Disaster and Shock
C
Which of the following refers to a management tool for organizing personnel, facilities, equipment, and communication for any emergency situation? A. Office of Emergency Management B. National Disaster Medical System C. The Incident Command System D. The Hospital Emergency Preparedness Plan
A
Which positioning strategy should be utilized for the patient diagnosed with hypovolemic shock? A. Modified Trendelenburg B. Supine C. Prone D. Semi-Fowler's
D
Which stage of shock would encompass mechanical ventilation, altered level of consciousness, and profound acidosis? A. Precompensatory B. Compensatory C. Progressive D. Irreversible
B
Which type of shock is caused by an infection? A. Anaphylactic B. Septic C. Cardiogenic D. Hypovolemic
A
Which type of shock occurs from an antigen-antibody response? A. Anaphylactic B. Cardiogenic C. Septic D. Neurogenic
anthrax
With this bioterrorism pathogen it can be transmitted by inhalation, cutaneous, or thru the GI tract. The manifestations: Incubation: Respiratory: within a week-2 months. It has an abrupt onset. S/S: Inhalation : Dyspnea, Diaphoresis, Sore throat, fever, cough, chest pain, septicemia, shock, meningitis, respiratory failure, widened mediastinum (chest x-ray) Cutaneous incubation: 1-7 days S/S: Cutaneous: small papule resembles an insect bite, Advances to a depressed, black ulcer, swollen lymph nodes in adjacent areas, edema. Incubation: GI 1-7 days S/S GI: Nausea, vomiting, diarrhea, anorexia, hematemesis, abdominal pain, ascites, sepsis. Found in nature, most commonly infects wild and domestic hoofed animals, spread through direct contact with bacteria and its spores. Spores are dormant, encapsulated bacteria that become active when they enter a living host. Treatment is antibiotics to prevent systemic manifestations, Effective only if treated early, Ciprofloxacin is the treatment of choice. Penicillin, Doxycycline, Post-exposure prophylaxis for 30 days (if vaccine available) or 60 days (if not available) Vaccine has limited availability.
C
Which of the following is a clinical characteristic of neurogenic shock? A. Tachycardia B. Moist skin C. Bradycardia D. Cool skin
B
Which of the following is a procedure done in emergency situations when endotracheal intubation is not possible? A. Parathyroidectomy B. Cricothyroidotomy C. Radical neck dissection D. Thyroidectomy
C
Which of the following is a vesicant? A. Chlorine B. Sarin C. Nitrogen mustard D. Hydrogen cyanide
B
Which of the following is known as the universal distress signal? A. Flaring nostrils B. Clutching of the neck C. Labored breathing D. Use of accessory muscles
A
Which of the following medications is used for patients with bronchospasm? A.Albuterol (Proventil) B.Diphenhydramine (Benadryl) C. Crystalloids D. Diazepam (Valium)
A
Several patients that have been involved in a bombing are unlikely to survive. What priority are these patients given during triage? A. Priority 4 B. Priority 1 C. Priority 3 D. Priority 2
A
A client who experienced shock is now nonresponsive and having cardiac dysrhythmias. The client is being mechanically ventilated, receiving medications to maintain renal perfusion, and is not responding to treatment. In this stage, it is most important for the nurse to A. Encourage the family to touch and talk to the client. B. Inform the family that everything is being done to assist with the client's survival. C. Open up discussion among the family members about nursing home placement. D. Contact a spiritual advisor to provide comfort to the family.
A, B, D
A 16-year-old victim of a motor-vehicle collision is brought into your ED with extensive traumatic injuries. The paramedic reports that the client has "shock." What are the etiologies of shock? Choose all correct options. A. Blood volume decreases B. Heart fails as effective pump C. Blunt force trauma D. Peripheral vascular dilation
C
A client experiences an acute myocardial infarction. Current blood pressure is 90/58, pulse is 118 beats/minute, and respirations are 30 breaths/minute. The nurse intervenes first by administering the following prescribed treatment: A. Morphine 2 mg intravenously B. NS at 60 mL/hr via an intravenous line C. Oxygen at 2 L/min by nasal cannula D. Dopamine (Intropin) intravenous solution
D
A client has developed shock as the result of the MVA. His treatment is focused on preventing the development of more than one type of shock and to minimize the effects of the type of shock he is demonstrating. Which of the following is NOT a category of shock? A. None of the options are correct B. Circulatory C. Cardiogenic D. Hepatic
D
A client is admitted to the hospital with reports of chest pain. The nurse is monitoring the client and notifies the physician when the client exhibits A. Troponin levels less than 0.35 ng/mL B. A change in apical pulse rate from 102 to 88 beats/min C. Decreased frequency of premature ventricular contractions (PVCs) to 4 per minute D. Adventitious breath sounds
B
A client is experiencing septic shock and infrequent bowel sounds. To ensure adequate nutrition, the nurse administers A. A full liquid diet B. A continuous infusion of total parenteral nutrition C. Isotonic enteral nutrition every 6 hours D. An infusion of crystalloids at an increased rate of flow
C. (Fever, persistent cough, and dyspnea are initial symptoms)
A client is suspected of exposure to inhaled anthrax. The nurse assesses for which initial symptoms? A. Headache, blurred vision, and generalized aches B. Difficulty swallowing, cramping, and diarrhea C. Fever, persistent cough, and dyspnea D. Skin lesions that develop into black scabs
B
A client with shock brought on by hemorrhage has a temperature of 97.6° F (36.4° C), a heart rate of 140 beats/minute, a respiratory rate of 28 breaths/minute, and a blood pressure of 60/30 mm Hg. For this client, the nurse should question which physician order? A. "Monitor urine output every hour." B. "Infuse I.V. fluids at 83 ml/hour." C. "Administer oxygen by nasal cannula at 3 L/minute." D. "Draw samples for hemoglobin and hematocrit every 6 hours."
