Critical Care Exam 2
Intra-aortic balloon pump
Increases tissue perfusion
Which patient being cared for in the emergency department is most at risk for developing hypovolemic shock?
2-day hx of n/v and diarrhea
The nurse has just completed administration of a 1000-L bolus of 0.9% normal saline. The nurse assesses the patient to be slightly confused, with a mean arterial blood pressure (MAP) of 50 mm Hg, a heart rate of 110 beats/min, urine output of 10 mL for the past hour, and a central venous pressure (CVP/RAP) of 3 mm Hg. What is the best interpretation of these results by the nurse?
Additional interventions needed
The nurse is caring for a patient following insertion of an intraaortic balloon pump (IABP) for cardiogenic shock unresponsive to pharmacotherapy. Which hemodynamic parameter best indicates an appropriate response to therapy?
CI of 2.5L/min/m2
Cardiogenic shock s/s
CO decreased CVR increased due to heart pump failure
Beck's Triad
Cardiac Tamponade Hypotension Distention Muffled heart sounds
What is variant ACS
Caused by spasms
Cardiac Tamponade
Compression of the heart from fluids
The nurse admits a patient to the coronary care unit in cardiogenic shock. The nurse anticipates administering which medication in an effort to improve cardiac output
Dobutamine
The nurse is caring for a patient admitted with cardiogenic shock. Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure (PAOP) of 18 mm Hg and a cardiac index (CI) of 1.0 L/min/m2. What is the priority pharmacological intervention?
Dobutamine
What causes rhabdomyosis?
Electrical burns
Hypertensive Urgency vs. Emergency
Emergency includes BP AND organ damage
Assessment of anaphylactic shock
Hemodynamics decrease
A patient is admitted to the cardiac care unit with an acute anterior myocardial infarction. The nurse assesses the patient to be diaphoretic and tachypneic, with bilateral crackles throughout both lung fields. Following insertion of a pulmonary artery catheter by the physician, which hemodynamic values is the nurse most likely to assess?
High pulmonary artery diastolic pressure and low cardiac output
The nurse admits a 35-year-old patient to the emergency department following a 3-day history of nausea and vomiting. Vital signs assessed by the nurse include a BP of 70/50 mm Hg, HR 145 beats/min, RR 36 breaths/min, and SpO2 of 92% on room air. The nurse recognizes which classification of shock?
Hypovolemic shock
Large volume crystalloid solution to treat hypovolemia can be accomplished with which of the following infusions? (Select all that apply.)
LR and NS
Which statement correctly reflects crystalloid fluid replacement therapy in shock states?
Lactated Ringer's should NOT be infused if lactic acidosis is severe
A patient is admitted after collapsing at the end of a summer marathon. She is lethargic, with a heart rate of 110 beats/min, respiratory rate of 30 breaths/min, and a blood pressure of 78/46 mm Hg. The nurse anticipates administering which therapeutic intervention?
Lactated Ringers
Cardiac tamponade hemodynamics
Low CO High CVP
tx ACS
MONA
A primary goal in all shock states is to
Maintain adequate tissue perfusion
Silent MI
More common in women Little to no s/s, but with ST elevation
Unstable ACS
NO enzyme elevation After tx with Nitro 3x Q5min
NSTEMI
NON-Q wave or ST elevation
After receiving handoff report from the night shift, the nurse completes the morning assessment of a patient with severe sepsis. Vital sign assessment notes blood pressure 95/60 mm Hg, heart rate 110 beats/min, respirations 32 breaths/min, oxygen saturation (SpO2) 96% on 45% oxygen via Venturi mask, temperature 101.5° F, central venous pressure (CVP/RAP) 2 mm Hg, and urine output of 10 mL for the last hour. Given this report, the nurse obtains orders for treatment that include which of the following? (Select all that apply.)
NS and Tylenol
The nurse is caring for a patient in cardiogenic shock experiencing chest pain. Hemodynamic values assessed by the nurse include a cardiac index (CI) of 2.5 L/min/m2, heart rate of 70 beats/min, and a systemic vascular resistance (SVR) of 2200 dynes/sec/cm-5. Upon review of physician orders, which order is most appropriate for the nurse to initiate?
Nitro
pink, frothy sputum
PE
Pericarditis s/s
Pericardial friction rub
STEMI
Q wave and ST elevation
The nurse is caring for a patient in cardiogenic shock who is being treated with an infusion of dobutamine (Dobutrex). The physician's order calls for the nurse to titrate the infusion to achieve a cardiac index of >2.5 L/min/m2. The nurse measures a cardiac output, and the calculated cardiac index for the patient is 4.6 L/min/m2. What is the best action by the nurse?
Reduce the rate
A patient is admitted with an acute myocardial infarction (AMI). The nurse monitors for which potential complications? (Select all that apply.)
Select all
A 72-year-old woman is brought to the ED by her family. The family states that she's "just not herself." Her respirations are slightly labored, and her heart monitor shows sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions (PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin levels are elevated, and her 12-lead electrocardiogram (ECG) shows elevated ST segments in leads II, III, and AVF. The nurse knows that these symptoms are most likely associated with which diagnosis?
Silent MI
A patient is admitted to the critical care unit following coronary artery bypass surgery. Two hours postoperatively, the nurse assesses the following information: pulse is 120 beats/min; blood pressure is 70/50 mm Hg; pulmonary artery diastolic pressure is 2 mm Hg; cardiac output is 4 L/min; urine output is 250 mL/hr; chest drainage is 200 mL/hr. What is the best interpretation by the nurse?
The patient is at risk for developing hypovolemic shock
The nurse is caring for a young adult patient admitted with shock. The nurse understands which assessment findings best assess tissue perfusion in a patient in shock? (Select all that apply.)
UO, BP and LOC
Why insert a pulmonary artery catheter?
Used to detect sepsis
What is shock?
When O2 supply does not meet O2 demand
Burn Shock
When tissues don't receive enough oxygen and perfusion
The majority of cases of cardiogenic shock are caused by
acute myocardial infarctions
What causes intra-abdominal HTN in burn patients
compartment syndrome
Stable ACS
enzyme elevation reduced with rest
Neurogenic Shock s/s
massive vasodilation hypoperfusion
dissecting aneurysm
tear within the vessel layers
In distributive shock, the major physiological problem causing the shock is
vasodilation and relative hypovolemia