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Questions and Answers
What is the rationale for administering dopamine to a client with decreased cardiac output, rising creatinine level, and anuria?
What is the rationale for administering dopamine to a client with decreased cardiac output, rising creatinine level, and anuria?
Which of the following precautions should be taken when administering IV dopamine?
Which of the following precautions should be taken when administering IV dopamine?
What is the optimal outcome for a client receiving dopamine for decreased cardiac output and anuria?
What is the optimal outcome for a client receiving dopamine for decreased cardiac output and anuria?
What is the most likely outcome for a client with decreased cardiac output, rising creatinine level, and anuria, despite receiving dopamine?
What is the most likely outcome for a client with decreased cardiac output, rising creatinine level, and anuria, despite receiving dopamine?
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Which of the following is a key advantage of using an arterial line for hemodynamic monitoring?
Which of the following is a key advantage of using an arterial line for hemodynamic monitoring?
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Why is it important to perform the Allen test before placing an arterial line?
Why is it important to perform the Allen test before placing an arterial line?
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What is the advantage of a pulmonary artery catheter for hemodynamic monitoring?
What is the advantage of a pulmonary artery catheter for hemodynamic monitoring?
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What is the purpose of the phlebostatic axis in hemodynamic monitoring?
What is the purpose of the phlebostatic axis in hemodynamic monitoring?
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What is the primary goal of aggressive fluid resuscitation in sepsis management?
What is the primary goal of aggressive fluid resuscitation in sepsis management?
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Which laboratory test is NOT typically included in the initial blood work for sepsis diagnosis?
Which laboratory test is NOT typically included in the initial blood work for sepsis diagnosis?
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What is the recommended timeframe for administering antibiotics to a patient suspected of septic shock?
What is the recommended timeframe for administering antibiotics to a patient suspected of septic shock?
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Which of the following medications is commonly used as a vasopressor in septic patients?
Which of the following medications is commonly used as a vasopressor in septic patients?
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What is a possible outcome if the fluid resuscitation in a septic patient is successful?
What is a possible outcome if the fluid resuscitation in a septic patient is successful?
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What type of fluid solution is commonly used for resuscitation in sepsis management?
What type of fluid solution is commonly used for resuscitation in sepsis management?
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Which of the following statements is true regarding the use of low-dose corticosteroids in septic shock management?
Which of the following statements is true regarding the use of low-dose corticosteroids in septic shock management?
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Which laboratory test is crucial for assessing the severity of sepsis and monitoring treatment response?
Which laboratory test is crucial for assessing the severity of sepsis and monitoring treatment response?
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What treatment is sometimes used to address DIC but is not considered routine?
What treatment is sometimes used to address DIC but is not considered routine?
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What is NOT a recognized risk factor for developing MODS?
What is NOT a recognized risk factor for developing MODS?
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Which statement accurately describes the physiological response leading to MODS?
Which statement accurately describes the physiological response leading to MODS?
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What is the primary cause of infection following trauma that can lead to MODS?
What is the primary cause of infection following trauma that can lead to MODS?
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What impact does an increasing number of affected organs have on the mortality rate associated with MODS?
What impact does an increasing number of affected organs have on the mortality rate associated with MODS?
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Which treatment option is appropriate for fluid resuscitation in MODS?
Which treatment option is appropriate for fluid resuscitation in MODS?
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How does lactic acidosis contribute to MODS?
How does lactic acidosis contribute to MODS?
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Which demographic is at an increased risk for MODS due to extreme age?
Which demographic is at an increased risk for MODS due to extreme age?
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What is the name of the medical triad that indicates cardiac tamponade?
What is the name of the medical triad that indicates cardiac tamponade?
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Which of the following is NOT a symptom of cardiac tamponade?
Which of the following is NOT a symptom of cardiac tamponade?
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What is the primary cause of sepsis?
What is the primary cause of sepsis?
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Which of the following is a hallmark of sepsis?
Which of the following is a hallmark of sepsis?
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What is the significance of having at least 2 SIRS criteria components in diagnosing sepsis?
What is the significance of having at least 2 SIRS criteria components in diagnosing sepsis?
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Which of the following is an example of a SIRS criteria component?
Which of the following is an example of a SIRS criteria component?
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What is the relationship between SIRS and sepsis?
What is the relationship between SIRS and sepsis?
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Which of the following is a potential cause of shock in the client?
Which of the following is a potential cause of shock in the client?
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What is the primary consequence of vasodilation in sepsis?
What is the primary consequence of vasodilation in sepsis?
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What is the primary role of catecholamines in the body's response to hypotension?
What is the primary role of catecholamines in the body's response to hypotension?
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Which of the following is a hallmark of the progressive stage of shock?
Which of the following is a hallmark of the progressive stage of shock?
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What is the primary function of renin in the body's response to shock?
What is the primary function of renin in the body's response to shock?