D
A confused client exhibits a blood pressure of 112/84, pulse rate of 116 beats per minute, and respirations of 30 breaths per minute. The client's skin is cold and clammy. The nurse next A. Contacts the admitting physician B. Calls the Rapid Response Team C. Re-assesses the vital signs D. Administers oxygen by nasal cannula at 2 liters per minute
A
A nuclear reactor overheated, releasing radiation throughout the plant. A worker close to reactor received at least 800 rads and has had an onset of vomiting, bloody diarrhea, and, when brought to the hospital, was in shock. What is this patient's predicted survival? A. Improbable B. Probable C. Likely D. Possible
A. (Cipro-rationale it can be used to treat and prophalaxis of anthrax)
A nurse checks emergency medications kept on hand for disaster threats of anthrax. The nurse determines that there are sufficient amounts of which drug? A. Ciprofloxacin (Cipro) B. Penicillin C. Vancomycin D. Amoxicillin (Amoxil)
Variola vaccine
A nurse is participating in a mock bio-terrorist drill. The order reads "The client has been infected by the smallpox virus." The nurse knows that the mock client needs to be treated with _____________________.
D
A nurse knows that the major clinical use of dobutamine (Dobutrex) is to: A. prevent sinus bradycardia. B. treat hypotension. C. treat hypertension. D. increase cardiac output.
A
A nurse practitioner visits a patient in a cardiac care unit. She assesses the patient for shock, knowing that the primary cause of cardiogenic shock is: A. A myocardial infarction. B. Arrhythmias. C. Valvular damage. D. Cardiomyopathies.
B, E
A nurse working as part of a disaster response team is triaging clients. Which of the following clients would the nurse color code as green? Select all that apply. A. Unresponsive client with a penetrating head wound B. Client with a first-degree burn to the forearm C. Client with multiple injuries in profound shock D. Client with a sucking chest wound E. Client with a fractured arm
B
A nursing instructor is describing the role of a nurse during a disaster. Which of the following would best reflect the nurse's role? A. Directly specified by the physician in charge B. Variable depending on the needs of the situation C. Provision of comprehensive client-specific care D. Client care within the area of expertise
D
A patient arrives in the emergency department with complaints of chest pain radiating to the jaw. What medication does the nurse anticipate administering to reduce pain and anxiety as well as reducing oxygen consumption? A. Codeine B. Dilaudid C. Demerol D. Morphine
D
A patient is admitted to the ED for the treatment of a large wound to his right leg. After determining that his injuries did not pose an immediate threat to life, the nurse's next priority in treating the wound would be to: A. Splint the wound in a functional position. B. Cleanse the wound and the surrounding area. C. Administer tetanus prophylaxis. D. Inspect the wound to assess the extent of damage to underlying structures.
