Shock EAQ

Which lab value would the nurse expect to increase if a patient with septic shock is progressing into disseminated intravascular coagulation [DIC]?

Serum lactate

Which action would the nurse take to decrease a patient's risk for shock?

Give abx, administer O2, initiate inotropic drugs, monitor BP, obtain serum lactate level

Which physiologic change is seen in a patient with prolonged sepsis?

Hypoxia, decrease UO, change in cognition

Which finding may reflect increased cardiac output in patients with septic shock?

Normal CVP

Which condition indicates an expected outcome of treatment for sepsis and septic shock?

Normal aerobic cellular metabolism, arterial blood gasses within normal range, absence of multiple organ dysfunction syndrome

Which problem would the nurse expect to occur in a patient with SIRS related to sepsis?

Oliguria, hypotension, tissue hypoxia

A patient with which problem or condition is at highest risk for septic shock?

On prednisone therapy for rheumatoid arthritis; decreased immune system

Which blood product is preferred for use to treat patients with septic shock?

Platelets; because the patient may have impaired clotting,increasing the risk for bleeding

Which condition is identified as a specific cause of distributive shock?

Sepsis, Anaphylaxis, Capillary leak; sepsis, anaphylaxis and capillary leak are all chemical-induced causes of distributive shock

Which type of shock has no loss of blood volume from the body but has toxic metabolites that contribute to organ dysfunction?

Septic

Which typical sign or symptom indicates the early stage of septic shock?

Tachypnea; mild hypotension, a low urine output

Which medication may be included in the care plan of a patient with septic shock?

Vasoconstrictors, insulin therapy, inotropic agents, low-dose corticosteroids, broad-spectrum IV abx

distributive shock occurs when blood volume is not lost from the body

but is distributed to the interstitial tissues where it does not circulate or deliver oxygen to the tissues

During severe sepsis the body's immune response can become self-destructive if not controlled so drugs that provide adrenal support are

hydrocortisone and fludrocortisone

Septic shock is a type of distributive shock in which

there is no blood volume loss, but low levels of oxygen are perfused to the body tissues because of infections

Which statements made by a student nurse indicates understanding of the etiology of severe sepsis?

"Sepsis is commonly seen in patients with acquired immune deficiency syndrome [AIDS]", "in an immunocompromised patient, bacteria, and fungi can cause sepsis", "central venous access devices increase the risk for sepsis"

The nurse enters the room of an older patient with an UTI who has developed septic shock. Which cue would the nurse expect to notice during the assessment to support this diagnosis?

Febrile, agitation, tachypnea, tachycardia, hypotension

Which patient has an increased risk for sepsis?

50yo malnourished man, 82yo man with DM, 30yo woman with massive burns

How do you confirm sepsis?

BLOOD CULTURESSS

Which problems places a patient at the highest risk for septic shock?

Burns on 40% of the body

Which clinical manifestation of septic shock distinguished it from hypovolemic shock?

Decreased blood pressure and increased blood glucose level

Which condition is a risk factor for distributive shock?

Diminished immune response

Physiologic change is related to septic shock?

Elevated WBC

A patient with HIV is admitted with a bacterial infection. According to the MEWS, which parameter would the nurse assess to determine the patients risk for septic shock?

Heart rate, RR, systolic BP, LOC, temp and urine output

For which reason does reduced urine output occur in patients experiencing sepsis during systemic inflammatory response syndrome?

Impaired oxygenation and perfusion

Which assessment findings suggest that a patient who sustained a spider bite 12 hours ago has sepsis?

Increased RR, decreased BP, increased serum glucose level

Which sign or symptom does the nurse expect in a patient with sepsis?

Increased serum creatinine levels, increased fluid intake and decreased output, adrenal insufficiency

The nurse is caring for a patient in the beginning stages of sepsis. Which factor would affect gas exchange and tissue perfusion at this time?

Inflammation, oxidative stress, vascular changes ; as the bacteria multiply and spread throughout the body, this activates the inflammatory process, which causes oxidative stress and vascular changes.

Which issue would the nurse anticipate finding in a patient with septic shock who has disseminated intravascular coagulation [DIC]?

Low fibrinogen levels; late in septic shock, HCT and Hgb levels, fibrinogen, and platelet count are low from DIC

Which clinical symptoms in a postop patient indicate early sepsis with an excellent recovery rate if treated?

Low grade fever and mild hypotension