icu 4 b

Question 1

Stages of Shock

Answer 1

compensatory stage, progressive stage, irrevrsible stage

Question 2

1. Compensatory stage

Answer 2

▪ Activation of neural, hormonal and biochemical compensatory mechanisms in an
attempt to overcome the increasing consequences of anaerobic metabolism and to
maintain homeostasis

Question 3

2. Progressive stage (decompensatory stage)

Answer 3

▪ This stage begins as compensatory mechanisms fail. Aggressive interventions are
necessary to prevent the development of MODS (multi organ dysfunction syndrome)

Question 4

3. Irreversible stage

Answer 4

This is the final stage of shock. Decreased perfusion from peripheral vasoconstriction
and decreased CO exacerbate anaerobic metabolism

Question 5

Management principles shock

Answer 5

Focus is on treatment of the underlying cause and restoring optimum perfusion
and oxygenation using the ‘VIP’ acronym

Question 6

VIP acronym

Answer 6

üVentilation, including airway, added oxygen and ventilation
üInfusion of appropriate volume expanders
üImproved heart Pumping with drug therapy such as anti-dysrhythmics, inotropes,
diuretics and vasodilators

Question 7

Nurses and other healthcare professionals have often used the Trendelenburg position

Answer 7

n patients who
are experiencing hypotensive crisis. HOWEVER, evidence to support this practice is poor and its routine
use is NOT recommended. It may result in temporary rise in BP but leads to further HD instability and
may cause other complications.

Question 8

Quality Care principles
Give patients a FASTHUG to ensure daily assessment and intervention in priority
areas

Answer 8

ü Feeding
ü Analgesia
ü Sedation
ü Thromboembolic prophylaxis
ü Head of bed elevation
ü Ulcer prophylaxis
ü Glycaemic contro

Question 9

sepsis

Answer 9

life threatening organ dysfunction cause by dyregulated host response to infection

Question 10

septic shock

Answer 10

subset of sepsis with circulatory and cellular/ metabolic dysfunction associated with higher risk of mortality

Question 11

Diagnostic Criteria for Systemic inflammatory response syndrome
(SIRS)

Answer 11

Temp >38.3 or < 36
HR >90bpm
RR >20 BPM
White cells <4 or > 12 x 10 9/L
Acutely altered mental status
Hyperglycaemia (BGL >6.6 mmol/L) unless diabetic)
Lactate > 2 mmol/L

Question 12

Identifying sepsis

Answer 12

Step 1: Identify SIRS Recognition of SIRS requires 2 or more criteria
Step 2: Confirm suspicion or evidence of infection
Step 3: Evaluate for presence of organ dysfunction

Question 13

Step 2: Confirm suspicion or evidence of infection

Answer 13

Practitioner must make a thorough evaluation of the patient seeking a likely source of infection. Source
does not need to be confirmed (i.e don’t wait for cultures or imaging to delay treatment)
SIRS criteria + infection = sepsis

Question 14

Step 3: Evaluate for presence of organ dysfunction

Answer 14

Determine the presence of organ dysfunction via battery of biochemical, haematological, radiological and
physiological investigations and observations. The presence of 1 criteria for organ dysfunction in the
presence of sepsis defines severe sepsis

Sepsis + organ dysfunction = severe sepsis