A
A patient is being brought into the ED who is probably infected with anthrax. The nurse should ensure what level of personal protective equipment to wear for everyone who will come in contact with the patient? A. Level D B. Level A C. Level B D. Level C
B (SVO2 should be >70%, Urine 30 ml/hr, Map 65 or higher, CVP 2-8)
A patient is being treated for septic shock. On assessment, the nurse notes an abnormal finding that is reported to the health care provider. Which of the following is most likely that finding? A. Urinary output of 60 mL/hr B. SVO2 of 55% C. MAR reading of 65 mm Hg D. CVP reading of 10
A
A patient is in the progressive stage of shock with lung decompensation. What treatment does the nurse anticipate assisting with? A. Intubation and mechanical ventilation B. Pericardiocentesis C. Administration of oxygen via venture mask D. Thoracotomy with chest tube insertion
B
A patient is suspected to have an air embolus after being in close proximity to an explosion at a sports arena. What position should the nurse place the patient in to prevent migration of the embolus? A. High-Fowler's position B. Prone left lateral position C. Lithotomy D. Supine with head of the bed at 30 degrees
B
A patient visits a health clinic because of urticaria and shortness of breath after being stung by several wasps. The nurse practitioner immediately administers which medication to reduce bronchospasm? A. Benadryl B. Epinephrine C. Proventil D. Prednisone
D
A patient was suspected of being in direct contact with anthrax but is exhibiting no signs or symptoms. What type of prophylaxis does the nurse know this patient will have to take? A. Rocephin (Ceftriaxone) IV for 7 days B. Penicillin G IM for 1 dose C. Erythromycin for 2 weeks D. Ciprofloxacin (Cipro) for 60 days
A. (Prepare to inject atropine)
A soldier in the military is exposed to a nerve agent. The nurse takes what immediate action? A. Prepare to inject atropine B. Flush eyes with water C. Apply a steroid to the skin D. Induce vomiting
B
A vasoactive medication is prescribed for a patient in shock to help maintain MAP and hemodynamic stability. A medication that acts on the alpha-adrenergic receptors of the SNS is ordered. Its purpose is to: A. Relax the bronchioles. B. Constrict blood vessels in the cardiorespiratory system. C. Vasodilate the skeletal muscles. D. Decrease heart rate.
B
Colloids are used to expand intravascular volume in fluid replacement therapy. The nurse monitors the central venous pressure (CVP) reading and continues fluid replacement to achieve a reading of: A. 6 to 7 mm Hg. B. 8 to 10 mm Hg. C. 1 to 3 mm Hg. D. 4 to 5 mm Hg.
D.
All people who have household or face-to-face contact with the patient diagnosed with smallpox after the fever begins should be vaccinated within what timeframe to prevent infection and death? A. 2 weeks B. 1 week C. 10 days D. 4 days
Stages of shock
All types of shock progress through the same stages and produce similar effects on the body systems. There are 3 ______ ___ _____. 1. Pre-shock (Compensatory stage) 2 Shock (Uncompensated or Progressive) 3. End organ damage
A
An alarm has reached your ED regarding a serious MVA between a full tour bus and a school bus - the number of casualties expected is quite high. As you reach the site and being your assessments, you find many abrasions and lacerations. Which of the following nursing interventions are required to maintain the skin integrity when caring for clients in disaster situations? A. Apply a semiocclusive dressing over the wound B. Apply cold water over the wound C. Administer IM antibiotic to prevent wound infection D. Administer a prescribed colony-stimulating agent
B
An alarm has reached your ED regarding a serious MVA between a full tour bus and a school bus — the number of casualties expected is quite high. While part of your staff is sent to the accident site, the remaining staff readies your unit for mass traumas. At the accident site, your practice begins. As a nurse, what would you expect as your top priority? A. Set-up communication system B. Assess as many victims as possible at the site C. Organize volunteers D. Get forms ready for completion
C
An elderly man has sustained multiple bee stings on his arms, neck, and chest. He went to the ED because of the presence of hives and swelling, which got worse over time. Using the triage system with five levels, his care would be considered: A. Urgent. B. Resuscitative. C. Emergent. D. Minor.
C. (Ciprofloxacin and doxycycline)
An occupational health professional is conducting a class on risks of occupational exposure to inhalation of anthrax. Should an exposure occur, the employees are told they should receive which medication? A. Penicillin and vancomycin B. Erythromycin and vancomycin C. Ciprofloxacin and doxycycline D. Tetracycline and ampicillin
Epinephrine
Drug use: ACLS protocol, vasopressor Contraindications: Sensitivities, caution in cardiac disease SE: Paradoxical bronchospasm, arrhythmias, HTN, nervousness Nursing: Monitor BP, pulse, ECG, respirations, chest pain, shock
Atropine
Drug use: Antiarrhythimc, tx of sinus bradycardia, heart block, reversal of anticholinesterase agets (neostigmine, physostigmine, pyridostigmine (nerve agents) Contraindications: Sensitivity, acute hemorrhage SE: Tachycardia, drowsiness, blurred vision Nursing: Monitor ECG, I/O, bowel sounds Antidote: physostigmine
Ciprofloxacin
