Cardiogenic Shock Management Quiz

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Questions and Answers

Which of the following is not an adverse effect associated with vasoactive medications?

Chest pain

Weight gain (correct)

Dizziness

Dry mouth

Which laboratory test is commonly performed to evaluate possible myocardial injury in urgent clinical assessment?

Urinalysis

Troponin (correct)

Blood cultures

D-Dimer

What is the primary goal of collaborative care in managing cardiogenic shock?

Decrease respiratory rate

Reduce heart rate

Restore blood flow to the myocardium (correct)

Enhance blood volume

Which of the following procedures is indicated if a flail valve is present in a patient with cardiogenic shock?

Valve replacement Signup and view all the answers

Which of the following imaging studies is commonly used to rule out a pulmonary embolism (PE)?

CT Pulmonary Angiogram (CTPE) Signup and view all the answers

What is the appropriate intervention for cardiac tamponade?

Pericardiocentesis Signup and view all the answers

Which intervention should be prioritized for a patient with obstructive shock due to a tension pneumothorax?

Needle decompression Signup and view all the answers

What is a key nursing intervention for venothromboembolic disease?

Encourage mobility Signup and view all the answers

What is the primary use of an epinephrine ampule in an anaphylaxis kit?

For IM use ONLY Signup and view all the answers

Which diagnostic tool is essential for confirming a pulmonary embolism?

VQ Scan Signup and view all the answers

In the context of spinal cord injury, what is a critical nursing intervention for neurogenic shock?

Stabilize the cervical spine with a collar Signup and view all the answers

Which medication may be ordered to prevent rebound or biphasic reactions in anaphylaxis?

Glucocorticoids (IV) Signup and view all the answers

What symptom indicates that a patient may require further monitoring when managing venothromboembolic disease?

Syncope or presyncope Signup and view all the answers

What is a potential risk associated with antihistamines in the context of anaphylaxis?

They can cause anaphylaxis themselves Signup and view all the answers

What is a primary goal for nursing interventions in patients with obstructive shock?

To identify the cause of obstruction and implement treatment Signup and view all the answers

Which type of solution is generally preferred for patients experiencing hypovolemic shock not caused by bleeding?

Crystalloids Signup and view all the answers

When teaching a patient about self-administration of anticoagulants at home, which point should be emphasized?

Monitor for signs of bleeding Signup and view all the answers

What happens to a cell when placed in a hypertonic solution?

The cell shrinks as water is drawn out Signup and view all the answers

What is the primary function of isotonic solutions in relation to cells?

To ensure no net effect on cell size Signup and view all the answers

Which of the following is NOT a use of crystalloid solutions?

Treating severe bleeding Signup and view all the answers

What should be avoided when using antihistamines post-anaphylaxis treatment?

Using them for managing airway obstruction Signup and view all the answers

What is the primary goal of interventions for patients experiencing septic shock?

To ensure patent airway and maximize oxygen delivery Signup and view all the answers

Which laboratory assessments should be performed immediately for a patient in septic shock?

Blood cultures, lactate, and CBC Signup and view all the answers

In patients with septic shock, what is a critical consideration for enteral nutrition?

Anticipate enteral nutrition within the first 24 hours if possible Signup and view all the answers

What is a recommended approach to monitoring patients in septic shock?

Assess vital signs and conduct systematic assessments every 15 minutes as needed Signup and view all the answers

What constitutes the ongoing documentation needed for patients in septic shock?

Interventions and evaluations of treatment effectiveness Signup and view all the answers

Which group of patients is at a greater risk for developing septic shock?

Elderly or immunocompromised individuals Signup and view all the answers

What is an important ongoing care consideration for patients with septic shock regarding nutrition?

Monitoring protein and nitrogen balance is vital Signup and view all the answers

Which of the following statements best reflects a key preventative strategy against septic shock?

Universal precautions should be practiced at all times Signup and view all the answers

What is the primary goal in treating Disseminated Intravascular Coagulation (DIC)?

Treat the underlying disease Signup and view all the answers

Which laboratory finding is indicative of Disseminated Intravascular Coagulation (DIC)?

Elevated D-Dimer levels Signup and view all the answers

What should be monitored in patients undergoing treatment for hypotension?

Fluid intake to prevent overload Signup and view all the answers

Which of the following is NOT typically included in the urgent clinical assessment for respiratory failure?

Liver panel Signup and view all the answers

In acute respiratory distress syndrome (ARDS), which nursing intervention is essential?

