Questions and Answers
Crackles heard only at the lung bases require immediate intervention in a patient who has had a myocardial infarction.
False
Mild bradycardia usually requires atropine in patients who have a spinal cord injury.
False
Which information is most important to report for a patient with pneumonia and sepsis?
Which actions should the nurse take for a patient with suspected neurogenic shock? (Select all that apply)
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What preventive actions can help limit the development of systemic inflammatory response syndrome (SIRS)? (Select all that apply)
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How many milliliters per hour should the nurse set the infusion rate for a 198-lb patient receiving a dobutamine infusion at 5 mcg/kg/min?
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In which order should the nurse implement the following interventions for a 67-kg patient with septic shock? (Put a comma and a space between each answer choice)
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Which order by the healthcare provider should the nurse question for a 78-kg patient with septic shock?
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Which intervention ordered by the healthcare provider should the nurse question for a patient with an elevated pulmonary artery wedge pressure?
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Which assessment finding will help confirm a diagnosis of neurogenic shock?
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Which intervention should the nurse anticipate for an older patient with cardiogenic shock and high systemic vascular resistance?
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What medication will the nurse anticipate an order for when a patient has a blood pressure of 82/40 mm Hg after receiving 2 L of normal saline for septic shock?
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To evaluate the effectiveness of pantoprazole (Protonix) for a patient with systemic inflammatory response syndrome (SIRS), which assessment will the nurse perform?
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Which medication should be anticipated for a patient with cardiogenic shock and increased pulmonary artery wedge pressure?
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What should the emergency department nurse obtain in preparation for the arrival of a seriously injured patient from a motor vehicle crash?
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Which finding is the best indicator that fluid resuscitation for a 90-kg patient with hypovolemic shock has been effective?
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Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock?
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Which patient data indicate a nurse should consult with the healthcare provider before starting norepinephrine?
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Which finding indicates that the nitroprusside infusion for cardiogenic shock is effective?
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Which assessment information is most important for the nurse to evaluate treatment effectiveness in a patient with anaphylactic shock?
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Which data collected may indicate that a patient with cardiogenic shock is developing multiple organ dysfunction syndrome (MODS)?
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Which intervention should the nurse implement first for a patient with septic shock having low blood pressure and elevated pulse rate?
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Which action by a new RN caring for patients experiencing shock indicates a need for more education?
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Which finding related to a patient in septic shock is most important for the nurse to report?
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What is the first action by the nurse for a patient admitted for shock of unknown etiology?
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Which finding is most important for the nurse to report regarding a patient who has been vomiting and diarrhea for 4 days?
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Which intervention should the nurse implement first for a patient with cool, clammy skin, tachycardia, and hypotension after a motor vehicle crash?
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Which assessment finding for a patient receiving a phenylephrine infusion indicates a need for immediate action?
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Which intervention would the nurse complete first for a patient who experiences respiratory distress and syncope after eating strawberries?
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Which finding indicates an immediate need to report for a patient receiving vasopressin for septic shock?
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After change-of-shift report in a progressive care unit, which patient should the nurse care for first?
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Study Notes
Shock Types and Management
- Septic shock requires significant fluid resuscitation; vasopressors like norepinephrine are used when hypotension persists after initial treatment.
- Cardiogenic shock is indicated by elevated pulmonary artery wedge pressure (PAWP) and may require interventions like furosemide to reduce preload.
- Neurogenic shock is characterized by hypotension and bradycardia, usually following spinal cord injury.
Hemodynamic Monitoring
- Central venous pressure (CVP) and PAWP guide fluid management and indicate volume status and cardiac function.
- Urine output, especially in hypovolemic shock, serves as a primary indicator of successful fluid resuscitation.
- Tachycardia and hypotension can signal shock progression, and monitoring vitals is essential for timely interventions.
Drug Administration and Considerations
- Nitroprusside, an arterial vasodilator, is used to decrease systemic vascular resistance (SVR) in cardiogenic shock.
- Vasopressors should not be initiated unless adequate fluid resuscitation has been achieved, as evidenced by CVP values.
- Epinephrine is a priority intervention for anaphylactic shock, providing rapid stabilization of hemodynamics and airway.
Assessments and Findings
- Cool, clammy skin in septic shock indicates worsening condition, unlike initially warm skin in early stages.
- Changes in mental status, such as confusion, in dehydration patients signal advancing shock that requires urgent intervention.
- Elevated creatinine levels may indicate renal failure or the potential onset of multiple organ dysfunction syndrome (MODS) in critically ill patients.
Response to Emergency Situations
- In trauma situations, priority interventions include securing the airway (100% oxygen) and establishing IV access for fluid resuscitation.
- Patients with neurogenic shock may require atropine for bradycardia; however, temperature regulation is critical due to potential hypothermia risks.
- Continuous monitoring of vital signs and readiness for possible intubation are essential in managing critical cases, especially following significant injuries.
Implementation of Care
- Immediate actions in shock include airway management and ensuring aggressive fluid replacement, especially in hypovolemic or septic cases.
- Regular assessments of breath sounds in cardiogenic shock are vital due to pulmonary congestion risks.
- Norepinephrine administration must be closely monitored in relation to fluid status, ensuring blood pressure is appropriately managed without prior resuscitation.
Key Interventions in Conditions
- Norepinephrine is initiated for patients experiencing inadequate blood pressure despite fluid resuscitation.
- Effective management of septic shock involves prompt fluid replacement and vasopressors, while excess saline can worsen fluid overload in cardiogenic shock.
- Multi-system assessments, including checking for signs of DIC in septic patients, are crucial for early detection of complications.### Neurogenic Shock Management
- Neurogenic shock patients typically have normal blood volume; excessive administration of lactated Ringer's solution can cause volume overload.
- Caution with lactated Ringer's is necessary in shock situations due to impaired liver function, which affects lactate conversion to bicarbonate.
Preventing Systemic Inflammatory Response Syndrome (SIRS)
- Effective preventive actions include early ambulation of postoperative patients and the use of aseptic technique for invasive lines.
- Removing indwelling urinary catheters promptly post-surgery limits infection risk, which is crucial as sepsis is a common cause of SIRS.
- Administering antibiotics within one hour of suspicion of sepsis reduces the risk of progression to SIRS.
- Enteral nutrition is preferred over parenteral nutrition as it helps maintain intestinal integrity and decreases infection risk.
Dobutamine Infusion Calculation
- For a dobutamine infusion at a rate of 5 mcg/kg/min for a 198-lb patient, the required infusion rate is 27 mL/hr from a solution of 250 mg in 250 mL.
Interventions for Septic Shock
- Initial response to a septic shock patient should prioritize oxygen saturation improvement, followed by intravenous fluid resuscitation with normal saline.
- Norepinephrine infusion is essential to restore hemodynamic stability, with administration rates starting at 0.5 mcg/min.
- Blood and urine cultures should be obtained before initiating antibiotic therapy to ensure an effective treatment approach.
- Maintain oxygen saturation above 95% through titrated oxygen administration as a key priority in managing hypoxemic conditions.
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Description
This quiz covers the different types of shock, including septic, cardiogenic, and neurogenic shock, and their management. It also delves into hemodynamic monitoring and drug administration considerations.