Drug use: Antrax-MCI Tularemia Contraindications: Sensitivities, myasthenia gravis SE: Pseudomembranous colitis, Increase intracranial pressure, seizures, hepatotoxicity Nursing: Assess for infection, monitor bowel function (may occur several weeks of cessation of the medication), renal function, 8th cranial nerve
Penicillin
Drug use: Botulism, anthrax (not alone), Lyme Contraindications: Sensitivities, renal complications SE: Seizures, diarrhea, nausea, vomiting, rash, anaphylaxis Nursing: Assess for infection, hx of reaction to PCN, obtain culture and sensitivity prior to administration, hyperkalemia, monitor for rash, pruritus, laryngeal edema, wheezing-keep epinephrine nearby
Benzodiazepine (alprazolam, diazepam, lorazepam)
Drug use: Nerve agents, anxiety, insomnia, MI Contraindications: Sensitivity, pulmonary impairment, uncontrolled pain, sleep apnea SE: Respiratory depression, dizziness, lethargy Nursing: Monitor VS, phlebitis, dependence
Morphine
Drug use: Pain, Pulmonary edema Contraindications: Sensitivities, respiratory depression, paralytic ileus SE: Respiratory depression, hypotension, confusion, constipation
Doxycycline
Drug use: Plague, Lyme disease, Anthrax Contraindications: Sensitivities, alcohol containing products SE: Pseudomembranous colitis, Steven-Johnsons syndrome, Toxic epidermal necrolysis Nursing: Monitor for infection, bowel functions, rash, renal function
Cidofovir
Drug use: Small pox, cytomegalovirus Contraindications: Sensitivities, concurrent use of NSAIDS or aminoglycoside SE: Hepatotoxicity, pancreatitis, renal failure, metabolic acidosis Nursing: Monitor vision, may need anti-nausea tx, VS, renal function, blood sugars, CBC
Streptomycin/Aminoglycoside (Gentamicin)
Drug use: Tularemia, TB, Plague, anti-infective Contraindications: Sensitivities SE: Ototoxicity, nephrotoxicity Nursing: Assess for infection, 8th cranial nerve, renal function
Activated charcoal
Drug used: Acute management of many oral poisonings Contraindications: None known SE: Black stools Nursing: Assess neuro, consult poison control center
B
During preshock, the compensatory stage of shock, the body, through sympathetic nervous system stimulation, will release catecholamines to shunt blood from one organ to another. Which of the following organs will always be protected? A. Liver B. Brain C. Lungs D. Kidneys
A
Following a disaster, a client's condition is serious, but she is stable enough to survive if treatment is delayed 6 to 8 hours. What category of triage would the nurse place this client? A. Green B. Yellow C. Red D. Black
C
Following a motor vehicle collision, a client is admitted to the emergency department with a blood pressure of 88/46, pulse of 54 beats/min with a regular rhythm, and respirations of 20 breaths/min with clear lung sounds. The client's skin is dry and warm. The nurse assesses the client to be in which type of shock? A. Cardiogenic B. Anaphylactic C. Neurogenic D. Septic
C
For a patient in hypovolemic shock, which type of fluid is used initially? A. .9NS B. D5.9 NS C. Lactated Ringer's D. D5W
End organ damage
In this stage of shock the affects are irreversible and total body failure. If perfusion is not restored, irreverisble end organ damage occurs, the patient does not respond to treatment and cannot survive.
Shock -Uncomensated or Progressive
In this stage of shock the body loses its ability to compensate. Activation of the inflammatory and immune responses may develop. Heart, Kidneys, and the Brain are the first organs affected. S/S: Worsening mental status, pulse becomes weak and thready, BP decreases, urine output decreases further.
C
Industrial trauma resulted in the transport of a client to your ED. Enroute, his systolic BP was 98 and sinking. Which systolic BP supports the diagnosis of shock? A. 75 B. 72 C. All options are correct D. 80
Pre-shock -Compensatory Stage
Is early shock. The body's compensatory mechanisms take over to try to keep the tissues perfused. Signs and symptoms are subtle, but it is imperative to recognize them. S/S: Increased heart rate, BP-normal, Increased respiratory rate, Decreased urinary output, Mental status changes, Cool/clammy skin.
B, C, E, F
It is essential for a nurse to be able to identify the signs and symptoms of shock. Which of the following are signs and symptoms of shock? Select all that apply. A. Increased pulse pressure B. Tachycardia C. Hypotension D. Increased capillary refill time E. Oliguria F. Cool, moist skin
A
Medical and nursing interventions for patients who present with multiple injuries follow a sequence of treatment priorities. Which of the following is the first priority of care? A. Establish an airway. B. Prevent hypovolemic shock. C. Control hemorrhage. D. Assess for head and neck injuries.
B
Morphine sulfate has which of the following effects on the body? A. Increases afterload B. Reduces preload C. No effect on preload or afterload D. Increases preload
C
Permanent brain injury or death will occur within which time frame secondary to hypoxia? A. 9 to 10 minutes B. 1 to 2 minutes C. 3 to 5 minutes D. 6 to 8 minutes
A
Shock occurs when tissue perfusion is inadequate to deliver oxygen and nutrients to support cellular function. When caring for patients who may develop indicators of shock, the nurse is aware that the most important measurement of shock is: A. Blood pressure. B. Breath sounds. C. Renal output. D. Heart rate.
