Neurogenic Shock and Sepsis or Septic Shock

Using the Severe Sepsis Screening Tool, which assessment finding would indicate end-organ dysfunction? Select all that apply. One, some, or all responses may be correct. Bilirubin 5 mg/dL Systolic blood pressure 75 mm Hg Serum creatinine 1.6 mg/dL Lactate 4 mmol/L INR 1.25

Bilirubin 5 mg/dL A bilirubin level greater than 2 mg/dL would indicate liver dysfunction and end-organ damage. Systolic blood pressure 75 mm Hg A systolic blood pressure less than 90 mm Hg would indicate end-organ dysfunction. Lactate 4 mmol/L A lactate level greater than 2 mmol/L would indicate end-organ dysfunction.

Which result would indicate a sufficient amount of fluid was given for adequate tissue perfusion for a patient with a spinal cord injury? Lactate level of 6 mmol/L Arterial blood gas pH of 7.26 Blood pressure of 102/58 Hemoglobin level of 10.2 g/dL

Blood pressure of 102/58 A systolic blood pressure above 90 mm Hg is the best indicator that this patient received a sufficient amount of fluid at this time. Neurogenic shock requires a careful approach due to fluid overload concerns.

Which assessment finding indicates neurogenic shock is affecting a patient's thermoregulation? Poikilothermia Mottled extremities Erythematous abdomen Cold, clammy upper extremities

Poikilothermia In neurogenic shock, impaired thermoregulation occurs because of loss of vasomotor tone in the cutaneous blood vessels that dilate and constrict to maintain body temperature. The patient becomes poikilothermic, or dependent on the environment for temperature regulation.

A nurse is assessing a patient admitted with cellulitis that has an elevated white blood count. Which additional laboratory values would the nurse expect to be elevated, indicating sepsis? Select all that apply. One, some, or all responses may be correct. Hemoglobin Procalcitonin Prothrombin Serum glucose Alkaline phosphatase

Procalcitonin An elevated procalcitonin level is a valuable biomarker of significant bacterial infection. Serum glucose Serum glucose levels increase as part of the response in the development of insulin resistance during sepsis.

A nurse is monitoring the effectiveness of a continuous insulin infusion for a patient with septic shock. The last glucose reading was 425 mg/dL at 0900/9 am. Which would be the best time to recheck the patient's glucose and which reading is the target of this therapy? 1100/11 am with a goal of less than 180 mg/dL 1200/12 pm with a goal of less than 160 mg/dL 1300/1 pm with a goal of less than 120 mg/dL 1230/12:30 pm with a goal of less than 140 mg/dL

1100/11 am with a goal of less than 180 mg/dL Glucose levels should be monitored every 1 to 2 hours. So, either 10 or 11 am is an appropriate answer. The target goal is less than 180 mg/dL.

Which patient is at the highest risk for septic shock? 14-year-old male with congenital heart defects 28-year-old female with a history of diabetes 37-year-old male with burn injuries and invasive lines 46-year-old female with breast cancer

37-year-old male with burn injuries and invasive lines Male sex, burn injuries, traumatic wounds, and the presence of invasive lines all increase the risk of septic shock.

Which patient is at the highest risk for sepsis and septic shock? A 40-year-old female with a history of hypertension after orthopedic surgery with a urinary catheter A 60-year-old female with a history of diabetes admitted for chest pain and has a peripheral intravenous line A 68-year-old male patient with a history of lupus admitted with hepatitis and has a triple-lumen subclavian line A 70-year-old male with a history of gastroesophageal reflux disease admitted for abdominal pain

A 68-year-old male patient with a history of lupus admitted with hepatitis and has a triple-lumen subclavian line Certain intrinsic (unmodifiable/innate) and estrinistic (external) factors increase the risk of sepsis. This patient is an older male with an immunosuppressive condition. He also has an invasive device. He has four risk factors with the highest risk of sepsis and septic shock.

