Critical Perfusion Quiz

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Questions and Answers

What is the result of decreased systemic vascular resistance (SVR) in the context of shock?

Increased blood pressure

Improved organ function

Decreased tissue oxygenation (correct)

Increased cardiac output

Which type of shock results from a loss of 25-30% of circulating blood volume?

Distributive shock

Cardiogenic shock

Hypovolemic shock (correct)

Obstructive shock

Septic shock is characterized by the release of which type of molecules that damage blood vessel linings?

Neurotransmitters

Antibodies

Hormones

Inflammatory cytokines (correct)

What condition is primarily caused by a spinal cord injury above the level of T6?

Neurogenic shock Signup and view all the answers

Anaphylactic shock is mediated by which immunoglobulin?

IgE Signup and view all the answers

Obstructive shock involves which of the following?

Blockage of blood flow Signup and view all the answers

Which of the following is NOT a subcategory of distributive shock?

Cardiogenic shock Signup and view all the answers

Toxic shock syndrome is primarily associated with which type of infection?

Staphylococcus aureus Signup and view all the answers

What is necessary to prepare a patient for surgery before the procedure?

Document lab work Signup and view all the answers

Which of the following is critical for post-operative care?

Hemodynamic monitoring Signup and view all the answers

What is the primary purpose of grafting blood vessels during CABG surgery?

To improve blood flow to the heart muscle Signup and view all the answers

Which medication class is primarily used to lower cholesterol levels in surgical patients?

Statins Signup and view all the answers

What is a primary consideration for ensuring the availability of resources before surgery?

Personnel allocation Signup and view all the answers

Which of the following is a nonmodifiable risk factor for coronary artery disease?

Family history Signup and view all the answers

Which of the following activities should be completed post-operative to manage patient care effectively?

Recognize and manage complications Signup and view all the answers

Which chronic condition is least likely to contribute to the need for CABG surgery?

Asthma Signup and view all the answers

During CABG surgery, what kind of pain might a patient experience post-operatively?

Incisional pain Signup and view all the answers

What type of nutrition should be initiated within 24 hours after surgery?

Enteral nutrition Signup and view all the answers

Which laboratory study is NOT typically required before undergoing CABG surgery?

Urinalysis Signup and view all the answers

Which of the following options is NOT a key factor in patient preparation for surgery?

Radiological imaging Signup and view all the answers

Which aspect is NOT considered a part of overall health during CABG recovery?

Therapeutic relationships Signup and view all the answers

What is a recommended topic to cover during client teaching prior to surgery?

Post-operative pain management Signup and view all the answers

What role does the nurse play in the care of a client undergoing CABG surgery?

Consider various factors affecting patient care Signup and view all the answers

Which of the following psychological health impacts might a patient experience post-CABG?

Anxiety Signup and view all the answers

What is one of the primary roles of a nurse in patient care?

Frequent assessments to determine change in condition Signup and view all the answers

What should a nurse prioritize when analyzing cues during patient assessment?

Identifying early subtle and apparent changes to the client’s condition Signup and view all the answers

In planning patient care, which of the following is important for a nurse to do?

Collaborate with members of the health care team Signup and view all the answers

Which nursing action is crucial during the implementation phase?

Implementing appropriate nursing interventions Signup and view all the answers

What is a primary goal of the coronary artery bypass graft (CABG) procedure?

To restore blood flow to the heart muscle caused by narrowing of the coronary arteries Signup and view all the answers

Which of the following nursing interventions would be appropriate in a situation requiring volume resuscitation?

Positioning the client with feet elevated Signup and view all the answers

What is an integral part of evaluating patient outcomes?

Determining if the patient’s condition improved, worsened, or stayed the same Signup and view all the answers

What should a nurse do to ensure effective education for clients and care partners?

Adapt the education based on the client’s comprehension and needs Signup and view all the answers

Which of the following is not a component of the Sequential Organ Failure Assessment (SOFA) score?

Gastrointestinal Signup and view all the answers

What is one of the primary roles of a nurse in managing a client with organ failure?

Update the health care team on the client’s condition Signup and view all the answers

Which of the following is included in routine laboratory assessments for clients with possible organ failure?