Client C
The ICU nurse is required to closely monitor four clients diagnosed with shock. During the shift assessment, the nurse documents the following values for the clients. Which client is most stable? Client A: Heart rate 70 beats per minute, systolic blood pressure (BP) 100 mm Hg, urine output 30 mL/hour Client B: Capillary refill time between 7 and 10 seconds, urine output 35 mL/hour Client C: Heart rate 115 beats per minute, systolic BP 129 mm Hg, urine output 60 mL/hour Client D: Capillary refill time between 5 and 6 seconds, urine output 30 mL/hour
A, B, E
Stress ulcers occur frequently in acutely ill patient. Which of the following medications would be used to prevent ulcer formation? Select all that apply. A. Ranitidine (Zantac) B. Lansoprazole (Prevacid) C. Desmopressin (DDAVP) D. Furosemide (Lasix) E. Famotidine (Pepcid)
B
Which category of the traditional triage system is reserved for patients who do not have life-threatening illnesses? A. Emergent B. Nonurgent C. Fast-track D. Urgent
A
The NATO triage system uses color-coded tagging to identify severity of injuries. A patient with survivable but life-threatening injuries (i.e., incomplete amputation) would be tagged with which color? A. Red B. Yellow C. Green D. Black
B
The central venous pressure (CVP) reading in hypovolemic shock is typically which of the following? A. Unable to measure B. Low C. Normal D. High
C
The client exhibits a blood pressure of 110/68 mm Hg, pulse rate of 112 beats/min, temperature of 102°F with skin warm and flushed. Respirations are 30 breaths/min. The nurse assesses the client may be exhibiting the early stage of which shock? A. Cardiogenic B. Anaphylactic C. Septic D. Neurogenic
C
The clinic nurse is triaging a client who had visited a smallpox affected community 14 days ago. The client has developed a fever but no rash. Should the nurse consider the client at risk for smallpox? A. No, smallpox rash develops within 7 days. B. No, fever and rash develop immediately on exposure. C. Yes, fever and rash may follow 14 asymptomatic days. D. No, in smallpox a rash develops before fever.
A
The nurse assesses a patient who experienced a reaction to a bee sting. The patient's clinical findings indicate a pre-shock condition, which is evidenced by: A. Cold, clammy skin and tachycardia. B. Crackles and shallow breathing. C. A systolic blood pressure of 75 mm Hg. D. A heart rate of 140.
D
The nurse assesses the patient for the negative effect of IV nitroglycerin (Tridil) for shock management which is: A. Increased cardiac output. B. Reduced afterload. C. Reduced preload. D. Decreased blood pressure.
A
The nurse determines that a patient in shock is experiencing a decrease in stroke volume when what clinical manifestation is observed? A. Narrowed pulse pressure B. Increase in diastolic pressure C. Increase in systolic blood pressure D. Decrease in respiratory rate
D (Atopic dermatitis)
The nurse is assisting in a clinic with administration of smallpox vaccine. The nurse specifies that which clients should not be given the vaccine? A. Males who have had cardiac bypass surgery B. Toddlers C. Females of childbearing age D. Individuals with atopic dermatitis
A
The nurse is aware that fluid replacement is a hallmark treatment for shock. Which of the following is the crystalloid fluid that helps treat acidosis? A. Lactated Ringer's B. Albumin C. Dextran D. 0.9% sodium chloride
C
The nurse is caring for a client at risk for impending shock. The nurse is assessing the vital signs frequently. What systolic blood pressure (BP) value would indicate impending shock? A. 122 mm Hg B. 114 mm Hg C. 91 mm Hg D. 79 mm Hg
A
The nurse is using continuous central venous oximetry (ScvO2) to monitor the blood oxygen saturation of a patient in shock. What value would the nurse document as normal for the patient? A. 70% B. 40% C. 50% D. 60%
D
Which category of triage encompasses patients who have serious health problems but whose injuries are not immediately life-threatening? A. Psychological support B. Emergent C. Nonurgent D. Urgent
B
The nurse observes a patient in the progressive stage of shock with blood in the nasogastric tube and when connected to suction. What does the nurse understand could be occurring with this patient? A. The patient is having a reaction to the vasoconstricting medications. B. The patient has developed a stress ulcer that is bleeding. C. The patient has a tumor in the esophagus. D. The patient has bleeding esophageal varices.
A
The nurse obtains a blood pressure of 120/78 mm Hg from a patient in hypovolemic shock. Since the blood pressure is within normal range for this patient, what stage of shock does the nurse realize this patient is experiencing? A. Compensatory stage B. Initial stage C. Irreversible stage D. Progressive stage
D
The nurse receives a call from EMS personnel that they are bringing in eight patients who have been exposed to a chemical after a spill. The patients have been "washed off." After the initial assessment, what should be done? A. Treat the patients for any burned areas from the chemical since they have already been decontaminated. B. Start an IV with lactated Ringer's solution at 125 mL/h. C. Have the patients wash with soap and water and then rinse. D. Remove clothing and jewelry and rinse the patients off with water.
