Podcast
Questions and Answers
A patient with a history of heart failure has a CVP reading of 9 mmHg. Which of the following is the MOST appropriate interpretation of this value?
A patient with a history of heart failure has a CVP reading of 9 mmHg. Which of the following is the MOST appropriate interpretation of this value?
- The patient likely has hypovolemia and requires immediate fluid resuscitation.
- The patient's preload is elevated, though a higher CVP reading is frequent in patients with heart failure. (correct)
- The patient's preload is within the normal range.
- The patient's elevated CVP is unexpected, irrespective of heart condition.
During the insertion of a pulmonary artery catheter, a nurse observes a change in waveform on the cardiac monitor that indicates the catheter has entered the right ventricle. What should the nurse do NEXT?
During the insertion of a pulmonary artery catheter, a nurse observes a change in waveform on the cardiac monitor that indicates the catheter has entered the right ventricle. What should the nurse do NEXT?
- Document the observation and continue monitoring the patient's vital signs.
- Confirm the catheter's position with a chest X-ray before proceeding further.
- Continue advancing the catheter until the waveform indicates entry into the pulmonary artery. (correct)
- Withdraw the catheter slightly and attempt to re-advance it into the right atrium.
A patient on positive pressure ventilation with PEEP has a pulmonary artery wedge pressure (PAWP) reading. What consideration is MOST important when interpreting the PAWP value?
A patient on positive pressure ventilation with PEEP has a pulmonary artery wedge pressure (PAWP) reading. What consideration is MOST important when interpreting the PAWP value?
- The trend of PAWP values over time provides more clinically relevant information than a single reading. (correct)
- PAWP is not impacted by positive pressure ventilation or PEEP.
- The absolute PAWP value is the primary indicator of left ventricular function.
- PAWP should be assessed only when the mitral valve is closed.
A patient's CVP reading is 1 mmHg. Which of the following conditions might the nurse suspect?
A patient's CVP reading is 1 mmHg. Which of the following conditions might the nurse suspect?
The physician orders to evaluate the patient's left ventricular function using hemodynamic monitoring. Which parameter would be MOST appropriate for the nurse to assess?
The physician orders to evaluate the patient's left ventricular function using hemodynamic monitoring. Which parameter would be MOST appropriate for the nurse to assess?
In the context of inflammation and its impact on hemodynamics, which of the following best describes the body's immediate response to substances like histamine released by irritated cells?
In the context of inflammation and its impact on hemodynamics, which of the following best describes the body's immediate response to substances like histamine released by irritated cells?
Why are functional hemodynamic indicators increasingly recommended over CVP (central venous pressure) monitoring for guiding fluid therapy?
Why are functional hemodynamic indicators increasingly recommended over CVP (central venous pressure) monitoring for guiding fluid therapy?
Although pulmonary artery catheters (PA catheters) provide comprehensive hemodynamic data, their usage has diminished. Which factor primarily contributes to this decline?
Although pulmonary artery catheters (PA catheters) provide comprehensive hemodynamic data, their usage has diminished. Which factor primarily contributes to this decline?
A patient presents with hypotension and signs of poor tissue perfusion. Initial assessment suggests a preload issue. If a pulmonary artery catheter is in place, which pressure reading would be MOST helpful in guiding initial fluid resuscitation?
A patient presents with hypotension and signs of poor tissue perfusion. Initial assessment suggests a preload issue. If a pulmonary artery catheter is in place, which pressure reading would be MOST helpful in guiding initial fluid resuscitation?
In assessing a patient's hemodynamic profile, which combination of parameters provides the MOST comprehensive overview of the patient's cardiovascular function?
In assessing a patient's hemodynamic profile, which combination of parameters provides the MOST comprehensive overview of the patient's cardiovascular function?
Why is Cardiac Index (CI) considered a more individualized measurement than Cardiac Output (CO)?
Why is Cardiac Index (CI) considered a more individualized measurement than Cardiac Output (CO)?
A patient with COPD is likely to have an elevated:
A patient with COPD is likely to have an elevated:
A patient presents with a Systemic Vascular Resistance (SVR) of 600 dynes/sec/cm. What physiological condition is most likely indicated by this value?
A patient presents with a Systemic Vascular Resistance (SVR) of 600 dynes/sec/cm. What physiological condition is most likely indicated by this value?
If a patient's Mixed Venous Oxygen Saturation (SVO2) is trending downward, what is the most likely explanation?
If a patient's Mixed Venous Oxygen Saturation (SVO2) is trending downward, what is the most likely explanation?
Patient X has a CO of 5.0 L/min, height of 5' 5" (165 cm) and weight of 180 lbs (82 kg). Which of the following Cardiac Index (CI) values is most likely for this patient?
Patient X has a CO of 5.0 L/min, height of 5' 5" (165 cm) and weight of 180 lbs (82 kg). Which of the following Cardiac Index (CI) values is most likely for this patient?
What is the primary goal of stroke volume optimization techniques in less invasive hemodynamic monitoring?