A patient with chronic obstructive pulmonary disease (COPD) is being transferred to the intensive care unit for symptomatic hypotension, lethargy, and a fever of 102.4°F. Additional findings include a Pao2/fraction of inspired oxygen (Fio2) ratio of 150 and a lactate level of 5 mmol/L. Which most likely conditions are causing these findings? ST elevated myocardial infarction (STEMI) and sepsis Metabolic alkalosis and sepsis Acute renal failure (ARF) and septic shock Acute respiratory distress syndrome (ARDS) and septic shock

Acute respiratory distress syndrome (ARDS) and septic shock Pulmonary dysfunction is manifested by a Pao2/Fio2 of less than 300 and indicates ARDS. Hypotension, fever, and a lactate level greater than 2 mmol/L are more suggestive of septic shock.

A nurse is implementing a risk care plan for ineffective peripheral tissue perfusion for a patient in neurogenic shock. Which strategies would the nurse most likely employ? Select all that apply. One, some, or all responses may be correct. Encourage bed rest with bathroom privileges. Administer enoxaparin subcutaneously as prescribed. Apply sequential pneumatic stockings to lower extremities. Offload pressure points with pillows under both knees. Utilize passive range-of-motion exercises. Administer filgrastim subcutaneously as prescribed.

Administer enoxaparin subcutaneously as prescribed. Prophylaxis medications to prevent DVT include enoxaparin. Enoxaparin is an anticoagulant used to prevent the formation of blood clots. It is part of a risk care plan. Apply sequential pneumatic stockings to lower extremities .Prophylaxis strategies include the application of sequential compression devices and compression stockings to increase circulation and prevent pooling. It is part of a risk care plan. Utilize passive range-of-motion exercises. Prophylaxis strategies include passive range of motion (PROM). PROM allows extremities to be stretched beyond what the patient might accomplish. This improves circulation and mobility. It is part of a risk care plan.

A patient with a recent history of abdominal surgery is admitted to the intensive care unit with gram-positive blood cultures and sepsis. Which treatment interventions should be a priority for the nurse? Select all that apply. One, some, or all responses may be correct. Obtain a wound culture after the first dose of a broad-spectrum antibiotic. Administer the first dose of antibiotics within 60 minutes of admission. Initiate hydrocortisone therapy within 30 minutes of admission proactively to maintain normal blood pressure. Obtain a second set of blood cultures before the third dose of antibiotics for trough levels. Start a 24-hour urine collection for creatinine clearance upon admission. Begin rapid administration of crystalloid intravenous therapy within 60 minutes of admission.

Administer the first dose of antibiotics within 60 minutes of admission. Guidelines for surviving sepsis have been developed and includes starting antibiotics within 1 hour of identification. Begin rapid administration of crystalloid intravenous therapy within 60 minutes of admission. Crystalloid therapy is a priority for sepsis for hypotension or lactate level of 4 mmol/L or greater and is included in the sepsis 1-hour bundle.

Which strategy can be used for a patient with bradycardia resulting from neurogenic shock? Cardiac ablation Diltiazem Cardioversion Atropine

Atropine An anticholinergic agent, atropine can be used to treat bradycardia caused by neurogenic shock. Typically, treatment occurs when patients are symptomatic (i.e., short of breath, syncope).

Which clinical manifestation would the nurse expect to assess in a patient admitted for early septic shock? Select all that apply. One, some, or all responses may be correct. Heart rate 125 beats/min Blood pressure 96/42 mm Hg Respiratory rate 8 breaths/min Pao2 52 mm Hg PaCO2 30 mm Hg

Heart rate 125 beats/min Septic shock causes an increase in heart rate. Blood pressure 96/42 mm Hg A decrease in blood pressure is a result of septic shock. Pao2 52 mm Hg Septic shock causes a decreased Pao2 level. PaCO2 30 mm Hg Patients with septic shock have a decreased PaCO2 early in septic shock but an increased PaCO2 during the late stages.

Which symptom of neurogenic shock results in cardiovascular instability? Hypervolemia Tachycardia Hypothermia Dyspnea

Hypothermia Hypothermia and decreased thermoregulation results in cardiovascular instability.

A nurse in the intensive care unit is concerned that a patient with a spinal injury at T6 is in neurogenic shock. Blood pressures are steadily trending lower. Which additional information would the nurse most likely gather to indicate the patient's cardiac output and determine medication therapy? Mean arterial pressure (MAP) Orthostatic blood pressures Proportional pulse pressure (PPP) Positive tilt table test

Mean arterial pressure (MAP) MAP is the product of cardiac output and total peripheral vascular resistance. Vasopressor medications may be needed since a higher MAP is recommended to prevent spinal cord ischemia.

