Wk 7

Question 1

Factors influencing BP and CO

Answer 1

Preload: cardiac filling, volume of blood in ventricles at end of diastole
After load: resistance left ventricle must overcome to circulate blood
Contractility: how hard the heart muscle is contracting

Question 2

Oxygen delivery governed by three components

Answer 2

Hameoglobin
CO
O2 saturation

Question 3

Shock syndrome

Answer 3

Altered physiological state that can effect functioning of all cells and systems, decreased blood flow to tissues resulting in cell dysfunction and organ failure

Question 4

Main types of shock

Answer 4

Hypovolemia
Cardiogenic
Obstructive
(Decrease CO, as a result increase SVR)

Septic
Neurogenic
Anaphylactic
(Decrease SVR, as a result increased CO)

Question 5

Obstructive and distributive circulatory shock

Answer 5

Ob: inability of heart to fill properly, outflow is obstructed

Dis: neurogenic, anaphylactic, septic

Question 6

Clinical features of shock

Answer 6

Pallor: col and clammy 
Decreased peripheral perfusion to increase central perfusion
Increased HR
Decreased BP
Increased RR

Question 7

Hypo perfusion

Answer 7

Decreased blood flow to tissue results in cellular dysfunction

Question 8

Hypovolemia shock

Answer 8

Loss of circulating blood volume
Drop in CO and hypo perfusion
Cause: haemorrhage, burns, dehydration

Question 9

Nursing management of hypovolemia shock

Answer 9

ABCDE
Monitor pt
O2therapy
Replace fluid loss: bloods, colloid, crystalloid, plasma, MAP >65
Inotropic drugs 
Nutritional support
Surgical interventions

Question 10

Cardiogenic shock

Answer 10

Failure of heart to pump efficiently. Low CO results in poor perfusion

Question 11

Nursing management of cardiogenic shock

Answer 11

ABCDE
Monitor pt
O2 ventilation
Vaso-active drugs: inotropes - adrenaline, noradrenaline, dopamine, dobutamine
Thrombolysis
Surgery
Strict fluid balance
Intra-aortic balloon pump
Nutrition

Question 12

IABP

Answer 12

In thoracic aorta, inflated during diastole to increase coronary perfusion, deflated during systole to decrease after load
Treats: shock, MI, IHD before surgery

Question 13

Neurogenic shock

Answer 13

Interruption of autonomic nerve supply from central nervous system
Increased vasodilation

Nursing management
ABCDE 
Monitor 
oxygen
Cardio-active drugs
Fluid replacement 
Nutritional support

Question 14

Anaphylactic shock

Answer 14

Overwhelming reaction to antigen, massive amounts of histamine, vasodilation with drop in BP, increased tissue permeability oedema

NM
ABCDE
O2
IM adrenaline 0.5mg
Fluid replacement
Steroids

Question 15

Sepsis

Answer 15

Organ dysfunction caused by disregulated host response to infection

Question 16

Septic shock

Answer 16

Subset of sepsis with circulatory/metabolic dysfunction associated with higher risk of mortality ph

Question 17

QSOFA: quick sepsis-related organ failure assessment

Answer 17

Hat:2 or more

Hypotension: SBP <100
Altered mental state: GCS less than 15
Tachypnoea: RR >22

Question 18

SSI signs and symptoms of infection

Answer 18

Temp >38.3 or <36
HR >90
RR >20
WBC <4 or > 12
Hyperglycaemia >6.6 unless diabetic

Question 19

Septic shock

Answer 19

Infectious agents or infection induced mediators in bloodstream create Haemodynamic compromise
Oedema due to increased permeability of capillaries

Question 20

Treating sepsis and nursing management

Answer 20

Vasopressors: adrenaline, noradrenaline, vasopressin
Enteral feeding
Insulin therapy
Ventilation
Catheter
Fluids
Antibiotics

NM
ABCDE
Monitor 
O2
Fluid replacement
Vado-active drugs: inotropes and vasopressors 
Antibiotic therapy
Nutrition
Comfort

Question 21

MODS

Answer 21

Altered organ function in acutely ill patient requiring medical intervention to achieve homeostasis
Caused by sepsis
Pulmonary system goes first usually, then cadiovascular, renal

Question 22

Stroke volume

Answer 22

Blood squeezed out of left ventricle