What is the primary goal of stroke volume optimization techniques in less invasive hemodynamic monitoring?
Based on the information, what is a key reason for the shift towards less invasive hemodynamic monitoring methods?
Based on the information, what is a key reason for the shift towards less invasive hemodynamic monitoring methods?
Which physiological principle is most closely associated with stroke volume optimization?
Which physiological principle is most closely associated with stroke volume optimization?
A patient in NS requires advanced hemodynamic monitoring, and their physician wants to use a Doppler-based method. Based on the content, what consideration should be taken into account?
A patient in NS requires advanced hemodynamic monitoring, and their physician wants to use a Doppler-based method. Based on the content, what consideration should be taken into account?
You are caring for a critically ill patient and need to assess their fluid responsiveness. Which of the following is a minimally invasive technique that can be used to estimate this?
You are caring for a critically ill patient and need to assess their fluid responsiveness. Which of the following is a minimally invasive technique that can be used to estimate this?
A patient develops cardiogenic shock following a massive myocardial infarction. Which percentage of ventricular myocardium damage is MOST likely associated with the development of this condition?
A patient develops cardiogenic shock following a massive myocardial infarction. Which percentage of ventricular myocardium damage is MOST likely associated with the development of this condition?
A patient is experiencing profound vasodilation leading to compromised tissue perfusion. Which type of shock is MOST likely the cause?
A patient is experiencing profound vasodilation leading to compromised tissue perfusion. Which type of shock is MOST likely the cause?
Which characteristic is COMMON among all types of distributive shock (neurogenic, anaphylactic, and septic)?
Which characteristic is COMMON among all types of distributive shock (neurogenic, anaphylactic, and septic)?
Following a spinal cord injury, a patient exhibits massive vasodilation and impaired thermoregulation. Which type of shock is the MOST likely cause?
Following a spinal cord injury, a patient exhibits massive vasodilation and impaired thermoregulation. Which type of shock is the MOST likely cause?
A patient is suspected of experiencing anaphylactic shock. Which physiological response is MOST indicative of this type of shock?
A patient is suspected of experiencing anaphylactic shock. Which physiological response is MOST indicative of this type of shock?
A patient in the progressive stage of shock is exhibiting decreased cellular perfusion. What physiological consequence is MOST likely to occur if this condition is not promptly addressed?
A patient in the progressive stage of shock is exhibiting decreased cellular perfusion. What physiological consequence is MOST likely to occur if this condition is not promptly addressed?
In the context of shock, which factor is the MOST common underlying denominator across all types, regardless of the initiating cause?
In the context of shock, which factor is the MOST common underlying denominator across all types, regardless of the initiating cause?
A critical care nurse is monitoring a patient at risk for shock. Which nursing action is MOST crucial for improving patient survival rates?
A critical care nurse is monitoring a patient at risk for shock. Which nursing action is MOST crucial for improving patient survival rates?
A patient’s shock is caused by a combination of reduced oxygen delivery, increased oxygen consumption and inability to utilize oxygen. Which intervention would address the MOST comprehensive aspects of this patient's condition?
A patient’s shock is caused by a combination of reduced oxygen delivery, increased oxygen consumption and inability to utilize oxygen. Which intervention would address the MOST comprehensive aspects of this patient's condition?
Which of the following statements BEST describes the role of critical care nurses in managing patients experiencing shock?
Which of the following statements BEST describes the role of critical care nurses in managing patients experiencing shock?
A patient in septic shock remains hypotensive despite initial fluid resuscitation. According to the provided information, what is the next appropriate intervention?
A patient in septic shock remains hypotensive despite initial fluid resuscitation. According to the provided information, what is the next appropriate intervention?
A patient is suspected of having sepsis. Blood cultures, urine culture and wound cultures have been ordered. According to the information provided, what is the ideal timeframe for administering antibiotics?
A patient is suspected of having sepsis. Blood cultures, urine culture and wound cultures have been ordered. According to the information provided, what is the ideal timeframe for administering antibiotics?
Which intervention addresses source control in a septic patient with a confirmed central line infection and an infected wound?
Which intervention addresses source control in a septic patient with a confirmed central line infection and an infected wound?
During the hyperdynamic phase of septic shock, a patient exhibits an increased cardiac output and decreased SVR. What is the underlying cause of this decreased SVR?
During the hyperdynamic phase of septic shock, a patient exhibits an increased cardiac output and decreased SVR. What is the underlying cause of this decreased SVR?
Which of the following best describes the primary mechanism by which sepsis leads to altered tissue perfusion?
Which of the following best describes the primary mechanism by which sepsis leads to altered tissue perfusion?
In the progression from sepsis to septic shock, what key physiological change differentiates septic shock and significantly increases mortality?
In the progression from sepsis to septic shock, what key physiological change differentiates septic shock and significantly increases mortality?
A patient in septic shock is exhibiting signs of adrenal insufficiency despite fluid resuscitation and vasopressor support. What adjunctive therapy might be considered based on this information?