Ensuring oxygen/ventilation support Signup and view all the answers

Which of the following therapies is crucial in managing severe bleeding associated with DIC?

Platelet therapy Signup and view all the answers

What is a common nursing intervention in the care of a patient with respiratory failure?

Encouraging family-centered care Signup and view all the answers

What immediate investigation is crucial when assessing a patient’s risk for pulmonary embolism?

CT Pulmonary Angiogram Signup and view all the answers

Which type of shock is characterized by confusion, agitation, and decreased urine output?

Alkalosis Signup and view all the answers

In treating cardiogenic shock, which medication is primarily used to support heart function?

Inotropes Signup and view all the answers

What is the primary approach in the management of hypovolemic shock?

Rapid fluid replacement Signup and view all the answers

Which type of shock requires aggressive fluid resuscitation and immediate administration of epinephrine?

Anaphylactic shock Signup and view all the answers

In septic shock, what laboratory test is critical for obtaining cultures?

Blood cultures Signup and view all the answers

What is primarily monitored when providing aggressive fluid resuscitation in septic shock?

CVP and PAOP Signup and view all the answers

In neurogenic shock, what is a key treatment strategy to maintain hemodynamics?

Cautious fluid administration Signup and view all the answers

Which complication follows the progression from infection to septic shock?

Multiple organ dysfunction syndrome Signup and view all the answers

Which supportive therapy is essential for treating cardiogenic shock?

Address dysrhythmias Signup and view all the answers

What is the initial management strategy for a patient in septic shock?

Aggressive fluid resuscitation Signup and view all the answers

Which of the following is a central nervous system adverse effect of vasoactive medications?

Headache Signup and view all the answers

Which laboratory test is NOT included in the urgent clinical assessment for patients suspected of cardiogenic shock?

Thyroid function test Signup and view all the answers

What is an essential procedure indicated for managing a flail valve in a patient with cardiogenic shock?

Emergency CABG Signup and view all the answers

Which of the following adverse effects is commonly observed in the cardiovascular system due to vasoactive medications?

Tachycardia Signup and view all the answers

What is the purpose of thrombolytic therapy in the context of collaborative care for cardiogenic shock?

To dissolve blood clots and restore blood flow Signup and view all the answers

What is a primary intervention required to restore adequate mean arterial pressure (MAP) in shock management?

Aggressive fluid resuscitation Signup and view all the answers

Which clinical presentation is most commonly associated with cardiogenic shock?

Anxiety and decreased urine output Signup and view all the answers

In managing neurogenic shock, which symptom distinguishes it from other types of shock?

Warm or cool, dry skin Signup and view all the answers

What are the common respiratory symptoms observed in anaphylactic shock?

Wheezing and stridor Signup and view all the answers

During your assessment, which complication should you anticipate in a patient experiencing septic shock?

Decreased blood pressure Signup and view all the answers

Which statement best describes the priority of safety equipment location in patient care?

It should be easily accessible and functional at all times. Signup and view all the answers

What does the baseline head-to-toe assessment ideally include at the beginning of a shift?

Vital signs and site-to-source line tracing Signup and view all the answers

In the context of hypovolemic shock, which of the following is a common nursing observation?

Cold, clammy skin and tachycardia Signup and view all the answers

What is the primary goal when managing a patient in septic shock regarding vital signs?

Maintain MAP above 65 mmHg Signup and view all the answers

Which laboratory test is essential to perform immediately in suspected septic shock?

Blood cultures Signup and view all the answers

What should be monitored closely to prevent complications during the management of septic shock?

Vital signs every 15 minutes initially Signup and view all the answers

When should enteral nutrition ideally begin in a patient with septic shock?

Within the first 24 hours Signup and view all the answers

What is a key prevention strategy to reduce the risk of septic shock in at-risk populations?

Advocate for timely catheter removal Signup and view all the answers

Which nutritional consideration is important for patients in septic shock?

Enteral feeding is preferred if risk factors exist Signup and view all the answers

What is a common complication that nursing staff should monitor for in patients with septic shock?

Multiple organ dysfunction syndrome (MODS) Signup and view all the answers

What should be prioritized in the immediate action plan for a patient experiencing septic shock?

Maximizing oxygen delivery and IV access Signup and view all the answers

What is a common nursing intervention for patients diagnosed with venothromboembolic disease?

Assess for changes in mobility tolerance Signup and view all the answers

What procedure is typically performed for cardiac tamponade?

