Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

NRSG 327 Week 4 - Shock: Exam Study Guide with Questions and Answers, Exams of Nursing

This study guide provides a comprehensive overview of shock, a critical medical condition characterized by decreased tissue perfusion and impaired cellular metabolism. It delves into the different types of shock, including hypovolemic, cardiogenic, obstructive, and distributive shock, exploring their causes, symptoms, and treatment approaches. The guide also examines the stages of shock, from the initial stage to the refractory stage, highlighting the importance of early recognition and intervention. It includes numerous questions and answers related to shock, providing valuable insights for students in the nursing field.

Typology: Exams

2024/2025

Available from 03/14/2025

BetaTutors
BetaTutors ๐Ÿ‡บ๐Ÿ‡ธ

4.5

(4)

1.5K documents

1 / 10

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
NRSG 327 WEEK 4 - SHOCK- EXAM STUDY GUIDE
QUESTIONS WITH CORRECT ANSWERS 2025
1) Shock -- Answer โœ”โœ” "A syndrome characterized by decreased tissue perfusion and
impaired cellular metabolism...results in an imbalance between the supply of and the
demand for oxygen and nutrients"
2) What is a syndrome? -- Answer โœ”โœ” o A collection of signs and symptoms
- It is a manifestation of a disease, not a disease itself
3) who is at risk to develop shock? -- Answer โœ”โœ” o Those with infections
- Anyone who has any trauma/ blood loss
- Actively Vomiting (low phosphate, potassium, ABGs, electrolyte
imbalances)
- Decreased immunity
- Systolic. Diastolic dysfunctions (cardiac hypertrophy)
- Hypovolemic shock (PPH)
- Respiratory problems sepsis (especially in peds)
4) Cardiac Output= -- Answer โœ”โœ” Heart Rate x Stroke Volume
5) what are the three main parts of stroke volume -- Answer โœ”โœ” preload, afterload
and contractility
6) Stroke Volume -- Answer โœ”โœ” The amount of blood ejected with each contraction
7) Preload -- Answer โœ”โœ” Volume of blood in the ventricles at the end of diastole
(relaxation)
8) Factors Affecting Preload -- Answer โœ”โœ” o Size of ventricles, ability to stretch and
relax (if ventricles are not able to relax and fill it will affect the preload)
pf3
pf4
pf5
pf8
pf9
pfa

Partial preview of the text

Download NRSG 327 Week 4 - Shock: Exam Study Guide with Questions and Answers and more Exams Nursing in PDF only on Docsity!