Blood cultures Signup and view all the answers

Which nursing action is essential for the evaluation phase of the nursing process?

Assessing the effectiveness of interventions Signup and view all the answers

What is a common treatment modality for respiratory failure in critically ill patients?

Mechanical ventilation Signup and view all the answers

What is the main purpose of monitoring electrolytes in patients with organ failure?

To assess renal function Signup and view all the answers

Which intervention should be prioritized for a patient showing signs of organ failure?

Frequent assessments Signup and view all the answers

In the context of managing a patient with organ failure, what does IV fluids primarily aim to address?

Correcting electrolyte imbalances Signup and view all the answers

Which of the following medications is not identified as part of the emergency medications used during a cardiac arrest?

Ibuprofen Signup and view all the answers

What is a common risk factor associated with Abdominal Aortic Aneurysm (AAA)?

Hypertension Signup and view all the answers

Which therapy is generally involved in the immediate treatment of cardiopulmonary arrest?

Defibrillation Signup and view all the answers

In the context of an Abdominal Aortic Aneurysm, which symptom is typically indicative of a ruptured aneurysm?

Sudden onset back and abdominal pain Signup and view all the answers

Which of the following is NOT part of the LEAN acronym for emergency medications during cardiac arrest?

Amiodarone Signup and view all the answers

Which medication is utilized specifically for its role in treating cardiac arrest by facilitating heart rhythm stabilization?

Magnesium Signup and view all the answers

Which of the following is NOT a typical characteristic of an Abdominal Aortic Aneurysm?

Severe bilateral leg edema Signup and view all the answers

When considering treatment options for cardiopulmonary arrest, which of the following therapies offers the benefit of oxygen support?

Oxygen Therapy Signup and view all the answers

Study Notes

Critical Alterations in Perfusion

Shock is a result of circulatory failure, causing tissue hypoxia, cellular death, and organ dysfunction.
Types of shock include:
- Distributive shock: Decreased systemic vascular resistance (SVR) and perfusion.
- Hypovolemic shock: Loss of 25-30% of circulating blood volume.
- Cardiogenic shock: Decreased cardiac output leading to systemic hypoperfusion.
- Obstructive shock: Blockage of blood flow disrupting circulation to major arteries.
  - Subcategories of distributive shock include septic shock (inflammatory cytokines damaging blood vessels), anaphylactic shock (allergic hypersensitivity), and neurogenic shock (autonomic dysregulation).
Shock stages include:
- Initial stage: Low oxygen to organs, increased lactic acid.
- Compensatory stage: Aldosterone release, vasoconstriction to vital organs, increased heart rate and catecholamine release.
- Progressive stage: Oliguria or anuria, altered level of consciousness, pallor, cool and clammy skin, electrolyte imbalance and hypotension.
- Refractory stage: Irreversible cellular and organ failure, impending death.

Pathophysiology: Distributive Shock

Decreased SVR and Perfusion are key features.
Septic shock results from inflammatory cytokines damaging blood vessel walls.
Anaphylactic shock arises from severe allergic reactions triggered by allergens.
Neurogenic shock is caused by autonomic dysfunction, often due to spinal cord injury above T6.
Toxic shock is linked to Staphylococcus aureus infection, leading to excessive cytokine activation.

Pathophysiology: Hypovolemic Shock

Occurs when intravascular volume is reduced by 25% to 30%, causing poor cardiac output.
Hemorrhagic shock is a type caused by insufficient blood and oxygen perfusion, creating an imbalance between oxygen supply and demand to body tissues.

Pathophysiology: Cardiogenic Shock

Circulatory failure and hypoperfusion due to cardiac dysfunction, causing myocardial ischemia.

Pathophysiology: Obstructive Shock

Blood flow is blocked and circulation to major organs is impaired.
Conditions include pulmonary embolism, tension pneumothorax, mechanical ventilation (high PEEP), aortic dissection, pericardial tamponade, pericardial effusion, and cardiac mass.

