NUR 2212 Study Guide Critical Care -

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NUR 2212 Study Guide – Critical Care - Miami Dade College

• Know pathophysiology of the shock

● Decreased tissue perfusion ● Cells lack oxygen & nutrients and they will eventually die, organs will fail ● Shock is rapidly progressive, life threatening (triggers flight or fight syndrome) ● Early detection of shock with rapid response is necessary to improve patient outcome ● If patient is in shock assess them more often because they have reduced compensatory mechanisms and rapidly progressing through the stages of shock ● Catecholamines might not increase vasoconstriction in elderly as in younger adults due to decreased baroreceptor response.● Elderly patient requires more frequent monitoring because compensatory mechanism

TB QUESTION

A nurse in the ICU is planning the care of a patient who is being treated for shock. Which of the following statements best describes the pathophysiology of this patient’s health problem?

• Blood is shunted from vital organs to peripheral areas of the body.
• Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
• Circulating blood volume is decreased with a resulting change in the osmotic

pressure gradient.

• Hemorrhage occurs as a result of trauma, depriving vital organs of adequate

perfusion.

Ans: B

Feedback: Shock is a life-threatening condition with a variety of underlying causes. Shock is caused when the cells have a lack of adequate blood supply and are deprived of oxygen and nutrients. In cases of shock, blood is shunted from peripheral areas of the body to the vital organs. Hemorrhage and decreased blood volume are associated with some, but not all, types of shock

• Know S/S of neurogenic shock

S/S of neurogenic shock:

● Decreased B/P (hypotension), tachycardia, decreased urinary output, altered loss of concentration ● Warm, dry skin due to loss of sympathetic muscle ● Abnormal hemodynamic measurements, ABG's 1 / 4

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● The person will not have sympathetic response to the point of injury ● Blood pressure cannot be maintained; they will have massive vasodilation & loss of sympathetic tone ● Can be as a result of head trauma, spinal chord injury, epidural anesthesia, or a car accident where they lose a lot of blood ● Exam question will say“Spinal chord injury”= possibility of neurogenic shock

TB QUESTION

A patient with a T2 spinal cord injury is exhibiting manifestations of neurogenic shock. The nurse would be correct in monitoring for which of the following?

• Increased cardiac markers
• Hypotension
• Tachycardia
• Excessive sweating

ANS: B

TB QUESTION

The ICU nurse is caring for a patient in neurogenic shock following an overdose of antianxiety medication. When assessing this patient, the nurse should recognize what characteristic of neurogenic shock?

• Hypertension
• Cool, moist skin
• Bradycardia
• Signs of sympathetic stimulation

Ans: C Feedback: In neurogenic shock, the sympathetic system is not able to respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock.

TB QUESTION

A nurse in the ICU receives a report from the nurse in the ED about a new patient being admitted with a neck injury he received while diving into a lake. The ED nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that that patient is probably experiencing?

• Anaphylactic shock
• Neurogenic shock 2 / 4

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• Septic shock
• Hypovolemic shock

Feedback: Neurogenic shock can be caused by spinal cord injury. The patient will present with a low blood pressure; bradycardia; and warm, dry skin due to the loss of sympathetic muscle tone and increased parasympathetic stimulation. Anaphylactic shock is caused by an identifiable offending agent, such as a bee sting. Septic shock is caused by bacteremia in the blood and presents with tachycardia. Hypovolemic shock presents with tachycardia and a probable source of blood loss.

• Know about nutritional needs during shock: Rationale for increased nutritional needs

● They will need increased calories because they are in a hypercaloric state- burning more calories due to the shock ● The release of catecholamines creates an increase in metabolic rate and metabolic requirements ● There is a rapid depletion of glucose stores early in shock (pt may require more than 3,000 cals per day) ● Requirements are met by breaking down lean mass. In this catabolic process skeletal muscle mass is broken down even when the pt has large stores of adipose tissue. Loss of skeletal muscle further prolongs recovery time. Stress ulcers occur frequently in acutely ill patients because of the compromised blood supply to the GI tract. Therefore, antacids, H2 blockers and PPIs may be prescribed (rxed) to prevent ulcer formation ● Enteral feedings are preferred to parenteral feedings to reduce the risk of infection ● Hypermetabolic state

TB QUESTION

In all types of shock, nutritional demands increase rapidly as the body depletes its stores of glycogen. Enteral nutrition is the preferred method of meeting these increasing energy demands. What is the basis for enteral nutrition being the preferred method of meeting the body’s needs?

• It slows the proliferation of bacteria and viruses during shock.
• It decreases the energy expended through the functioning of the GI system.
• It assists in expanding the intravascular volume of the body.
• It promotes GI function through direct exposure to nutrients.

Ans: D Feedback: Parenteral or enteral nutritional support should be initiated as soon as possible. Enteral nutrition is preferred, promoting GI function through direct exposure to nutrients and limiting infectious complications associated with parenteral feeding. Enteral feeding does not decrease the proliferation of microorganisms or the amount of energy 3 / 4

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expended through the functioning of the GI system and it does not assist in expanding the intravascular volume of the body.

TB QUESTION

The intensive care nurse caring for a patient in shock is planning assessments and interventions related to the patient’s nutritional needs. What physiologic process contributes to these increased nutritional needs?

• The use of albumin as an energy source by the body because of the need for

increased adenosine triphosphate (ATP)

• The loss of fluids due to decreased skin integrity and decreased stomach acids due

to increased parasympathetic activity

• The release of catecholamines that creates an increase in metabolic rate and caloric

requirements .

• The increase in GI peristalsis during shock and the resulting diarrhea.

Ans: C Feedback: Nutritional support is an important aspect of care for patients in shock.Patients in shock may require 3,000 calories daily. This caloric need is directly related to the release of catecholamines and the resulting increase in metabolic rate and caloric requirements.Albumin is not primarily metabolized as an energy source. The special nutritional needs of shock are not related to increased parasympathetic activity but are instead related to increased sympathetic activity. GI function does not increase during shock.

• Know role of ADH during shock and its consequences in the UOP

○ Urinary output usually decreases to less than 0.5 mL/kg per hour (or less than 30 mL per hour) ○ Hypernatremia stimulates the release of ADH by the pituitary gland, ADH then causes the kidneys to retain water in an effort to raise BP and blood volume.■ Leads to decreased UOP

TB QUESTION

The acute care nurse is providing care for an adult patient who is in hypovolemic shock. The nurse recognizes that antidiuretic hormone (ADH) plays a significant role in this health problem.What assessment finding will the nurse likely observe related to the role of the ADH during hypovolemic shock?

• Increased hunger
• Decreased thirst
• Decreased urinary output
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