A patient in septic shock is exhibiting signs of adrenal insufficiency despite fluid resuscitation and vasopressor support. What adjunctive therapy might be considered based on this information?
Why is the body's initial clotting response considered an important function in the early stages of infection?
Why is the body's initial clotting response considered an important function in the early stages of infection?
What is the significance of recognizing and aggressively treating septic shock in its early stages?
What is the significance of recognizing and aggressively treating septic shock in its early stages?
During sepsis, the body's immune response transitions from localized to systemic. What is the primary implication of this transition?
During sepsis, the body's immune response transitions from localized to systemic. What is the primary implication of this transition?
A patient with a confirmed infection has a temperature of 39°C, a heart rate of 105 bpm, and an altered mental status. According to qSOFA criteria, which of these findings MOST strongly suggests the patient may be developing sepsis?
A patient with a confirmed infection has a temperature of 39°C, a heart rate of 105 bpm, and an altered mental status. According to qSOFA criteria, which of these findings MOST strongly suggests the patient may be developing sepsis?
During septic shock, widespread vasodilation is triggered by inflammatory mediators. What is the MOST immediate effect of this vasodilation on tissue perfusion?
During septic shock, widespread vasodilation is triggered by inflammatory mediators. What is the MOST immediate effect of this vasodilation on tissue perfusion?
In a patient experiencing septic shock, increased cell wall permeability contributes to hypovolemia. What physiological mechanism is MOST directly responsible for this?
In a patient experiencing septic shock, increased cell wall permeability contributes to hypovolemia. What physiological mechanism is MOST directly responsible for this?
The 'Hour-1 Bundle' for septic shock emphasizes obtaining blood cultures prior to administering antibiotics. What is the PRIMARY rationale for this sequence?
The 'Hour-1 Bundle' for septic shock emphasizes obtaining blood cultures prior to administering antibiotics. What is the PRIMARY rationale for this sequence?
During septic shock disseminated intravascular coagulation (DIC) can occur. What is the MOST significant consequence of disseminated intravascular coagulation (DIC) related to perfusion?
During septic shock disseminated intravascular coagulation (DIC) can occur. What is the MOST significant consequence of disseminated intravascular coagulation (DIC) related to perfusion?
During the MODS phase of septic shock, a patient develops acute kidney injury. Which assessment finding is MOST indicative of this complication?
During the MODS phase of septic shock, a patient develops acute kidney injury. Which assessment finding is MOST indicative of this complication?
A patient in the MODS stage of septic shock is exhibiting signs of disseminated intravascular coagulation (DIC). Which laboratory finding is MOST consistent with this condition?
A patient in the MODS stage of septic shock is exhibiting signs of disseminated intravascular coagulation (DIC). Which laboratory finding is MOST consistent with this condition?
A patient in the late stages of septic shock is diagnosed with ARDS. Which ventilator strategy is MOST appropriate to minimize further lung injury?
A patient in the late stages of septic shock is diagnosed with ARDS. Which ventilator strategy is MOST appropriate to minimize further lung injury?
During the MODS phase of septic shock, a patient develops hepatic failure. Which sign or symptom is MOST indicative of this complication?
During the MODS phase of septic shock, a patient develops hepatic failure. Which sign or symptom is MOST indicative of this complication?
A patient in the MODS stage of shock has a pulmonary artery catheter in place. Which set of hemodynamic parameters would MOST likely indicate a patient is experiencing cardiogenic shock?
A patient in the MODS stage of shock has a pulmonary artery catheter in place. Which set of hemodynamic parameters would MOST likely indicate a patient is experiencing cardiogenic shock?
A patient in septic shock is receiving fluid resuscitation. What assessment finding would indicate that vasopressor support should be initiated?
A patient in septic shock is receiving fluid resuscitation. What assessment finding would indicate that vasopressor support should be initiated?
A patient is suspected of having sepsis. Cultures have been ordered. What is the MOST appropriate timeframe for administering broad-spectrum antibiotics?
A patient is suspected of having sepsis. Cultures have been ordered. What is the MOST appropriate timeframe for administering broad-spectrum antibiotics?
A patient with a central venous catheter develops sepsis, and the catheter is suspected as the source. Besides antibiotics, what intervention should be considered?
A patient with a central venous catheter develops sepsis, and the catheter is suspected as the source. Besides antibiotics, what intervention should be considered?
During the hyperdynamic phase of septic shock, a patient exhibits an elevated cardiac output. What is the primary physiological mechanism contributing to this response?
During the hyperdynamic phase of septic shock, a patient exhibits an elevated cardiac output. What is the primary physiological mechanism contributing to this response?
Which condition is MOST likely associated with the hyperdynamic phase of septic shock?
Which condition is MOST likely associated with the hyperdynamic phase of septic shock?
A patient in septic shock is not responding to vasopressors, and their blood pressure remains low. What additional therapy should the nurse anticipate?
A patient in septic shock is not responding to vasopressors, and their blood pressure remains low. What additional therapy should the nurse anticipate?