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What is the significance of hyperventilation in shock?
What is the significance of hyperventilation in shock?
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What is the primary concern regarding the client's restlessness?
What is the primary concern regarding the client's restlessness?
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What are the clinical manifestations of shock in the refractory stage?
What are the clinical manifestations of shock in the refractory stage?
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Which vital sign finding is most likely to indicate the client is progressing towards shock?
Which vital sign finding is most likely to indicate the client is progressing towards shock?
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What is the relationship between oxygen delivery (DO2) and oxygen consumption (VO2)?
What is the relationship between oxygen delivery (DO2) and oxygen consumption (VO2)?
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Which of the following is NOT a major factor in determining cardiac output?
Which of the following is NOT a major factor in determining cardiac output?
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What is the primary reason that oxygen delivery (DO2) is measured?
What is the primary reason that oxygen delivery (DO2) is measured?
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Which of the following is an example of hypovolemic shock?
Which of the following is an example of hypovolemic shock?
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What is the significance of measuring oxygen consumption (VO2) in a critically ill patient?
What is the significance of measuring oxygen consumption (VO2) in a critically ill patient?
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How does afterload affect cardiac output?
How does afterload affect cardiac output?
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Why is it critical to monitor oxygen consumption (VO2) in a patient experiencing shock?
Why is it critical to monitor oxygen consumption (VO2) in a patient experiencing shock?
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Flashcards
Shock
Shock
A life-threatening condition where the circulatory system fails to supply adequate oxygen to meet metabolic demands.
Oxygen Delivery (DO2)
Oxygen Delivery (DO2)
The amount of oxygen delivered to tissues, evaluated through cardiac output and arterial oxygen content.
Oxygen Utilization (VO2)
Oxygen Utilization (VO2)
The measure of how effectively tissues extract oxygen from the blood, normal levels are 60%-75%.
Cardiac Output
Cardiac Output
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Preload
Preload
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Afterload
Afterload
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Contractility
Contractility
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Hypovolemic Shock
Hypovolemic Shock
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Neural compensation
Neural compensation
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Endocrine compensation
Endocrine compensation
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Progressive shock
Progressive shock
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Refractory shock
Refractory shock
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Chemical compensation
Chemical compensation
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Hypotension triggers
Hypotension triggers
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Tachypnea
Tachypnea
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Metabolic acidosis
Metabolic acidosis
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Cardiac Tamponade
Cardiac Tamponade
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Beck's Triad
Beck's Triad
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SIRS
SIRS
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Sepsis
Sepsis
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Septic Shock
Septic Shock
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Symptoms of Cardiac Tamponade
Symptoms of Cardiac Tamponade
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Cytokines in Sepsis
Cytokines in Sepsis
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Serum Lactate
Serum Lactate
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Vasodilation in Septic Shock
Vasodilation in Septic Shock
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Blood Cultures
Blood Cultures
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Complete Blood Count (CBC)
Complete Blood Count (CBC)
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Coagulation Studies
Coagulation Studies
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Aggravated Fluid Resuscitation
Aggravated Fluid Resuscitation
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Norepinephrine (Norepi)
Norepinephrine (Norepi)
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Corticosteroid Therapy
Corticosteroid Therapy
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Arterial Blood Gas (ABG)
Arterial Blood Gas (ABG)
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Fresh Frozen Plasma
Fresh Frozen Plasma
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Platelet Replacement
Platelet Replacement
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Multiple Organ Dysfunction Syndrome (MODS)
Multiple Organ Dysfunction Syndrome (MODS)
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Risk Factors for MODS
Risk Factors for MODS
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Impact of MODS on Health
Impact of MODS on Health
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Lactic Acidosis
Lactic Acidosis
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Oxidative Stress
Oxidative Stress
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Sepsis and MODS Connection
Sepsis and MODS Connection
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Dopamine Administration
Dopamine Administration
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Cardiac Output Decrease
Cardiac Output Decrease
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Anuria
Anuria
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Creatinine Level Rising
Creatinine Level Rising
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Pulmonary Artery Catheter
Pulmonary Artery Catheter
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Central Venous Pressure (CVP)
Central Venous Pressure (CVP)
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Allen Test
Allen Test
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Transducer Positioning
Transducer Positioning
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Study Notes
Shock, Sepsis, & Critical Cardio
- Shock is a life-threatening syndrome
- The circulatory system can't supply adequate oxygen to tissues.
- Oxygen delivery (DO2) is the amount of oxygen delivered to tissues
- Oxygen utilization (VO2) reflects the relationship between oxygen delivery and extraction at tissue level.
- CO = Cardiac output - amount of blood ejected every minute
- Preload is blood in ventricles at end of diastole
- Afterload is the resistance to flow that the ventricle must overcome to eject blood.
- Contractility is the force of mechanical contraction.
