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Questions and Answers
Crackles heard only at the lung bases require immediate intervention in a patient who has had a myocardial infarction.
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.
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 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)
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)
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?
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)
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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)?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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.