Other than cultures and source control, what intervention is important when managing a patient with sepsis?
Other than cultures and source control, what intervention is important when managing a patient with sepsis?
A patient in septic shock has warm, flushed skin despite a low blood pressure. What best explains these signs and symptoms?
A patient in septic shock has warm, flushed skin despite a low blood pressure. What best explains these signs and symptoms?
Which of the following scenarios would MOST likely lead to hypovolemic shock?
Which of the following scenarios would MOST likely lead to hypovolemic shock?
A patient is in the compensatory stage of shock. Which physiological response is MOST indicative of this stage?
A patient is in the compensatory stage of shock. Which physiological response is MOST indicative of this stage?
Distributive shock is characterized by a maldistribution of blood volume. Which hemodynamic parameter is MOST directly affected by this maldistribution?
Distributive shock is characterized by a maldistribution of blood volume. Which hemodynamic parameter is MOST directly affected by this maldistribution?
A patient with a history of heart failure develops cardiogenic shock after a myocardial infarction. Which intervention would be the MOST appropriate INITIAL step in managing this patient's shock?
A patient with a history of heart failure develops cardiogenic shock after a myocardial infarction. Which intervention would be the MOST appropriate INITIAL step in managing this patient's shock?
A patient with peritonitis is at risk for developing hypovolemic shock due to:
A patient with peritonitis is at risk for developing hypovolemic shock due to:
Which of the following conditions is LEAST likely to directly cause hypovolemic shock?
Which of the following conditions is LEAST likely to directly cause hypovolemic shock?
In a patient with septic shock, widespread vasodilation leads to decreased afterload. Which compensatory mechanism would the body INITIALLY employ to maintain cardiac output?
In a patient with septic shock, widespread vasodilation leads to decreased afterload. Which compensatory mechanism would the body INITIALLY employ to maintain cardiac output?
A patient experiencing anaphylactic shock would exhibit which combination of the following hemodynamic and clinical manifestations?
A patient experiencing anaphylactic shock would exhibit which combination of the following hemodynamic and clinical manifestations?
In the late stages of septic shock, what hemodynamic parameter is MOST likely to increase significantly from its value in the early stages?
In the late stages of septic shock, what hemodynamic parameter is MOST likely to increase significantly from its value in the early stages?
A patient presenting with neurogenic shock is MOST likely to exhibit which of the following hemodynamic profiles?
A patient presenting with neurogenic shock is MOST likely to exhibit which of the following hemodynamic profiles?
A patient is suspected of being in the early stages of septic shock. Which hemodynamic parameter would be MOST indicative of this condition?
A patient is suspected of being in the early stages of septic shock. Which hemodynamic parameter would be MOST indicative of this condition?
A patient with cardiogenic shock is likely to present with which set of hemodynamic values?
A patient with cardiogenic shock is likely to present with which set of hemodynamic values?
In hypovolemic shock resulting from significant hemorrhage, which of the following compensatory mechanisms would you expect to observe?
In hypovolemic shock resulting from significant hemorrhage, which of the following compensatory mechanisms would you expect to observe?
During anaphylactic shock, what is the MOST likely cause of the decreased systemic vascular resistance (SVR)?
During anaphylactic shock, what is the MOST likely cause of the decreased systemic vascular resistance (SVR)?
Why are astute observation and assessment skills critical for acute care nurses managing patients at risk for or experiencing shock?
Why are astute observation and assessment skills critical for acute care nurses managing patients at risk for or experiencing shock?
What is the MOST important initial nursing intervention for a patient exhibiting signs and symptoms of hypovolemic shock?
What is the MOST important initial nursing intervention for a patient exhibiting signs and symptoms of hypovolemic shock?
During the hyperdynamic phase of septic shock, cardiac output may be normal or increased despite depressed myocardial function. Which of the following compensatory mechanisms primarily contributes to this phenomenon?
During the hyperdynamic phase of septic shock, cardiac output may be normal or increased despite depressed myocardial function. Which of the following compensatory mechanisms primarily contributes to this phenomenon?
In the hyperdynamic phase of septic shock, why does the oxygen level in venous blood remain higher than expected despite increased cardiac output and oxygen demand?
In the hyperdynamic phase of septic shock, why does the oxygen level in venous blood remain higher than expected despite increased cardiac output and oxygen demand?
A patient in the hypodynamic phase of septic shock exhibits decreased circulating volume. How does this impact oxygen levels in venous blood?
A patient in the hypodynamic phase of septic shock exhibits decreased circulating volume. How does this impact oxygen levels in venous blood?
A patient in septic shock is in the hyperdynamic phase. What effect does this phase typically have on renal perfusion and urine output?
A patient in septic shock is in the hyperdynamic phase. What effect does this phase typically have on renal perfusion and urine output?
In the progression of septic shock, what is the likely consequence of the vasoconstriction of the renal bed?
In the progression of septic shock, what is the likely consequence of the vasoconstriction of the renal bed?
Which set of the following conditions contribute to reduced cardiac output (CO) and cardiac index (CI) during the hypodynamic phase of septic shock?