Pericardiocentesis Signup and view all the answers

Which of the following interventions should be prioritized for managing obstruction in obstructive shock caused by a tension pneumothorax?

Immediate needle decompression Signup and view all the answers

When monitoring a patient with venothromboembolic disease, what symptom should prompt further evaluation?

Shortness of breath on exertion Signup and view all the answers

What is an essential nursing intervention for a patient with a spinal cord injury and neurogenic shock?

Stabilize the cervical spine with a collar Signup and view all the answers

What is a key focus in the nursing evaluation for patients receiving treatment for venothromboembolic disease?

Patient comfort during rest Signup and view all the answers

Which symptom indicates a potential deterioration in a patient with obstructive shock?

Persistent tachycardia Signup and view all the answers

What should be monitored continuously in a patient experiencing venothromboembolic disease?

Vital signs and signs of distress Signup and view all the answers

What is the main purpose of using vasopressor medications?

To elevate blood pressure and achieve a MAP greater than 65 mmHg Signup and view all the answers

Which adrenergic drug primarily stimulates β₁ receptors on heart muscles to increase contractility?

Dobutamine Signup and view all the answers

What does an increased serum osmolality indicate?

Fluid volume deficit Signup and view all the answers

Why should vasoactive medications ideally be administered through a central line?

To prevent tissue ischemia or necrosis from extravasation Signup and view all the answers

Which of the following statements about urine osmolality is true?

An increase indicates fluid volume deficit Signup and view all the answers

What effect does norepinephrine have when administered?

Constricts arteries and increases heart contractility Signup and view all the answers

At low doses, what effect does dopamine have on the body's arteries?

Dilation of visceral arteries, such as those to the kidneys Signup and view all the answers

What should be closely monitored when administering vasoactive medications?

Vital signs and hemodynamics Signup and view all the answers

What is the primary function of antihistamines in the management of anaphylaxis?

Alleviate pruritus and hives Signup and view all the answers

Which of the following describes the tonicity of a hypertonic solution?

It draws water out of cells, causing them to shrink. Signup and view all the answers

In the case of severe hypovolemic shock not caused by bleeding, which solution is generally preferred?

Crystalloid solutions Signup and view all the answers

What is a potential risk associated with the use of antihistamines after epinephrine treatment for anaphylaxis?

Sedation impairing self-recognition of symptoms Signup and view all the answers

Which component is specifically identified for IM use in an anaphylaxis kit?

Ampule of epinephrine Signup and view all the answers

What is a characteristic of crystalloids compared to colloids in fluid management?

They do not alter coagulation profiles. Signup and view all the answers

When using antihistamines post-anaphylaxis, which symptom should not be expected?

Increased alertness Signup and view all the answers

What role do glucocorticoids play in the management of anaphylaxis?

Prevent rebound or biphasic reactions Signup and view all the answers

Study Notes

Nursing 488: Supporting People with Life-Threatening Health Challenges - Multisystem Dysfunction

Course covers the nursing process for individuals with acute multi-system dysfunction, focusing on common pharmacological interventions and complex alterations like shock and acid/base imbalance.

Objectives

Demonstrate understanding of the nursing process across the lifespan for individuals with acute multi-system dysfunction.
Explore, discuss, and identify common pharmacological interventions for individuals with complex acute multi-system dysfunction, including shock and acid/base imbalance.

Shock

Features: Insufficient tissue perfusion (blood delivery) leading to cellular hypoxia and death; life-threatening medical emergency.
May be reversible with urgent interventions but can progress to multi-organ failure and death.
Multiple possible causes, grouped into categories.
Hypotension is a key clinical finding.

Multiple Organ Dysfunction Syndrome (MODS)

Target Organs: Cardiovascular, lung, gastrointestinal, liver, central nervous system (CNS), renal, and skin dysfunctions.
Multiple causes and resulting organ dysfunction patterns vary across patient populations. Pre-existing conditions (e.g., kidney disease) increase the likelihood of specific organ dysfunction.

Main Abnormalities in Shock Forms

Hypovolemic: Loss of blood volume.
Distributive: Inappropriately dilated arteries resulting in inappropriate blood flow distribution.
Cardiogenic: Inability of the heart to adequately pump blood.
Obstructive: Obstruction to blood flow.

Upstream Considerations

Planning: Know the patient's GOC designation, identify patients at risk for shock (anticipate symptoms), and monitor vital signs, I/O and labs.
Safety/Baseline Head-to-Toe Assessment: Complete this ASAP, document for the multidisciplinary team.
Safety Equipment Check: Know location of emergency equipment (e.g., crash cart, O2, suction equipment), and supplies in each patient room.