Shock: Etiology

Sepsis, pancreatitis, burns, infection commonly cause shock.
Neurogenic shock (spinal cord injury or trauma), hypovolemic shock (loss of blood), anaphylactic shock (allergic reaction) also factor in.

Shock: Impact on Overall Health

Life-threatening condition with risk to all body systems.
Increased mortality in older adults.

Phases of Shock: Clinical Presentation

Initial phase: Subtle manifestations, pale skin, feeling unwell or anxious.
Compensatory phase: Activated sympathetic nervous system, tachycardia, tachypnea, decreased peripheral pulses, stable or fluctuating BP, increased capillary refill time
Progressive phase: Deteriorating condition, altered consciousness, weak pulses, pale or ashen skin, increased capillary refill time, oliguria or anuria.
Refractory phase: Impending death, comatose and hypotensive, unresponsive to vasopressors, renal failure, and respiratory failure despite oxygen therapy.

Shock: Lab & Diagnostic Testing

Complete blood count (CBC), Electrolytes, Blood Urea Nitrogen (BUN), Creatinine (CRE), Prothrombin time (PT)/Partial thromboplastin time (PTT), Alanine transaminase (ALT)/Aspartate transaminase (AST), Lactate, Blood, urine, and sputum cultures, Cardiac enzymes, Arterial blood gas (ABGs).
ECG, Chest X-ray, CT scan, are also used.

Shock: Role of the Nurse

Patient/family education about ICU routines and environment.
Reinforcement of information on diagnosis, treatment, and prognosis of shock.

Shock: Nursing Process (1 of 3)

Recognize subtle changes in physical status (vital signs, mental status, hemodynamics, urine output, respiratory status, cardiovascular status).
Frequent assessments are essential.
Analyze hemodynamics and assessment findings to identify client needs.

Shock: Nursing Process (2 of 3)

Prioritize suspected diagnoses/hypotheses and possible treatment plans based on the early manifestations.
Consult with multiple disciplines/healthcare professionals for an optimal treatment approach.
Develop plan of care that encompasses appropriate interventions.
Ensure sufficient supplies for anticipated changes in patient condition.

Shock: Nursing Process (3 of 3)

Constantly evaluate patient response to interventions.
Evaluate trends, lab values, and assessment findings.
Monitor for improvements or deterioration.

Shock: Treatments & Therapies

Supportive care, including IV fluids, mechanical ventilation, hemodynamic monitoring with pulmonary artery or arterial lines, and IV antibiotics.
Norepinephrine or other vasopressors and inotropes to manage blood pressure and cardiac output.
Consider blood or blood products.
Consider mechanical circulatory support such as a ventricular assist device (VAD), extracorporeal membrane oxygenation (ECMO), or cardiac transplant.
Nutritional support (enteral/parenteral) is also crucial .

Hemodynamic Monitoring

Monitors arterial pressure by using radial artery.
Provides waveform and constant blood pressure readings to the healthcare team.
Allows identification of trends or abrupt changes in blood pressure.

Cardiac Tamponade: Pathophysiology

Fluid accumulation around the heart, leading to pericardial space enlargement where the ventricles can no longer relax.
Three phases of tamponade are characterized.
Phase one: fluid accumulation in the pericardial space stiffens ventricles.
Phase two: Cardiac Output decreases, as the heart cannot fill completely.
Phase three: Continued fluid accumulation leads to fatal cardiac failure.

Cardiac Tamponade: Etiology

Central line placement, malignancies, infection.
Complications from MI, aortic dissection, previous high-risk surgery. Aortic aneurysm, Hypoparathyroidism.
Kidney failure, Leukemia, and radiation to the chest.

Cardiac Tamponade: Impact on Overall Health

Anxiety, restlessness, difficulties breathing, heart failure, edema, bleeding, and potential death.

Cardiac Tamponade: Clinical Presentation

Hypotension, jugular vein distension, and muffled heart sounds.