Which set of the following conditions contribute to reduced cardiac output (CO) and cardiac index (CI) during the hypodynamic phase of septic shock?
A patient in the hypodynamic phase of septic shock has reduced myocardial contractility. Which of the following best describes its effect on cardiac output (CO) and cardiac index (CI)?
A patient in the hypodynamic phase of septic shock has reduced myocardial contractility. Which of the following best describes its effect on cardiac output (CO) and cardiac index (CI)?
Which of the following is the correct sequence of clinical manifestations occurring during septic shock?
Which of the following is the correct sequence of clinical manifestations occurring during septic shock?
A patient who experienced a severe allergic reaction is displaying signs of anaphylactic shock. Besides epinephrine, which physiological response is MOST indicative of this type of shock that the nurse should monitor?
A patient who experienced a severe allergic reaction is displaying signs of anaphylactic shock. Besides epinephrine, which physiological response is MOST indicative of this type of shock that the nurse should monitor?
After a motor vehicle accident, a patient is diagnosed with a spinal cord injury and is exhibiting signs of neurogenic shock. Which combination of clinical manifestations would the nurse expect to observe?
After a motor vehicle accident, a patient is diagnosed with a spinal cord injury and is exhibiting signs of neurogenic shock. Which combination of clinical manifestations would the nurse expect to observe?
A patient is diagnosed with cardiogenic shock following a massive myocardial infarction. What percentage of damage to the left ventricle is MOST likely associated with the development of this condition?
A patient is diagnosed with cardiogenic shock following a massive myocardial infarction. What percentage of damage to the left ventricle is MOST likely associated with the development of this condition?
A patient is experiencing profound vasodilation leading to compromised tissue perfusion. Which type of shock is MOST likely indicated by these symptoms?
A patient is experiencing profound vasodilation leading to compromised tissue perfusion. Which type of shock is MOST likely indicated by these symptoms?
What is the underlying mechanism for the decreased systemic vascular resistance (SVR) observed in all types of distributive shock?
What is the underlying mechanism for the decreased systemic vascular resistance (SVR) observed in all types of distributive shock?
A patient who has experienced significant trauma is suspected of being in the early stages of hypovolemic shock. Which of the following assessment findings would be MOST indicative of this early stage?
A patient who has experienced significant trauma is suspected of being in the early stages of hypovolemic shock. Which of the following assessment findings would be MOST indicative of this early stage?
Which of the following mechanisms is the MOST likely cause of hypovolemic shock in a patient with severe burns?
Which of the following mechanisms is the MOST likely cause of hypovolemic shock in a patient with severe burns?
A patient is admitted with peritonitis following a ruptured appendix. Which of the following pathophysiological processes associated with peritonitis is MOST likely to contribute to hypovolemic shock?
A patient is admitted with peritonitis following a ruptured appendix. Which of the following pathophysiological processes associated with peritonitis is MOST likely to contribute to hypovolemic shock?
A patient in the progressive stage of shock is exhibiting decreased cellular perfusion. What is the MOST likely compensatory mechanism that will be overwhelmed in this stage?
A patient in the progressive stage of shock is exhibiting decreased cellular perfusion. What is the MOST likely compensatory mechanism that will be overwhelmed in this stage?
A patient with a history of heart failure is admitted with fluid overload and respiratory distress. Which of the following types of shock is MOST likely to develop if the patient's condition worsens?
A patient with a history of heart failure is admitted with fluid overload and respiratory distress. Which of the following types of shock is MOST likely to develop if the patient's condition worsens?
A patient in the early stages of hypovolemic shock is receiving isotonic crystalloids for fluid replacement. What is the PRIMARY rationale for using isotonic solutions in this situation?
A patient in the early stages of hypovolemic shock is receiving isotonic crystalloids for fluid replacement. What is the PRIMARY rationale for using isotonic solutions in this situation?
A patient with cardiogenic shock exhibits hypotension and poor tissue perfusion. If a pulmonary artery catheter is in place, which hemodynamic finding would the nurse expect to see?
A patient with cardiogenic shock exhibits hypotension and poor tissue perfusion. If a pulmonary artery catheter is in place, which hemodynamic finding would the nurse expect to see?
A patient in hypovolemic shock has received a large volume of crystalloid fluids, but their blood pressure remains low, and oxygen saturation is not improving. Which intervention should the nurse anticipate NEXT?
A patient in hypovolemic shock has received a large volume of crystalloid fluids, but their blood pressure remains low, and oxygen saturation is not improving. Which intervention should the nurse anticipate NEXT?
A patient in septic shock is hypotensive despite aggressive fluid resuscitation. According to the guidelines, what should be the next intervention?
A patient in septic shock is hypotensive despite aggressive fluid resuscitation. According to the guidelines, what should be the next intervention?
After obtaining initial cultures, what is the recommended timeframe for administering broad-spectrum antibiotics in a patient diagnosed with sepsis?