A
The nurse receives an order to administer a colloidal solution for a patient experiencing hypovolemic shock. What common colloidal solution will the nurse most likely administer? A. 5% albumin B. Blood products C. 6% hetastarch D. 6% dextran
D (convulsions and loss of consciousness)
The nurse should plan to assess soldiers who might have been exposed to nerve gas agents for which symptoms? A. Malaise and hemorrhaging B. Memory loss and fatigue C. Fever and headaches D. Convulsions and loss of consciousness
B
The nursing instructor is discussing shock with the senior nursing students. The instructor tells the students that shock is a life-threatening condition. What else should the instructor tell the students about shock? A. It begins when peripheral blood flow is inadequate. B. It occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. C. It causes respiratory distress syndrome. D. It is a component of any trauma.
Isotonic solutions
These solutions contain the same concentration of dissolved substances as normally found in plasma. Does not cause fluid shifts. Normal saline-0.9% NS Lactated Ringers-LR
Hypertonic solution
These type of solutions are more concentrated than body fluids-contain more dissolved substances than body fluids. Draw fluid out of cells into vascular compartments. 3% saline, 5% saline, 7.5% saline, and Mannitol
Hypotonic solutions
These type of solutions contain fewer dissolved substances than body fluids. Draw fluid into the cells 1/2 NS-0.45% NS D5W + 1/2 NS-D5W 0.45% NS
Colloids
These types of fluids consists of water and molecules of suspended products such as blood cells and blood products. Albumin Dextra Packed RBC's
Vasoactive Medications
These types of medication therapy are used to: Increase the strength of myocardial contractions, regulate the heart rate, reduce myocardial resistance and initiate vasoconstriction.
pneumonic plague
This bioterrorism agent is a bacterial disease, it's incubation is 2-6 days. Carried by ticks. S/S Fever, headache, weakness, pneumonia (rapid) dyspnea, chest pain, cough, bloody sputum, respiratory failure/shock. Transmitted by tick bite, handling body tissues or fluids, droplet precautions should be implemented, post exposure chemophrphylaxis. Early treatment is essential, antibiotics streptomycin, gentamicin, also penicillin.
Tularemia
This bioterrorism agent is a bacterial disease, pneumonic most severe, incubation 21 days, symptoms can present in 1 day. S/S are sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, progressive weakness. Still present in southeastern US. You should use standard precautions it can be obtained from rabbits aka "Rabbit Fever" Can be treated with streptomycin or gentamicin, MCI use doxycycline or ciprofloxacin.
Lyme Disease
This bioterrorism agent is bacterial and is carried by ticks. S/S several days to week after infection: Stage 2: 3-10 weeks post. S/S: Erythema migrans, fatigue, chills, fever, headache, muscle/joint pain, swollen lymph nodes, Bell's palsy, meningitis, joint swelling. Spread through tick bites. Standard precautions should be implemented and it should be reported to CDC. Treatment for this bioterrorism agent is amoxicillin and Doxycycline
Ebola
This bioterrorism pathogen is a hemorrhagic virus-5 strains, infection leads to neutrophil inactivation, endothelial cell damage, widespread necrosis, hemorrhage, death. It has an abrupt onset of fever 8-12 days post exposure, fever, chills, myalgias, malaise, GI discomfort, watery diarrhea, bloody stool, nausea, vomiting, seizures, pain, confusion, cerebral edema, bleeding. Can lead to death in 6-16 days. Prognosis is poor 40-89% mortality. Spread by aerosol (weaponized) Person to person contact, animal orientation?, infects many cells and migrate to lymph nodes, liver, spleen, adrenal glands. In every secretion. Not airborne, Often confused with malaria and typhoid fever. There is no cure. IV fluid re-hydration, balance electrolytes, maintain blood pressure, treat opportunistic infections, supportive, no treatment. Log all people entering the room, Strict PPE regulations with an observer.
Botulism
This bioterrorism pathogen is a spore-forming anaerobe found in soil, seven different toxins, lethal bacterial neurotoxin, can die within 24 hours. It has an incubation period of 12-36 hours. S/S: Abdominal cramps, dry mouth, nausea, vomiting, diarrhea, cranial nerve palsies (diplopia, dysarthria, dysphonia, dysphagia) Skeletal muscle paralysis, respiratory failure, difficulty swallowing. Spread through air or food, No person-to person spread. Improperly canned foods, contaminated wounds-black tar heroin users. Treatment: induce vomiting, enemas, antitoxin, mechanical ventilation, Penicillin, No vaccine available, Toxin can be inactivated by heating food or drink to 212 degrees F. for at least 10 minutes.
