NSG 456 Exam IV Questions With Correct Answers.

NSG 456 Exam IV Questions With Correct Answers. 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 - answertwo 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 EXAM STUDY MATERIALS July 29, 2024 12:59 PM 10% immature WBC (aka "bands", neutrophils) NOT HELPFUL IN DIAGNOSIS SEPSIS Shock definition - answera 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? - answerIt can depend on the type of shock. Most shock is hypotensive, but it can be hypertensive (cardiogenic). Steps of Shock - answer1. 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 EXAM STUDY MATERIALS July 29, 2024 12:59 PM *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 deteriorates *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 Disseminated Intravascular Coagulation (DIC) - answer*clot, lyse clot, all coag factors used up - BLEED, BLEED, BLEED *abnormal labs (low plt, high PT + aPTT, high D-dimer + FDPs) *tx underlying disease, hypotension, tissue perfusion, acidosis, and hypoxia Irreversible Stage of Shock - answer*organ damage is so severe that patient does not respond to tx and cannot survive *BP remains low *anaerobic metabolism worsens; acidosis *multiple organ dysfunction progresses to complete organ failure *judgment that shock is irreversible often only made in retrospect *focused more on comfort care Multiple Organ Dysfunction Syndrome (MODS) - answer*altered function of two or more organs *medical interventions necessary to support continued organ function EXAM STUDY MATERIALS July 29, 2024 12:59 PM *high mortality rate: 60-75% Treatment to Reverse MODS - answer*controlled environment (quiet, low stimulation) *promoting adequate organ perfusion *providing nutritional support *maximizing comfort Modified Trendelenburg - answer*used in patients with shock to promote blood circulation back to heart Fluid Replacement in Shock - answer*intravenous *lactated ringers (most lytes) *colloids - albumin, PRBCs Hemodynamic and Cardiac Monitoring in Shock - answer*increase tissue perfusion *monitor UO *arterial line *capnography - measures end tidal CO2 Maintaining Airway and Oxygenation in Shock/Advanced Airway - answer*ventilation *intubation *ventilator VAP prevention bundle - answer-Elevation of the HOB between 30 and 45 degrees. -Daily "sedation vacations" to assess readiness to extubate. -Peptic ulcer disease prophylaxis. -DVT prophylaxis. -adequate oral hygiene -Q2 turns Medications for Shock - answer