After obtaining initial cultures, what is the recommended timeframe for administering broad-spectrum antibiotics in a patient diagnosed with sepsis?
A patient in cardiogenic shock is receiving treatment to improve cardiac output and tissue perfusion. Which assessment finding would indicate that the interventions are achieving the desired effect?
A patient in cardiogenic shock is receiving treatment to improve cardiac output and tissue perfusion. Which assessment finding would indicate that the interventions are achieving the desired effect?
A patient with suspected hypovolemic shock is being assessed. Which clinical manifestation would suggest the patient is in the LATE stage of shock rather than the early stage?
A patient with suspected hypovolemic shock is being assessed. Which clinical manifestation would suggest the patient is in the LATE stage of shock rather than the early stage?
A patient in septic shock has a central venous catheter suspected of being the source of infection. Besides administering antibiotics, what other intervention should be considered?
A patient in septic shock has a central venous catheter suspected of being the source of infection. Besides administering antibiotics, what other intervention should be considered?
During the hyperdynamic phase of septic shock, a patient exhibits an increased cardiac output and decreased SVR. What is the primary cause of the reduced SVR?
During the hyperdynamic phase of septic shock, a patient exhibits an increased cardiac output and decreased SVR. What is the primary cause of the reduced SVR?
A patient in septic shock is not responding adequately to fluid resuscitation and vasopressors, and continues to show signs of adrenal insufficiency. Which adjunctive therapy should the nurse anticipate?
A patient in septic shock is not responding adequately to fluid resuscitation and vasopressors, and continues to show signs of adrenal insufficiency. Which adjunctive therapy should the nurse anticipate?
Flashcards
Inflammation-Induced Vasodilation
Inflammation-Induced Vasodilation
Dilation of blood vessels due to substances released during inflammation.
Preload
Preload
The volume of blood in the ventricles at the end of diastole; affects cardiac output.
Hemodynamic Profile
Hemodynamic Profile
Monitoring preload, afterload and contractility to assess a patient's condition.
Functional Hemodynamic Indicators
Functional Hemodynamic Indicators
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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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Right Atrial Pressure (RAP)
Right Atrial Pressure (RAP)
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Pulmonary Artery (PA) Catheter
Pulmonary Artery (PA) Catheter
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Left Ventricular End-Diastolic Pressure (LVEDP)
Left Ventricular End-Diastolic Pressure (LVEDP)
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Cardiac Output
Cardiac Output
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Cardiac Index (CI)
Cardiac Index (CI)
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Pulmonary Vascular Resistance (PVR)
Pulmonary Vascular Resistance (PVR)
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Systemic Vascular Resistance (SVR)
Systemic Vascular Resistance (SVR)
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Mixed Venous Oxygen Saturation (SvO2)
Mixed Venous Oxygen Saturation (SvO2)
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High SVR Implies...
High SVR Implies...
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Less Invasive Hemodynamic Monitoring
Less Invasive Hemodynamic Monitoring
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Frank-Starling Law
Frank-Starling Law
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Stroke Volume Optimization
Stroke Volume Optimization
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Pulsus Paradoxus
Pulsus Paradoxus
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Passive Leg Raise (PLR)
Passive Leg Raise (PLR)
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Shock
Shock
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Cellular/Tissue Hypoxia
Cellular/Tissue Hypoxia
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Causes of Shock
Causes of Shock
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Nursing Role in Shock
Nursing Role in Shock
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Stages of Shock
Stages of Shock
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Cardiogenic Shock
Cardiogenic Shock
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Distributive Shock
Distributive Shock
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Anaphylactic Shock
Anaphylactic Shock
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Neurogenic Shock
Neurogenic Shock
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Profound Peripheral Vasodilation
Profound Peripheral Vasodilation
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Sepsis Definition
Sepsis Definition
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Septic Shock Definition
Septic Shock Definition
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Septic Shock Characteristics
Septic Shock Characteristics
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Sepsis Pathophysiology
Sepsis Pathophysiology
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Early Inflammatory Response
Early Inflammatory Response
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Initial Septic Shock Treatment
Initial Septic Shock Treatment
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Fluid Resuscitation for Perfusion
Fluid Resuscitation for Perfusion
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Vasopressors in Septic Shock
Vasopressors in Septic Shock
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Blood Culture Collection Sites
Blood Culture Collection Sites
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Hyperdynamic Phase of Septic Shock
Hyperdynamic Phase of Septic Shock
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qSOFA
qSOFA
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Sepsis Indicators
Sepsis Indicators
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Hour 1-Bundle
Hour 1-Bundle
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Lactate Level
Lactate Level
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Blood Cultures
Blood Cultures
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Four Stages of Shock
Four Stages of Shock
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Hypovolemic Shock
Hypovolemic Shock
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Types of Distributive Shock
Types of Distributive Shock