Pulsus Paradoxus

Can indicate pericardial effusion as a cause of cardiac tamponade.
Characterized by systolic blood pressure falling more than 10 mmHg upon inspiration

Lab & Diagnostic Studies (Cardiac Tamponade)

Echocardiogram, ECG, Chest X-ray, CT scan, cardiac MRI, coronary angiography, and right heart catheterization

Role of the Nurse (Cardiac Tamponade)

Frequent assessments to determine changes in the patient's condition.
Review of health records, identifying necessary resources, performing safety assessments, and being aware of one's own knowledge and skills required for patient care.
Providing education to patients and care partners.

Coronary Artery Bypass Graft (CABG): Nursing Process

Recognize cues (assessment).
Analyze cues (analysis).
Prioritize hypotheses (analysis).
Generate solutions (planning).
Take actions (implementation).
Evaluate outcomes (evaluation).

Coronary Artery Bypass Graft (CABG): Etiology

Nonmodifiable risk factors such as age, gender, family history are key factors in coronary artery disease.
Modifiable risk factors include diabetes, hypertension, hypercholesterolemia, obesity, poor diet, and smoking contribute to the need for CABG surgery.

Coronary Artery Bypass Graft (CABG): Impact on Overall Health

Physiological health issues such as pain at the incision site, muscle pain, throat pain and pain from discomfort from chest tubes,
Psychological health problems such as anxiety and depression.
Other overall health concerns can also arise from the surgery.

Coronary Artery Bypass Graft (CABG): Lab and Diagnostic Studies

Complete blood count (CBC), liver enzymes, and coagulation studies.

Coronary Artery Bypass Graft (CABG): Role of the Nurse

Assessment of resources, personnel, bed availability.
Pre-op aspects including document lab work, informed consent, and history and physical.
Post-op factors such as hemodynamic monitoring and preventing complications.

Valve Replacement: Pathophysiology

Heart valves (mitral, tricuspid, aortic, and pulmonary) are considered.
Open, shut, prolapse, and stenosis states of the valves.

Valve Replacement: Etiology

Age, family history, congenital heart disease, lack of exercise, diabetes, high cholesterol, hypertension, endocarditis, myocardial infarction, and rheumatic fever are risk factors.

Valve Replacement: Impact on Overall Health

High surgical risk for patients of advanced age with multiple comorbidities.
Potential positive or negative effect on quality of life. Evaluation of the impact of the surgery on quality of life is a crucial part of the post-operative process.

Valve Surgery: Clinical Presentation

Manifestations include shortness of breath, heart murmur, irregular heartbeat, chest pain, exhaustion, and edema in lower extremities.

Valve Surgery: Role of the Nurse

Communication, supply chain, staffing, and client safety.
Strategies for preventing medical errors and coping mechanisms are also important.
Addressing and treating pain.
Patient and family education.

Valve Surgery: Nursing Process

Recognize cues (assessment).
Analyze cues (analysis).
Prioritize hypotheses (analysis).
Generate solutions (planning).
Take action (Implementation).
Evaluate outcomes (evaluation).

Valve Surgery: Treatments & Therapies

Transcatheter aortic valve replacement (TAVR) surgery.
Pharmacology (medications to manage pain or associated conditions).
Nutritional support.
Monitoring hemodynamics and IV therapy.
Providing client and family education and support.

Cardiopulmonary Arrest: Pathophysiology

Electrical malfunction in the heart,
Sudden cessation of cardiac function,
Client stops breathing and becomes unresponsive,
Death occurs within minutes without intervention.

Cardiopulmonary Arrest: Rhythms

Shockable rhythms (ventricular fibrillation, ventricular tachycardia).
Non-shockable rhythms (cardiac asystole, pulseless electrical activity).

Cardiopulmonary Arrest: Etiology

Ischemic heart disease, hypovolemia, myocardial dysfunction, vasodilation that leads to septic shock, heart failure, cardiac tamponade, valvular heart disease, pulmonary embolism, and airway obstruction.

Cardiopulmonary Arrest: Clinical Presentation

Fatigue, weakness, dizziness, syncope, chest pain, shortness of breath, vomiting, palpitations, back pain.