NRSG 327 WEEK 4 - SHOCK- EXAM STUDY GUIDE

QUESTIONS WITH CORRECT ANSWERS 2025

  1. Shock -- Answer โœ”โœ” "A syndrome characterized by decreased tissue perfusion and impaired cellular metabolism...results in an imbalance between the supply of and the demand for oxygen and nutrients"
  2. What is a syndrome? -- Answer โœ”โœ” o A collection of signs and symptoms
  • It is a manifestation of a disease, not a disease itself
  1. who is at risk to develop shock? -- Answer โœ”โœ” o Those with infections
  • Anyone who has any trauma/ blood loss
  • Actively Vomiting (low phosphate, potassium, ABGs, electrolyte imbalances)
  • Decreased immunity
  • Systolic. Diastolic dysfunctions (cardiac hypertrophy)
  • Hypovolemic shock (PPH)
  • Respiratory problems sepsis (especially in peds)
  1. Cardiac Output= -- Answer โœ”โœ” Heart Rate x Stroke Volume
  2. what are the three main parts of stroke volume -- Answer โœ”โœ” preload, afterload and contractility
  3. Stroke Volume -- Answer โœ”โœ” The amount of blood ejected with each contraction
  4. Preload -- Answer โœ”โœ” Volume of blood in the ventricles at the end of diastole (relaxation)
  5. Factors Affecting Preload -- Answer โœ”โœ” o Size of ventricles, ability to stretch and relax (if ventricles are not able to relax and fill it will affect the preload)
  • Ex: Tamponade, Pericarditis, Stenosis, Fluid Balance (decreased fluid anemia, hypovolemia), Blood loss
  1. Contractility -- Answer โœ”โœ” Strength of myocardial cells
  2. How does contractility work? -- Answer โœ”โœ” o Nerve innervations/SNA
  • Na+/ K+
  • THKNK ELECTRICITY Contract the heart to make the blood flow
  1. Example of contractility -- Answer โœ”โœ” o Dysrhythmias, Electrolyte imbalances, Infarctions (big change seen on the ECG. Which shows contractility and electric conduction
  2. Afterload -- Answer โœ”โœ” Systemic Resistance the heart has to overcome to eject the blood out
  3. Afterload is determined by: -- Answer โœ”โœ” o Vessel tone Trauma, injuries to the vessels itself
  • Valves Goes hand in hand with preload Further resistance to get out also affects after load
  • Viscosity Dehydrated Blood sugar high = Blood thicker Sepsis = Blood thicker
  1. Normal CO -- Answer โœ”โœ” 5000ml/min (average)
  2. What type of shock impacts preload? -- Answer โœ”โœ” Hypovolemic shock
  3. What type of shock impacts contractility -- Answer โœ”โœ” o Cardiogenic shock
  • Obstructive shock
  1. What type of shock impacts afterload -- Answer โœ”โœ” Distributive shock
  1. A major complication of an anterior MI is _____. -- Answer โœ”โœ” Ventricular fibrillation arrest
  2. Complications of an anterior MI -- Answer โœ”โœ” - Dysrhythmias
  • HF
  • Death
  • Cardiogenic shock
  • Pericarditis
  • Most common: MI-> dysthymias-> quick shock/ HF->Problems
  1. What signs/symptoms of cardiogenic shock might we expect? -- Answer โœ”โœ” - Hypoperfusion (Decreased CO)
  • Chest Pain
  • Dyspnea
  • Decreased LOC/ Confusion/ Disorientation
  • Hypotension (Remember to check BP in both arms in case of aortic dissection)
  • Tachycardia/ Bradycardia
  • Raised JVP/ Distension of neck veins
  • Peripheral Edema
  • Quiet Heart sounds or presence of third and fourth heart sounds
  • Murmurs may be present and may indicate the cause, such as valve dysfunction
  • Altered Mental State
  1. What is the cause of cardiogenic shock compared to sepsis -- Answer โœ”โœ” cardiogenic shock is a result of heart issues while sepsis is usually from infections
  2. Risk factors for Cardiogenic Shock from MI: -- Answer โœ”โœ” - Age
  • HTN
  • DM
  • Multivessel coronary artery disease
  • Prior MI or Angina
  • Prior Diagnosis of HF
  • Left bundle-branch block
  1. Orders for cardiogenic shock from MI -- Answer โœ”โœ” - Blood tests
  • ABGs
  • Echo (beside)- key component
  • ECG (to see where we are at)
  • Chest X-ray Ultrasound (liver, renal
  • CT abdomen
  • MRI
  1. What blood tests should be ordered for cardiogenic shock from a MI -- Answer โœ”โœ” ยง CBC ยง Electrolytes (can we correct it) ยง Liver panel ยง Troponin (won't give us new information so not as helpful) ยง Lactate
  2. Cardiogenic shock drugs or treatments - O2 pressure -- Answer โœ”โœ” - Intubate and ventilate
  • We want to give the body a break
  1. Cardiogenic shock drugs or treatments - Volume (preload) -- Answer โœ”โœ” o Control SV (with drugs) ยง Low-> give blood
  2. Cardiogenic shock drugs or treatments - contractility (BP) -- Answer โœ”โœ” Control SV
  3. Inotropes -- Answer โœ”โœ” Strengthen cardiac contraction
  • We like them better as they are more specific to myocardial dysfunction (makes everything a lot tighter and constrict everything) than vasopressors (systemically vasoconstrict)
  • Milrine
  • Levophen (Nor-epi)
  • If we do not fix this - > patient will die
  • Hard time maintaining homeostasis
  • VS are obviously wrong
  1. Refractory stage of shock -- Answer โœ”โœ” - It is over...
  • It is to late - > we cannot save them
  • Are cells are organs are dying - > cannot give enough blood and O2 to them
  1. Compensatory stage - Neural response -- Answer โœ”โœ” o Baroreceptors SENSE: โ†“Pressure/Blood Flow
  2. Compensatory stage- Biochemical response -- Answer โœ”โœ” o Chemoreceptors SENSE: โ†“pH, โ†“O2 & โ†‘CO
  3. What is key in the compensatory stage of shock? -- Answer โœ”โœ” LAB VALUES
  • We want a RT to come and see pt have ABGs done ยง Chemoreceptor O2 and CO
  1. RAAS (renin-angiotensin-aldosterone system) -- Answer โœ”โœ” o Angiotensin II = โ†‘Afterload & BP
  • Aldosterone = โ†‘ preload
  • ADH (Anti-diuretic hormone) aka Vasopressin = โ†‘ Afterload & BP
  • Affects preload and afterload and kidneys
  1. Compensated shock: -- Answer โœ”โœ” Easily missed signs & symptoms- not super obvious ยท Skin normal or slightly pale, cool periphery ยท Slightly restless; possibly mild confusion; decreased concentration, โ†‘glucose ยท Mild tachycardia, strong pulses centrally, possibly slightly weaker peripherally; Normal to low BP (Having trending VS is key and looking back to see what it was a couple days ago) ยท Decreased urine output; urine concentration