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Distributive Shock Response
Distributive Shock Response
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Hypovolemic Shock Cause
Hypovolemic Shock Cause
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Causes of Hypovolemic Shock
Causes of Hypovolemic Shock
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Initial Antibiotic Therapy
Initial Antibiotic Therapy
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Septic Shock Diagnostics
Septic Shock Diagnostics
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Infection Source Control
Infection Source Control
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Septic Shock: Increased CO and CI
Septic Shock: Increased CO and CI
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Multiple Organ Dysfunction Syndrome (MODS)
Multiple Organ Dysfunction Syndrome (MODS)
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ARDS in MODS
ARDS in MODS
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DIC in MODS
DIC in MODS
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Anuria in MODS
Anuria in MODS
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Refractory Hypoxemia
Refractory Hypoxemia
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Determinants of Cardiac Output
Determinants of Cardiac Output
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Warm Shock Compensation
Warm Shock Compensation
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Cold Phase Septic Shock
Cold Phase Septic Shock
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Oxygen Extraction in Warm Shock
Oxygen Extraction in Warm Shock
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Oxygen Levels in Cold Shock
Oxygen Levels in Cold Shock
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Renal Perfusion in Warm Shock
Renal Perfusion in Warm Shock
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Vasoconstriction in Septic Shock
Vasoconstriction in Septic Shock
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Kidney Injury in Septic Shock
Kidney Injury in Septic Shock
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Septic Shock
Septic Shock
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Hypovolemic, Neurogenic, Anaphylactic and Septic shock on RAP
Hypovolemic, Neurogenic, Anaphylactic and Septic shock on RAP
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Hypovolemic, Cardiogenic, Neurogenic, Anaphylactic and Late Septic shock on CO/CI
Hypovolemic, Cardiogenic, Neurogenic, Anaphylactic and Late Septic shock on CO/CI
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Hypovolemic, Cardiogenic and Late Septic shock on SVR
Hypovolemic, Cardiogenic and Late Septic shock on SVR
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Shock Stage Variability
Shock Stage Variability
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Importance of Early Recognition
Importance of Early Recognition
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Tachycardia in Hypovolemic Shock
Tachycardia in Hypovolemic Shock
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Hypotension in Hypovolemic Shock
Hypotension in Hypovolemic Shock
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Fluid Replacement in Hypovolemic Shock
Fluid Replacement in Hypovolemic Shock
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Early Antibiotic Administration
Early Antibiotic Administration
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Infection Source Removal
Infection Source Removal
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Organ Support in Sepsis
Organ Support in Sepsis
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Hyperdynamic Phase
Hyperdynamic Phase
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Decreased SVR in Sepsis
Decreased SVR in Sepsis
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Decreased Systemic Vascular Resistance (SVR)
Decreased Systemic Vascular Resistance (SVR)
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Study Notes
Inflammation and Hemodynamics
- Irritated or inflamed cells release substances affecting blood vessels.
- These substances include histamine, prostaglandins, and leukotrienes.
- They cause blood vessels to dilate, bringing more blood to the injured area.
- Dilation leads to decreased preload, reducing cardiac output.
- Adequate preload, or volume, is necessary for the body to pump blood and perfuse tissues.
Advanced Hemodynamic Monitoring Overview
- Advanced hemodynamic monitoring is constantly evolving with scientific and technological advancements.
- Central venous pressure monitoring (CVP) is a basic method still used in some ICUs.
- CVP is not the recommended method to guide fluid management.
- Functional hemodynamic indicators should guide fluid therapy and optimize stroke volume.
- The unit reviews hemodynamic monitoring principles, including CVPs and pulmonary artery catheters to apply guiding principles in advanced hemodynamic monitoring.
Pulmonary Artery Catheters
- Pulmonary artery catheter (PA catheter or Swan-Ganz catheter) is decreasing in usage.
- PA catheters are not associated with improved outcomes in many patient populations.
- PA catheters measure pulmonary artery pressures.
- PA catheters provide data on volume status (preload), vascular resistance (afterload), and heart contractility.
- These measurements create a hemodynamic profile reflecting a patient's condition.
- Newer, less invasive methods determine fluid responsiveness to improve cardiac output.
Learning Outcomes
- Apply guiding principles when considering advanced hemodynamic monitoring.
- Analyze the numerical values of pulmonary artery catheters.
- Relate interventions to correct hemodynamic instability with advanced monitoring.
- Discuss how passive leg raising can predict fluid responsiveness.
- Explore less-invasive hemodynamic monitoring methods.
Guiding Principles for Advanced Hemodynamic Monitoring
- Before using advanced hemodynamic monitoring: consider whether it will provide additional guidance, and whether it is contraindicated, or risks outweigh benefits.
- Consider if similar information can be obtained non-invasively.
- Single pressure readings hold less significance than the pressure trend (increasing, decreasing, or stable).
- Values must be interpreted in relation to the patient's history, clinical course, and interventions such as mean arterial pressure.
- Accurate values require leveling the transducer or water manometer to the phlebostatic axis.
- Learners should memorize CVP and CO parameters.
- Understand what information pulmonary artery values provide in relation to cardiac function.
- Expected to interpret pulmonary artery values even when normal ranges are provided on exams.
