in the retroperitoneal space ^in pancreatitis, up to 11 liters of fluid can shift Early Hypovolemic Shock As the body senses the organs are underperfused it... -increases HR -increases RR -increases contractility -vasoconstricts (increases venous return; causes cool, clammy skin)-increases Na and H2O retention Late Hypovolemic Shock -low blood pressure ^decompensated/progressive -tx what is missing ^may need to provide fluid resuscitation or vasopressors Management of Hypovolemic Shock -lay patient flat or elevate their legs -trendelenburg ^do not perform in patients who have had a carotid endarterectomy; may cause a rebleed ^face is pale, raise the tale -isotonic fluids: NS, LR, and plasmalyte -PRBCs -albumin Albumin 25% Conc. Albumin -50 cc (higher concentration) -good for our cardiac patients ^ex. a patient with CHF -this is a better option because its a smaller volume, but a high concentration-we may see the patient have a diuretic ordered with this, so we don't fluid overload them 12.5% Conc. Albumin -250 cc (lesser concentration) *corrects fluid shifts *must have a filter needle for administration