When caring for a patient who reports to the emergency department with septic shock, which intervention would the nurse implement within the first hour of presentation? Select all that apply. One, some, or all responses may be correct. Measure the serum lactate level. Obtain blood cultures. Administer broad-spectrum antibiotics. Administer blood replacement products rapidly. Administer vasopressors for persistent hypotension.

Measure the serum lactate level. Serum lactate levels determine the severity of septic shock. Obtain blood cultures. The nurse would obtain blood cultures before administering antibiotics. Administer broad-spectrum antibiotics. The nurse would administer broad-spectrum antibiotics while awaiting culture results. Administer vasopressors for persistent hypotension. To maintain cardiac output and perfusion, the nurse may need to administer vasopressors.

Which patient symptoms meet the quick SOFA (Sequential Organ Failure Assessment) criteria for organ dysfunction? Awake, alert, and oriented × 3 with a systolic blood pressure of 110 New confusion to current place and a respiratory rate of 24 Glasgow Coma Scale score of 15 with a diastolic blood pressure of 70 Baseline orientation to person and place and heart rate of 62

New confusion to current place and a respiratory rate of 24 Two of the three guidelines must be met in order to conclude that organ dysfunction is occurring due to sepsis. The altered mentation and a respiratory rate above 22 meets this criteria.

When treating a patient with septic shock, which medication would the nurse use first to treat hypotension? Normal saline Hydrocortisone Dobutamine Norepinephrine

Normal saline Fluid resuscitation is the first step of treatment for hypotension when patients experience septic shock.

A patient after spinal surgery has the following vital signs; temperature 94.8°F (34.8°C), heart rate 50, respiratory rate 16, blood pressure 112/62, and a saturation 96% on room air. Which intervention would provide the greatest benefit for this patient? Provide crystalloid infusions. Administer vasopressors. Apply supplemental oxygen. Provide a hypothermic blanket.

Provide a hypothermic blanket. Temperatures below 95°F (35°C) indicate hypothermia. Application of a hypothermic blanket would provide the best treatment strategy for this patient. Hypothermia negatively impacts tissue perfusion.

Which indicator is one major difference separating sepsis from septic shock? Bacterial infection Serum lactate level Organ dysfunction Perfusion abnormality

Serum lactate level Septic shock is the end result, and the most severe result, of sepsis. It can be identified by serum lactate levels greater than 2 mmol/L in the absence of hypovolemia.

Which condition is the most common cause of neurogenic shock? Skeletal dysplasia Guillain Barré syndrome Spinal cord injury Spinal anesthesia

Spinal cord injury The most common cause of neurogenic shock is spinal cord injury and it typically occurs with injuries above the T6 level (high thoracic and cervical).

Which condition closely mimics and is sometimes referred to as neurogenic shock? Obstructive shock Refractory shock Spinal shock Compensated shock

Spinal shock Spinal shock is sometimes referred to and closely mimics neurogenic shock. Spinal shock differs in that signs and symptoms may be transient in nature. It typically does not occur due to ineffective tissue perfusion.

A nurse is assessing a patient with urticaria, a temperature of 96.5°F (35.8°C), a heart rate of 42, a respiratory rate of 24, a blood pressure of 84/53, and an oxygen saturation of 90% on room air. Which patient symptom more likely suggests a type of distributive shock classified as neurogenic? Select all that apply. One, some, or all responses may be correct. Temperature Heart rate Respiratory rate Blood pressure Urticaria Saturation

Temperature The patient's temperature is below normal limits. During neurogenic shock, hypothermia may be a more consistent finding because temperature regulation is now dependent on external factors. Febrile conditions are more associated with sepsis and anaphylactic shock. Heart rate Bradycardia, as seen in this patient, is more consistent with neurogenic shock because of the loss of sympathetic tone. Both distributive anaphylaxis and septic shock typically results in tachycardia.

Which inflammatory variable indicates sepsis? Fluid overload of 30 mL/kg in last 24 hours Respiratory rate of 28 breaths/min White blood count (WBC) of 16,000/mL Heart rate between 110 and 125 beats/min

White blood count (WBC) of 16,000/mL A WBC above 12,000/mL is an inflammatory variable that indicates sepsis.