Central Venous Pressure (CVP)/Right Atrial Pressure (RAP)
- Monitoring CVP is beneficial when learning to interpret hemodynamic monitoring parameters.
- CVP and right atrial pressure (RAP) are synonymous because they both indicate the pressure in the right atrium.
- CVP is used throughout the unit.
Normal CVP Value
- Normal CVP values range from 2-6 mmHg.
- The normal value represents preload in a normal, non-diseased heart.
- Higher CVP readings are common clinically.
Pulmonary Artery Pressures
- A PA catheter measures pulmonary artery pressures.
- It measures left ventricle pressure at the end of diastole (LVEDP) when the mitral valve is open.
- This pressure reading is indicative of left ventricular function.
- During insertion, the pressures in the right atrium, right ventricle, and pulmonary artery transmit back to a cardiac monitor, which displays a unique waveform and pressure for each area.
- Positive pressure ventilation and PEEP can increase pulmonary artery pressures. Consistent reading manner and trending are important.
Other Hemodynamic Parameters
Cardiac Output (CO)
- Normal cardiac output is between 4-8L/min.
Cardiac Index (CI)
- A highly individualized number based on body surface area.
- Body surface area is calculated using the patient's height and weight.
- Normal cardiac index ranges from 2.4-4L/minute.
- The cardiac index is more useful to determine shock state than cardiac output alone.
Pulmonary Vascular Resistance (PVR)
- The amount of resistance the right ventricle overcomes during systole.
- Affected by COPD, septic shock, and pulmonary embolus.
- Normal PVR: 100-250 dynes/sec/cm.
Systemic Vascular Resistance (SVR)
- This measures left ventricular afterload.
- High SVR indicates vasoconstriction.
- Low SVR indicates vasodilation.
- Normal SVR: 800-1400 dynes/sec/cm.
Mixed Venous Oxygen Saturation (SVO2)
- Measures the body's ability to supply oxygen to tissues sufficiently.
- Normal SVO2: 60%-80%.
PA Catheter Values
- Right Atrial Pressure (RAP) normal range is 2-6 mmHg and measures preload of the right ventricle.
- Right Ventricle Pressure (RVP) is normally RVSP: 15-25 mmHg and RVEDP: 2-6 mmHg. The RVP waveform is monitored to ensure catheter has not slipped back into the right ventricle.
- Pulmonary Artery Pressure (PAP) normal range is PAS: 15-25 mmHg, PAD 8-15 mmHg, and PAM: 10-20 mmHg.
- Pulmonary Artery Wedge Pressure (PAWP) normal range is 4-12 mmHg and measures preload of the left ventricle
Less Invasive Hemodynamic Monitoring
- PA catheters are not frequently used because patient outcomes haven't improved.
- CVP and PA catheters have limitations in determining the volume status of the patient and fluid replacement needs.
- Less or non-invasive methods measure pressures to reflect volume status currently in use.
- These methods optimize stroke volume, which relies on pulsus paradoxus and Frank Starling's law.
- Techniques range from passive leg raises (PLR) to finger-cuff to arterial pressure to transpulmonary thermodilution.
Caring for Hemodynamically Unstable Patients
- Volume (preload) maintenance matters for cardiac output.
- Consider if filling pressures are adequate, and review the patient's history for fluid volume deficits or overload.
- Review heart rate, is it too slow or too fast?
- Review afterload, is it reduced, is the patient warm?
Advanced Hemodynamic Monitoring Parameter Considerations
- Decreased Right Ventricular Preload (↓RAP/CVP) can be caused by fluid volume deficit or vasodilation and is treated with volume expanders or vasoconstrictors.
- Increased Right Ventricular Preload (↑RAP/CVP) can be caused by fluid volume overload or inability of RV to pump fluid, and can be treated with diuretics or inotropic therapy .
- Decreased Left Ventricular Preload (↓PAWP or est. Using ↓PAD) can be caused by fluid volume deficit or vasodilation and is treated with volume expanders or vasoconstrictors.
- Increased Left Ventricular Preload (↑PAWP or estimate Using ↑PAD) can be caused by fluid volume overload or inability of LV to pump fluid and is treated with diuretics or inotropic therapy.
- Increased Right Ventricular Afterload (↑PVR) can be caused by pulmonary hypertension and is treated with pulmonary vasodilators.
- Increased Left Ventricular Afterload (↑SVR) can be caused by chronic hypertension or SNS compensation and is treated with vasodilators.
- Decreased Left Ventricular Afterload (↓SVR) can be caused by vasodilation and is treated with peripheral vasoconstrictors.
- Decreased preload and increased SVR is caused from compensation and is treated by replacing fluids.
- Decreased SVR + Decreased Preload can stem from a massive inflammatory response and is treated with fluids and vasoconstrictors.
- Increased Preload and Increased SVR can be cause by SNS compensation for decreased CO and is treated with diuretics and vasodilators.
- Decreased cardiac output/index (↓contractility) is caused by ACS and is treated with oxygen, vasodilators, and inotropes.
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