Cardiopulmonary Arrest: Lab & Diagnostic Studies

ECG, coronary angiography, stress tests, chest x-rays, CT scans of the chest, echocardiograms, troponins, creatinine kinase, arterial blood gases, brain natriuretic peptide (BNP), complete blood count (CBC), metabolic panel, lipid panel, prothrombin time, partial thromboplastin time, D-dimer. These lab and diagnostic methods are used to evaluate the patient's condition and determine the appropriate responses.

Cardiopulmonary Arrest: Role of the Nurse

First responder duties such as assuring IV access, medication administration, oxygen delivery, and ventilation.
Performing CPR and recording vital times, rhythms, and actions during a code, as a leader in the healthcare team.
Providing support to patients and family members.

Cardiopulmonary Arrest: Nursing Process

Recognize cues (assessment).
Analyze cues (analysis).
Prioritize hypotheses (analysis).
Generate solutions (planning).
Take actions (Implementation).
Evaluate outcomes (evaluation).

Cardiopulmonary Arrest: Treatments and Therapies

Defibrillation, cardioversion, medications (epinephrine, amiodarone, lidocaine, atropine, Sodium Bicarbonate, Calcium, Magnesium, Dextrose), IV therapy, oxygen therapy, therapeutic hypothermia to manage emergency situations, and potential medications as part of cardiac arrest management.

Abdominal Aortic Aneurysm: Pathophysiology

Aneurysm is an abnormal widening or ballooning of the arterial wall.

Abdominal Aortic Aneurysm: Risk Factors

Atherosclerosis, smoking, sex, family history, hypertension, coronary artery disease, peripheral artery disease, renal insufficiency, COPD, and CHF are risk factors.

Abdominal Aortic Aneurysm: Clinical Presentation

Most AAAs are initially asymptomatic.
Ruptured AAAs present with sudden onset back and abdominal pain, abdominal distension, and signs and symptoms of hemorrhagic shock (Cullen's sign, Turner's sign).
They usually present with an audible bruit or a palpable pulsatile abdominal mass.

Abdominal Aortic Aneurysm: Role of the Nurse

Client teaching and provision of emotional support.

Abdominal Aortic Aneurysm: Nursing Process

Recognize cues (assessment).
Analyze cues (analysis).
Prioritize hypotheses (analysis).
Generate solutions (planning).
Take actions (Implementation).
Evaluate outcomes (evaluation).

Abdominal Aortic Aneurysm: Treatments and Therapies

Statins, beta-blockers, iron supplements, supervised exercise programs, respiratory therapy, smoking cessation, and surgical options such as endovascular aneurysm repair (EVAR) or open repair.

Systemic Inflammatory Response Syndrome (SIRS):

Characterized by inflammation and the release of cytokines.
Infection-related condition that leads to inflammation.
Conditions include pancreatitis, trauma, and burns.

Systemic Inflammatory Response Syndrome (SIRS): Clinical Presentation

Body temperature greater than 38°C or less than 36°C.
Heart rate greater than 90 bpm.
Tachypnea greater than 20 bpm or PaCO2 less than 32, and.
WBC less than 4,000/mm³ or greater than 12,000/mm³ or greater than 10% immature (band) forms.

Systemic Inflammatory Response Syndrome (SIRS): Lab & Diagnostic Studies

Blood cultures, complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), and platelet counts.

Systemic Inflammatory Response Syndrome (SIRS): Role of the Nurse

Assess the patient to ensure hemodynamic stability, and communicate findings to other healthcare providers in the care team.
Prevent progression to shock.
Educate patients and families.
Assess patients and families' coping mechanisms.

Systemic Inflammatory Response Syndrome (SIRS): Nursing Process

Recognize cues (assessment).
Analyze cues (analysis).
Prioritize hypotheses (analysis).
Generate solutions (planning).
Take actions (Implementation).
Evaluate outcomes (evaluation).

Systemic Inflammatory Response Syndrome (SIRS): Treatments and Therapies

Treatment focuses on the underlying cause of SIRS, such as surgical interventions (wound debridement, abscess drainage); pharmacological treatments (gram-positive and gram-negative antibiotics, glucocorticoids, glucose control), as well as vasopressors and inotropes.