Goals for Shock

Prevention
Early recognition
Restoration of MAP > 65 mmHg to achieve adequate oxygenation and perfusion.

Clinical Presentation in Major Types of Shock (Table)

Presents a table summarizing cardiovascular, respiratory, skin, neurological and renal symptoms in different shock types (cardiogenic, hypovolemic, neurogenic, anaphylactic, septic, obstructive).

Oxygenation, Circulation, Drug Therapy and Supportive Therapy (Table)

Provides a table to describe oxygenation, circulation, drug therapy, and supportive therapies in various shock types. Includes specifics, e.g., restoring blood flow (cardiogenic), rapid fluid replacement (hypovolemic), and use of antibiotics/vasopressors (septic).

Septic Continuum

A graphic illustrating the continuum from infection to bacteremia to sepsis to septic shock to multiple organ dysfunction syndrome to death.

Urgent Clinical Assessment and Common Lab/Diagnostic Imaging Investigations (Table)

Lists the STAT laboratory tests (ABG, CBC, electrolytes, creatinine, GFR, liver panel, calcium, phosphate, magnesium, INR, PTT, troponin, D-Dimer, CRP, blood cultures, sputum culture, urinalysis, C&S, CXR, ECG, CTPE) and diagnostic imaging investigations (e.g., CXR, CTPE).

Nursing Interventions (Septic Shock)

Emphasizes immediate communication and collaboration, including identifying patients at risk, and using protocols like maximizing oxygenation and fluid resuscitation (maintain MAP > 65 mmHg). Ongoing assessment of vital signs and head-to-toe assessment is key.

Collaborative Care (Septic Shock)

Key points for collaborative care, including nutritional support, treatment of associated complications, fluid replacement (e.g., crystalloids and colloids). Continuous monitoring of the patient's condition for any changes in their status; providing emotional support to the patient/family; collaboration with the health team to coordinate care.

Key Points (Prevention)

Universal Precautions
Aseptic ports of entry precautions
Advocating for removal of catheters at earliest opportunity.
Identifying patients at risk: Elderly and immunocompromised patients
Actively monitoring for early signs of septic shock.

Nursing Interventions (Hypovolemic Shock)

Prevention, recognition, immediate communication/collaboration, and immediate action to restore fluid volume (e.g., IV access, monitoring of vital signs). Focuses on managing the underlying cause of volume deficit. Common fluid replacement classes include crystalloids and colloid solutions.

Nursing Interventions (Anaphylaxis)

Prevention by noting patient allergies, ensuring accuracy of allergy information matching Connect Care and proper medication administration and purpose clarification. Recognition of symptoms and immediate calling for help (clear closed-loop communication).
First-line treatment: intramuscular (IM) epinephrine administration, supplemental oxygen, and immediate intravenous (IV) access.

Anaphylaxis - Immediate/Treatment

Prompt removal and stop the cause of the reaction. Communicate, assess, and immediately administer intramuscular epinephrine, supplemental oxygen, and establish IV access. Document pertinent data and plan for follow-up.

Anaphylaxis - Adjunct Medications

Discusses glucocorticoid therapy to prevent reaction rebound and/or biphasic reactions.
Discusses that antihistamines can alleviate some symptoms but are not a primary treatment or cure during an anaphylactic reaction.

Crystalloids

Solutions containing electrolytes and fluids (normally found in the human body), used to compensate for insensible fluid losses as maintenance fluids and to correct specific electrolyte and fluid disturbances. They do not contain proteins and do not carry a risk of viral transmission or anaphylaxis.

Tonicity

Briefly explains isotonic, hypertonic and hypotonic solutions (effects on cell shape and fluid content).

IV Solutions

Discusses isotonic, hypotonic and hypertonic solutions and their respective concentrations (osmolarity). Key examples include 0.9% Normal Saline, Lactated Ringer's solutions, and D5W. Includes specifics about associated osmolarity levels.

Fluid Shifts and Edema

Explains osmotic force in drawing water across semipermeable membranes (e.g., solutions like Normal Saline and Lactated Ringers). Discusses oncotic pressure (plasma protein effect) and hydrostatic pressure (force exerted on blood vessel walls). Describes factors contributing to capillary permeability impacting fluid shifts (e.g., burns and allergic inflammation). Mentions how increased permeability leads to fluid shift.
Discusses serum and urine osmolality, their importance to evaluate fluid volume imbalances, and how these tests can be used to further understand fluid balance.