Small pox
This bioterrorism pathogen is transferred by: Highly contagious, Direct person-to person spread, Transmitted in air droplets, Transmitted by handling contaminated materials. Treatment for this bioterrorism pathogen is: No known cure, vaccine available, Cidofovir under testing, Isolation for containment, Vaccine available for those exposed, Vaccinia immune globulin (VIG) available
Small pox
This bioterrrorism pathogen has 2 types: Variola major and minor. No longer vaccinated since 1980. Incubation 7-17 days, Sudden onset of symptoms: Fever, headache, Myalgia, Lesions that progress from macules to papules to pustular vesicles, malaise, back pain.
Crystalloids
This fluid replacement consist of water and dissolved crystals. 1-Isotonic solutions, 2-Hypertonic solutions, 3-Hypotonic solutions.
Disseminated Intravascular Coagulation (DIC)
This is a hematologic condition triggered by an underlying problem. It occurs because of chemicals (pro-coagulant factors) that are released as part of the inflammatory response. It occurs in two stages: 1 clotting or thrombotic state, 2 bleeding stage.
Shock
This is a life threatening condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular perfusion.
Systemic Inflammatory Response Syndrome (SIRS)
This occurs when there is systemic activation of the inflammatory process, Caused by any type of shock or other traumatic injury. Inflammatory process occurs throughout the body. (Sepsis)
Tagging system
This system uses a tracing number and assigns a triage tag to each patient. Color assigns priority.
Black-Expectant
This tag color indicates injuries are extensive and chances of survival are unlikely even with definitive care. Persons in this group should be separated from other causalities, but not abandoned. Comfort measures should be provided when possible. Don't leave alone have someone stay with them. Burns over 60% of BSA Wounds involving multiple organs High spinal cord injuries Agonal respirations Pulseless Profound shock
Yellow-Urgent
This tag color indicates injuries are life-threatening but survivable with intervention within the 30 min to an hour, individuals in this group can progress rapidly if treatment is delayed. Complex, lower extremity fractures Vascular injuries without compromise Stable abdominal wounds CNS injuries GU injuries Facial injuries with no airway obstructions Expected wait for treatment is 45-60 min
Green-Non-Urgent
This tag color indicates injuries are non life-threatening but survivable with minimal intervention. Patient can wait between 1-4 hours for treatment, sometimes more. Upper extremity fractures Sprains Burns (small surface area, not facial) Behavioral Psych Lacerations with minimal bleeding
Red-Emergent
This tag color indicates that injuries are life-threatening but survivable with immediate intervention. Patient should not wait more than 15 minutes! Individuals in this group can progress rapidly if treatment is delayed: Mechanical airway obstruction Pneumpthorax Open long bone fractures Partial amputations Chest wounds Abdominal wounds Burns 15-40% of body surface area (BSA)
Septic
This type of distributive shock is a potentially life-threatening complication of an infection. Occurs when chemicals are released into the bloodstream to fight infection-triggers the inflammatory response throughout the body causing massive vasodilation. Common causes: UTI's, Pneumonia. Commonly acquired by very old/very young, weakened immune systems, malnourished, drug and alcohol abuse, wounds or injuries. Can also be hospital acquired by previous overuse of antibiotics, prescence of invasive lines, exposure to drug resistant bacteria, Ill patients, Urosepsis
Anaphylactic
This type of distributive shock is a severe allergic reaction. There is an antigen-antibody reaction that causes the release of histamine or bradykinin that then causes massive vasodilation, capillary permeability and vascular collapse. Caused by allergens that are inhaled, ingested contacted or introduced into the body via injections. Hives or Urticaria, rash, facial swelling, high pitched stridor.
Neurogenic
This type of distributive shock is where there is a loss of sympathetic tone which prevents constriction of blood vessels casing massive vasodilation. Can be caused by spinal anesthesia, lack of glucose, spinal shock, depressant medications, spinal cord injury. Lack of sympathetic nervous system response. S/S is hypotension and BRADYcardia.
Obstructive
This type of shock is blockage in the heart or major vessels which causes a decrease in cardiac output and tissue perfusion. Causes: Pulmonary embolism, Tension pneumothorax, Cardiac tamponade, Aoritc dissection. More common in trauma.
Hypovolemic shock
This type of shock is decreased intravascular volume. (Dehydration) is a decrease in the volume of blood in the body: Caused by Blood loss or fluid loss of some kind. Vomiting, diarrhea, profuse sweating, burns, diuretics, weeping, NPO status.
Cardiogenic shock
This type of shock occurs when the heart's ability to contract and pump blood is impaired and there is an inadequate supply of oxygen to the heart and tissues. Common causes: CHF, MI, HF, Cardiomyopathy (any heart disease) Dysrhythmias, SVT (Supra Ventricular Tachycardia)
Distrubutive shock
This type of shock results from EXCESSIVE VASODILATION and increased permeability causing impaired distribution of blood flow: Vital organs not getting blood, Pooling of blood. Three types: Septic Anaphylactic Neurogenic
shock
Treatment of _____. Close, frequent monitoring, treat underlying cause, improve blood volume/pumping of the heart, and provide respiratory support.
