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