Vasopressor Medications

Key point: Adrenergic drug class use (dobutamine, dopamine, epinephrine, norepinephrine or phenylephrine) to increase blood pressure (MAP above 65 mmHg).

Vasoactive Medications - Nursing Considerations

Vasopressors are ideally administered through a central line.
If extravasation occurs, it can lead to tissue ischemia or necrosis.
Ongoing, stringent monitoring of vital signs necessary while the patient is in a specialized critical care unit (e.g., ICU, CCU, trauma or ER).

Vasoactive Medications - Adverse Effects

Lists common adverse effects (CNS, cardiovascular and gastrointestinal) related to the use of vasoactive medications.

Cardiogenic Shock - Collaborative Care

Interventions to restore blood flow to the heart muscle include thrombolytic therapy, angioplasty with stenting, emergency revascularization (CABG), valve replacement (flail valves), pericardiocentesis (tamponade), and pacemaker (heart block).

Obstructive Shock - Treatment Interventions

Treatment interventions are aimed at the cause; this may involve pericardiocentesis for cardiac tamponade; needle decompression, or placing chest tubes for tension pneumothorax; thrombolytics or embolectomy for pulmonary embolism.

Venothromboembolic Disease - Nursing Interventions

Key is to encourage mobility if appropriate, assess for and manage symptoms such as syncope/presyncope, shortness of breath and other complications. Implement passive range-of-motion exercises, encourage coughing, and teach the patient about their daily medications, restrictions, and signs/symptoms to watch for.

Nursing Implications

Includes considerations on continuous observation of the patient, planning and implementing nursing interventions and therapies, providing emotional support and collaboration with other health team members. Includes details about how to continuously observe the patient's condition to identify any changes in their status.

Neurogenic Shock - Nursing Interventions (Spinal Cord Injury)

Includes C-spine precautions, treatment of hypotension and bradycardia (vasopressors), cautious use of fluids, preventing hypothermia, and monitoring for complications like pressure injuries.

Disseminated Intravascular Coagulation (DIC)

Highlights that DIC is caused by an underlying disease or condition and its rapid evolution (hours- days), including significant bleeding symptoms such as thrombocytopenia, elevated PTT/INR, elevated D-Dimer and decreased fibrinogen levels. Points to supportive therapy like platelet and coagulation factor replacement (e.g., fresh frozen plasma and cryoprecipitate).

Respiratory Failure/Acute Respiratory Distress Syndrome (ARDS) - Nursing Interventions

Focuses on treating the underlying disorder, providing oxygen, maintaining fluid balance, administering medications, patient/family teaching, and ensuring appropriate family-centered care. Includes consideration for patients who are CO2 retainers.

Acute Respiratory Failure - Drug Therapy

Covers bronchodilators for bronchospasm relief, corticosteroids to decrease airway inflammation, and possibly diuretics or nitrates for pulmonary congestion caused by heart failure. IV antibiotics may also be used for infections. Oxygen therapy should consider whether the patient is a carbon dioxide retainer.

Acute Respiratory Distress Syndrome (ARDS) - Collaborative Care

Patient transfer to the ICU and management, including intubation, mechanical ventilation with positive end-expiratory pressure (PEEP), and specific considerations like awake proning.

Health Promotion Priorities

Encourages coughing, deep breathing, notifying the nurse immediately about chest pain, tightness or shortness of breath, promoting regular movement and ROM exercises, and discouraging venous stasis.
Addresses risk factors to respiratory conditions
Encourages mobility

Immediate Support (Code 66/Blue)

Defines the purpose, activation criteria, goals and interventions for Code 66 and Code Blue situations (life-threatening emergencies).

Common "STAT" Tests

Lists common "STAT" blood tests frequently ordered for patients with potential severe conditions, like CBC, electrolytes, creatinine, troponins, ECG, ABG, CXR and blood cultures.

SBAR Reporting

Describes SBAR as a structured communication tool for healthcare professionals.

IPASS

Presents the IPASS structure for passing critical information about a patient to other healthcare providers.

Thank You

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Description

Test your knowledge on the management of cardiogenic shock and related medical interventions. This quiz covers crucial topics such as myocardial injury evaluation, the role of vasoactive medications, and the priority actions during various shock types. Learn about essential nursing interventions and diagnostic approaches to improve patient outcomes in critical care settings.