Multiple Organ Dysfunction Syndrome (MODS): Pathophysiology

Extreme response to injury, sepsis, or burns.
Constant release of immune mediators, leading to altered organ function and failure.
Oxidation stress and an imbalance between antioxidants and free radicals.
Decreased cellular oxygenation, converting cells to anaerobic metabolism which initiates lactic acidosis.
The increase in metabolic acidosis leads to multiple organ dysfunction syndrome.

Multiple Organ Dysfunction Syndrome (MODS): Risk Factors

Chronic diseases, pre-existing organ dysfunction, immunosuppressive therapy, extreme age, malnutrition, cancer, trauma, alcoholism, sepsis, and severe trauma

Multiple Organ Dysfunction Syndrome (MODS): Impact on Overall Health

Infection is a leading cause of MODS after trauma.
High mortality rates (40%-50%).
Death rates increase with the number of organs affected.
Prolonged recovery can have damaging effects on the aging adult.

Multiple Organ Dysfunction Syndrome (MODS): Clinical Presentation

Respiratory, cardiovascular (tachycardia, decreased blood pressure, arrhythmia, decreased cardiac output), renal (decreased urine output, anuria, increased creatinine levels), and hepatic (increased bilirubin level, gastrointestinal issues like nausea, vomiting, impaired wound healing, central nervous system issues like disorientation, confusion, anxiety, and agitation) issues can occur.

Multiple Organ Dysfunction Syndrome (MODS): Lab & Diagnostic Studies

Sequential Organ Failure Assessment (SOFA) score, chest X-rays, blood cultures, arterial blood gases (ABGs), electrolytes, BUN/creatinine, CBC, PT/PTT.

Multiple Organ Dysfunction Syndrome (MODS): SOFA Scale

The SOFA scale is a scoring system employed to evaluate the degree of organ dysfunction in patients.

Multiple Organ Dysfunction Syndrome (MODS): Role of the Nurse

Update the health care team on the patient's condition.
Reposition the patient every two hours.
Provide comfort.
Frequent assessment.
Utilize clinical judgment.
Identify evidence-based solutions, and provide education to patients and families.

Multiple Organ Dysfunction Syndrome (MODS): Nursing Process

Recognize cues (assessment).
Analyze cues (analysis).
Prioritize hypotheses (analysis).
Generate solutions (planning).
Take actions (Implementation).
Evaluate outcomes (evaluation).

Multiple Organ Dysfunction Syndrome (MODS): Treatments and Therapies

Antibiotics, sedation, mechanical ventilation, IV fluids, medications, and hemodynamic monitoring are components of therapy.

Disseminated Intravascular Coagulation (DIC): Risk Factors

Pregnancy complications, blood infections, cancer, blood transfusion reactions, liver dysfunction, shock, trauma, and burns are risk factors.

Disseminated Intravascular Coagulation (DIC): Clinical Presentation

Bleeding around wounds, surgical sites, and venipuncture sites (ecchymosis, hematoma, petechiae).
Tissue necrosis, dyspnea, epistaxis, and conjunctival bleeding.

Disseminated Intravascular Coagulation (DIC): Lab & Diagnostic Testing

Prothrombin time (PT)/partial thromboplastin time (PTT) (increased), D-dimer (increased), fibrinogen (decreased), and platelet count (decreased).

Disseminated Intravascular Coagulation (DIC): Role of the Nurse

Verifying lab tests, frequent assessments for bleeding, collaborate with team members, administering oxygen therapy, client/family education, optimal oxygen delivery, reversal of clotting, and prevention of further injury.

Disseminated Intravascular Coagulation (DIC): Nursing Process

Recognize cues (assessment).
Analyze cues (analysis).
Prioritize hypotheses (analysis).
Generate solutions (planning).
Take actions (Implementation).
Evaluate outcomes (evaluation).

Disseminated Intravascular Coagulation (DIC): Treatments and Therapies

Fresh frozen plasma (FFP), whole blood, anticoagulants, and fluids (IV fluids).

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Description

Test your knowledge on various types of shock and their physiological effects. This quiz covers key concepts such as systemic vascular resistance, types of shock, and the underlying mechanisms involved. Perfect for students studying human physiology or critical care.