Week 11 Flashcards
Classifications of Shock
• Hypovolaemic • Cardiogenic • Circulatory (distributive)
What is shock?
A loss of effective circulation resulting in impaired tissue oxygen and nutrient delivery.
What are the stages of shock?
- Pre-compensatory (cellular level)
- Compensatory
- Progressive
- Irreversible
Describe compensatory stage of shock
• SNS causes vasoconstriction, increased HR, increased heart contractility in order to maintain BP & CO.
• The body shunts blood from skin, kidneys, extremities, GI tract in order to maintain vital systems.
Resulting in the pt having cool, clammy skin; hypoactive bowel sounds and decreased urine output.
Describe progressive stage of shock
Compensatory mechanisms start to fail resulting in:
• BP and mean arterial pressure decrease
• Hypoperfusion
• Vasoconstriction continues further compromising cellular perfusion
• Decreased pulmonary blood flow/alveoli collapse resulting in hypoxia/hypercapnia/acidosis
• Acute renal failure as glomerular filtration ceases
Describe irreversible stage of shock
Organ damage is now so severe that pt does not respond to treatment:
• BP undetectable • Anaerobic metabolism worses acidosis
• Multiple organ failure • Death
Early signs of shock
- Confusion/anxiety • Tachypnoea • Tachycardia
- Decreased urinary output, bowel sounds
- Cold, diaphoretic skin
- BP is normal (for now)
The critical care nurse is caring for a patient with cirrhosis. What is an essential nursing function when caring for a patient with cirrhosis?
a. Monitoring for constipation. b. Monitoring the pt for signs of hypervolemia. c. Monitoring the pt’s support network. d. Monitoring the pt’s mental status. e. Monitoring the pt’s oral intake.
d. Monitoring the pt’s mental status.
The nurse is caring for a pt with hepatic encephalopathy. While making the initial shift assessment the nurse notes that the pt has a flapping tremor of the hands. What will the nurse document this condition as in the pt’s charge?
a. Constructional apraxia. b. Palmar erythema. c. Asterixis.
d. None of the above. e. Fetor hepaticus.
c. Asterixis.
A nurse is assessing an elderly pt with gallstones. The nurse is aware that the pt may not exhibit typical symptoms and that symptoms that may be exhibited in the elderly pt may include what?
a. Fever and pain. b. Chills and jaundice. c. N&V.
d. Septic shock and oliguria. e. Spontaneous haemorrhage.
d. Septic shock and oliguria.
The nurse is caring for a pt with liver failure. The nurse understands that pts in liver failure often require vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin?
a. Vitamin A. b. Vitamin K. c. Vitamin D.
d. Vitamin B12. e. Vitamin B6.
b. Vitamin K.
Your pt has a gallstone blocking the bile duct. When you assess the pt’s laboratory studies what would you expect to find?
a. Increased BUN level. b. Decreased serum alkaline phosphatase level.
c. Decreased cholesterol level.
d. Increased bilirubin level in the blood.
e. Decreased serum GGT level.
d. Increased bilirubin level in the blood.
The triage nurse in the emergency department is assessing a pt who presented with complaints of not feeling well. The pt has ascites and an enlarged liver. The pt reports a hx of drinking a 12 pack of beer every evening for the past 15 years. The nurse is aware that the pt is at risk for which disease?
a. Cirrhosis. b. Coronary artery disease.
c. Hepatitis. d. Cardiovascular disease. e. Renal failure.
a. Cirrhosis.
A pt with a liver mass is undergoing a percutaneous liver biopsy. After the procedure the nurse assists the physician in positioning the pt. What position should they position the pt in?
a. Trendelenberg.
b. On the r/side with a pillow under the costal margin.
c. On the l/side with a pillow under the knees.
d. Supine position. e. Reverse Trendelenberg.
b. On the r/side with a pillow under the costal margin.
A pt is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be scheduled in 4 days. The pt asks why the surgery is being put off for a week when he has a “sick gallbladder”. What would the nurse’s best response?
a. To determine whether a laparoscopic procedure can be used.
b. To get the pt stronger. c. The surgeon is on a golfing holiday.
d. Surgery is delayed until the acute symptoms subside.
e. Surgery is delayed until the pt can eat a regular diet without vomiting.
d. Surgery is delayed until the acute symptoms subside.