ยท โ†‘ resp. rate; normal WOB, normal SpO ยท Thirst

  1. HOW LONG DOES The compensatory PHASE LAST? -- Answer โœ”โœ” o It depends on the pt the sicker they are the faster the stage is, the healthier they are the more time they have
  2. A client who was in an automobile collision is now in hypovolemic shock. Why is it important for the nurse to take the client's vital signs frequently during the compensatory stage of shock? -- Answer โœ”โœ” Arteriolar constriction occurs. - Think that our body is compensating and trying to constrict heart is actually going to increase contractility Cardiac workload (output) increases
  3. Progressive shock -- Answer โœ”โœ” o The compensatory mechanisms are no longer able to keep up with the overwhelming demand for them.....
  • CANNOT maintain homeostasis
  • AGGRESSIVE MEASURES MAY BE EFFECTIVE TO REVERSE OR SALVAGE WHAT FUNCTIONS REMAIN.
  • Not able to increase cardiac output unlike compensatory
  • Our body is going to put out a lot of acidity (lactic acid)
  • ABGs - > We are getting into our acidotic state
  • Accumulation of CO2 and acidosis
  • WE NEED TO CALL ICU TEAM TO SAVE OUR PATIENT
  1. Refractory Shock -- Answer โœ”โœ” The patient is going to be very sick
  2. Refractory shock - neuro -- Answer โœ”โœ” o Trend down of GCS score ยง Restless, confused
  • Patient In a coma
  • Low GCS
  • Swelling at brain cell
  1. Refractory shock - CVS -- Answer โœ”โœ” o High HR- Tachycardia (body is doing its last effort)
  • Dysrhythmias - when the heart gets mad it is going to do dysrhythmias
  1. DIC- disseminated intravascular coagulation -- Answer โœ”โœ” o Clotting and bleeding at the same time
  • You are clotting so much you end up bleeding
  • End up having severe bleeding
  1. During the progressive stage of shock, anaerobic metabolism occurs. The nurse expects that initially the anaerobic metabolism causes: -- Answer โœ”โœ” Metabolic acidosis
  2. Refractory Shock - cells -- Answer โœ”โœ” o At this point cellular damage and death is so great that permanent major organ damage has occurred and death is inevitable.
  • Cells are rupturing and releasing cellular contents and cytotoxic and vasoactive substance-the effects are further vasodilatation, myocardial depression further capillary membrane permeability. Cells are no longer able to function and multiple organ dysfunction is evident (by blood work)
  1. principles of treatment in shock -- Answer โœ”โœ” 1) Treat the underlying cause
  2. Increase Supply: ยท ABC's ยท Optimize O ยท Optimize CO ยท Optimize Hgb
  3. Decrease Demand: ยท Normothermia ยท Decrease Activity ยท Sedation/analgesia