ENPC 6th Ed Chap 7 Stabilization

Question 1

How can pulsus paradoxus be assessed by the nurse?

Answer 1

By palpating the pulse or observing a POX waveform. The waveform will dampen with inspiration or the felt pulse will weaken (102)

Question 1

What is Pulsus Paradoxus?

Answer 1

A drop in blood pressure with inspiration due to increased intrathoracic pressure

Question 2

What type of shock can a congenital heart disease cause?

Answer 2

Usually obstructive or distributive (102 BX)

Question 3

How might distributive shock present differently than other forms of shock as far as signs and symptoms?

Answer 3

“Be alert for bradycardia and vasodilation with warm, dry skin with neurogenic shock”
“Be alert for FLASH capillary refill (<1 second) and bounding pulses with septic and anaphylactic shock” (103 BX)

Question 4

Fluid volume boluses for septic shock?

Answer 4

20ml/kg up to 40-60ml/kg (107)

Question 5

Which vasopressor is preferred in fluid refractory shock in children?

Answer 5

Erpi and norepi over dopmamine (107 CP)

Question 6

What are some indications for chest compressions in a child?

Answer 6

1. No Pulse
2. HR <60 AND signs of poor prefusion

such as:
1. AMS
2. delayed cap refill >2 sec
3. cool skin
4. mottling
5. pallor
6. diaphoresis
7. hypotension
(111 RF)

Question 7

What signs might be present with respiratory failure?

Answer 7

Altered LOC
Skin color changes
WEAKENED respiratory effort (95)

Question 8

What signs might be present with respiratory distress?

Answer 8

Increased WOB (95)

Question 9

What hallmark sign denotes DECOMPENSATED shock?

Answer 9

Hypotension (96) without hypotension are you really “in shock”?

Question 10

What blood pressure parameters might be seen with COMPENSATED shock? What systemic signs mightbe present?

Answer 10

1. BP is maintained
2. DBP is ELEVATED d/t vasoconstriction,
   however the vasoconstriction shunts blood away form organs

cool skin, decreased UO, elevated lactate, tachy (cardia/pnea), weak peripheral pulses, cap refill 2-3 seconds, (97 table 7-1)

Question 11

What are some signs of DECOMPENSATED shock?

Answer 11

AMS, hypotension, increased WOB, pallor, weak or absent pulses (97)

Question 12

What are some signs of irreversible shock?

Answer 12

bradycardia, lethargy/stupor/unresponsive, mottled skin, weak or absent peripheral pulses. (99)

Question 13

What signs might be presents with a narrowed pulse pressure?

Answer 13

Increased DBP d/t vasoconstriction, weak pulse, delayed cap refill (98 BX 7-1)

Question 14

What signs might be present with a widened pulse pressure?

Answer 14

A decreased DBP due to vasodilation, flushed skin, bounding pulse (98 Bx 7-1)

Question 15

How much volume loss is required to produce hypotension?

Answer 15

30% in a 10kg patient may be <300 ml (100)

Question 16

How might the SBP reflect in early shock?

Answer 16

remain or normal or even increase (100)

Question 17

Compared to adults, describe the infants cardiac output?

Answer 17

Twice as much (100)

Question 18

Compared to adults describe pediatric oxygen consumption?

Answer 18

It is twice that of adults (100)

Question 19

What is the circulating blood volume of an infant?

Answer 19

90ml/kg

Question 20

What is the circulating blood volume of a child ?

Answer 20

80ml/kg

Question 21

What is the circulating blood volume of an adult?

Answer 21

70ml/kg

Question 22

What might a narrowed pulse pressure be a sign of?

Answer 22

Compensation in shock (100)

Question 23

What might signs of abnormal vasoconstriction include?

Answer 23

weak peripheral pulses, prolonged cap refill

Question 24

What might signs of abnormal vasodilation include?

Answer 24

flushed skin and bounding pulses

Question 25

What sites are preferable for assessing capillary refill?

Answer 25

“preferable sites …are those located AT the level of the heart. In the smaller pediatric population, a finger or toe is often not the most appropriate site” (101)

Question 26

Describe hypovolemic shock in terms of;
1. volume
2. preload
3. cardiac output
4. afterload

Answer 26

1. volume – decreased due to loss (bleeding/vomiting/burns/DKA)
2. preload–decreased
3. cardiac output – decreased due to decreased preload
4. afterload–may increase due to vasoconstriction compensation, once decompensated, may decrease (101)

Question 27

Describe obstructive shock in terms of;
1. volume
2. preload
3. cardiac output
4. afterload

Answer 27

“pump or pipe problem” obstruction that compresses the heart or vasculature (tamponade/tension pneumo/PE/HCM

1. volume–normal
2. preload–may be decreased depending on location
3. cardiac output–
4. afterload–

Question 28

What is Becks Triad?

Answer 28

A trio of finding s with cardiac tamponade that include, hypotension, muffled heart sounds and jugular vein distention (102)

Question 29

Three types of distributive shock?

Answer 29

Anaphylactic, neurogenic, septic (102)