D
Which is the most common type of shock? A. Obstructive B. Cardiogenic C. Distributive D. Hypovolemic
B
Which level of the triage system is implemented when the patient requires two or more resources? A. Nonurgent B. Urgent C. Emergent D. Minor
A
Which of the following colloids is expensive but rapidly expands plasma volume? A. Albumin B. Lactated Ringer's C. Dextran D. Hypertonic saline
Anthrax, small pox, botulism, ebola
What are agents of bioterrorism? Select all that apply a. small pox b. chicken pox c. anthrax d. agent orange e. botulism d. flu e. ebola
B, C, D
What can the nurse include in the plan of care to ensure early intervention along the continuum of shock to improve the patient's prognosis? (Select all that apply.) A. Administer vasoconstrictive medications to patients at risk for shock. B. Administer intravenous fluids. C. Monitor for changes in vital signs. D. Assess the patient who is at risk for shock. E Administer prophylactic packed red blood cells to patients at risk for shock.
All
What do you want to know about your patient when starting your shift? Select all that apply A. Reason for admission B. Mental status C. Vital sign trends D. Trends in lab values E. Any new procedures F. Any new medications
C
What priority intervention can the nurse provide to decrease the incidence of septic shock for patients who are at risk? A. Have patients wear masks in the health care facility. B. Insert indwelling catheters for incontinent patients. C. Use strict hand hygiene techniques. D. Administer prophylactic antibiotics for all patients at risk.
B, D, E
When a patient in shock is receiving fluid replacement, what should the nurse monitor frequently? (Select all that apply.) A. Ability to perform range of motion exercises B. Mental status C. Visual acuity D. Urinary output E. Vital signs
C
When a patient is in the compensatory stage of shock which of the following symptoms occurs? A. Urine output of 45 cc/hour B. Respiratory acidosis C. Tachycardia D. Bradycardia
A
When describing the use of smallpox as a biologic agent, which of the following would the nurse include as the primary means of infection? A. Direct contact B. Inhalation C. Ingestion D. Percutaneous absorption
A
When preparing for an emergency bioterrorism drill, the nurse instructs the drill volunteers that each biological agent requires specific patient management and medications to combat the virus, bacteria, or toxin. Which of the following statements reflect the patient management of variola virus (smallpox)? A. Smallpox spreads rapidly and requires immediate isolation. B. A vaccination is effective only if administered within 12 to 24 hours of exposure. C. Smallpox is spread by inhalation of spores. D. Acyclovir is effective against smallpox.
B
When vasoactive medications are administered, the nurse must monitor vital signs at least how often? A. 30 minutes B. 15 minutes C. Hourly D. 45 minutes
A
You are a nursing student preparing to care for an ICU client with shock. Your instructor asks you to name the different categories of shock. Which of the following is a category of shock? A. Distributive B. Cardiotonic C. Hypervolemic D. Restrictive
C
You are caring for a client in shock who is deteriorating. You are infusing IV fluids and giving medications as ordered. What type of medications are you most likely giving to this client? A. Hormone antagonist drugs B. Antimetabolite drugs C. Adrenergic drugs D. Anticholinergic drugs
C
You are caring for a client in the compensation stage of shock. You know that in this stage of shock adrenaline and noradrenaline are released into the circulation. What positive effect does this have on your client? A. Decreases blood return to the heart B. Decreases carbon dioxide exchange C. Increases myocardial contractility D. Contracts bronchioles
B
You are caring for a client who is in neurogenic shock. You know that this is a subcategory of what kind of shock? A. Obstructive B. Circulatory (distributive) C. Hypovolemic D. Carcinogenic
A
You are holding a class on shock for the staff nurses at your institution. What would you tell them about the stages of shock? A. In the compensation stage, catecholamines are released. B. Shock begins in the decompensation stage. C. Antiduretic and corticosteroid hormones are released at the beginning of the irreversible stage. D. The renin-angiotensin-aldosterone system fails in the compensation stage.
C
You are the nurse caring for a client in septic shock. You know to closely monitor your client. What finding would you observe when the client's condition is in its initial stages? A. A weak and thready pulse B. A slow but steady pulse C. A rapid, bounding pulse D. A slow and imperceptible pulse
C
You are the nurse caring for three clients who have been diagnosed with anthrax. They were exposed after boarding a flight where a white powdery substance was found in one of the restrooms. You know that these clients would be classed as being victims of which of the following? A. A radiologic disaster B. A chemical disaster C. A biologic disaster D. A natural disaster
A. (Red)
You have a patient that was in a car accident that is 35 y/o female, front seat passenger. Alert, confused. RUE deformity. Thoracic bruising from right shoulder to LLQ. Deformed RLE, pulse confirmed weak. BP 70/40, HR 134, RR 26, O2 94% on non-rebreather. What would you triage them as? A. Red B. Black C.Green D. Yellow