Learning Objectives
- Explain pathophysiology for perfusion.
- Explore risk factors that contribute to critically ill patients experiencing altered perfusion.
- Describe the impact of altered perfusion on critically ill clients' overall health.
- Differentiate clinical presentations in critically ill clients experiencing altered perfusion.
- Explore roles of nurses caring for critically ill clients experiencing altered perfusion.
- Apply the nursing process while caring for critically ill clients experiencing altered perfusion.
Classification of Shock
- Hypovolemic: Not enough blood volume (burns, significant blood loss)
- Cardiogenic: Inadequate heart pumping.
- Distributive: Disease causes poor vascular tone (sepsis, anaphylaxis).
- Obstructive: Mechanical barrier to ventricular filling (cardiac tamponade, tension pneumothorax, PE).
Assessment
- Central Nervous System: Restlessness, confusion, irritability, lethargy, coma (prolonged).
- Cardiovascular: Hypotension, narrow pulse pressure, tachycardia (then bradycardia, Skin color- cool, mottled, cyanotic (blood shunted), warm, flushed).
- Peripheral pulses: Thready
- Capillary refill: Sluggish
- Respiratory: Tachypnea, ABG's, pulse oximetry
- Renal: Oliguria (first), then anuria, increased creatinine.
- Gastrointestinal: Hypoactive bowel sounds, nausea, vomiting.
Pathophysiology: Distributive Shock
- Decreased SVR & Perfusion
- Septic shock: Inflammatory cytokines damage vessels & initiate clotting.
- Anaphylactic shock: Severe hypersensitivity.
- Neurogenic shock: Autonomic dysregulation caused by spinal cord injury above T6
- Toxic shock: Infection from Staphylococcus aureus causes excessive cytokine activation.
Stages of Shock
- Compensatory: Neural & endocrine compensatory mechanisms.
- Progressive: Failure of compensatory mechanisms, profound hypoperfusion, worsening metabolic acidosis, respiratory acidosis.
- Refractory: Prolonged inadequate blood supply, cell death, multisystem organ failure, death imminent.
Complications: Disseminated Intravascular Coagulation (DIC)
- Blood clots throughout the body, block small blood vessels.
- Risk factors: Pregnancy complications, blood infections, cancer, blood transfusions, liver dysfunction, shock, trauma, burns.
- Clinical presentation: Bleeding, hypovolemia, hypotension, decreased CO & LOC, ecchymosis, hematoma, petechiae, tissue necrosis, dyspnea, epistaxis, conjunctival bleeding.
- Lab diagnostics: Increased PT/PTT, decreased fibrinogen & platelets count.
Complications: Multiple Organ Dysfunction Syndrome (MODS):
- Extreme response to injury, sepsis, or burns.
- Constant release of immune mediators leads to oxidative stress.
- Cellular oxygenation decreased causing anaerobic metabolism & lactic acidosis.
- The increase in metabolic acidosis leads to MODS, causing muscle and vital organ breakdown.
- Risk Factors: Chronic disease, immunosuppressive therapy, extreme age, malnutrition, cancer, trauma, alcoholism, sepsis.
- Clinical Presentation: Respiratory, cardiovascular, hepatic, gastrointestinal, integumentary, & central nervous system issues; often leading to death.
Treatments & Therapies
- Shock: IV fluids (at least 30ml/kg for first three hours), mechanical ventilation, IV antibiotics, norepinephrine (for MAP), blood components, advanced mechanical support (intra-aortic balloon pump, ECMO), nutrition.
- Sepsis/Septic Shock: Aggressive fluid resuscitation, targeted antibiotics within 1 hour, Vasopressors, crystalloids (NS and LR), steroids, antihistamines & early intervention
- DIC: Fresh frozen plasma, platelets, whole blood and anticoagulants, IV fluids (LR/NS), treatment of underlying cause
- MODS: Supportive care, antibiotics, mechanical ventilation, IV fluids, and medications.
Cardiac Tamponade
- Fluid accumulation around the heart.
- 3 Phases: Pericardial fluid builds up, ventricles can't expand fully, CO decreases rapidly.
- Risk factors: central line placement, malignancies, infection, complications from MI, aortic dissection, previous high-risk surgery, aortic aneurysm, hypoparathyroidism.
Cardiac Output
- Blood ejected per minute.
- Influenced by preload, afterload, and contractility.
Other Important Information
- Learning objectives
- Different types of shock (hypovolemic, cardiogenic, distributive, obstructive).
- Stages of shock (compensatory, progressive, refractory)
- Treatment for each type of shock is crucial to preventing further complications.
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Description
This quiz explores the rationale, precautions, and outcomes associated with administering dopamine to clients experiencing decreased cardiac output and related conditions. It also covers hemodynamic monitoring techniques and the management of sepsis. Test your knowledge on key nursing concepts and pharmacological interventions.