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NSG 233 MED SURGE 3 FINAL EXAM
2026 LATEST QUESTIONS AND
ANSWERS| ACE YOUR GRADES.
Sepsis- Nursing Support During Weaning
Nursing Support During Weaning:
Soon after the patient is admitted, a consultation with a dietitian or
nutrition support team should be arranged to plan the best form of
nutritional replacement. Adequate nutrition may decrease the
duration of mechanical ventilation and prevent other
complications, especially sepsis. Sepsis can occur if bacteria
enter the bloodstream and release toxins that, in turn, cause
vasodilation and hypotension, fever, tachycardia, increased
respiratory rate, and coma. Aggressive treatment of sepsis is
essential to reverse this threat to survival and to promote weaning
from the ventilator when the patient's condition improves
Sepsis- Interventions
Nurses caring for patients in any setting must keep in mind the
risks of sepsis and the high mortality rate associated with sepsis
and septic shock. All invasive procedures must be carried out with
aseptic technique after careful hand hygiene. In addition, IV lines,
arterial and venous puncture sites, surgical incisions, traumatic
wounds, and urinary catheters must be monitored for signs of
infection. Nursing interventions to prevent infection need to be
implemented in the care of all patients. Nurses should identify
patients who are at particular risk for sepsis and septic shock (i.e.,
older adults and immunosuppressed patients and those with
extensive trauma, burns, or diabetes), keeping in mind that these
, Page | 2
high-risk patients may not develop typical or classic signs of
infection and sepsis. However, confusion with or without agitation
along with an increased respiratory rate may be the first sign of
infection and sepsis in any adult patient
When caring for a patient with sepsis or septic shock, the nurse
collaborates with other members of the health care team to
identify the site and source of sepsis and the specific organisms
involved. The nurse often obtains appropriate specimens for
culture and sensitivity. Prescribed antibiotics are not given until
these specimens are obtained. Hyperthermia (elevated body
temperature) is common with sepsis and raises the patient's
metabolic rate and oxygen consumption. Efforts may be made to
reduce the temperature by administering acetaminophen or
applying a hypothermia blanket. During these therapies, the nurse
monitors the patient closely for shivering, which increases oxygen
consumption. Efforts to increase comfort are important if the
patient experiences fever, chills, or shivering.
The nurse administers prescribed IV fluids and medications,
including antibiotic agents and vasoactive medications, to restore
vascular volume. Because of decreased perfusion, serum
concentrations of antibiotic agents that are normally cleared by
the kidneys and liver may increase and produce toxic effects.
Therefore, the nurse monitors blood levels (serum levels of
antibiotic agents, procalcitonin, CRP, BUN, creatinine, WBC
count, hemoglobin, hematocrit, platelet levels, coagulation
studies) and reports changes to the primary provider. As with
other types of shock, the nurse monitors the patient's
hemodynamic status, fluid I&O, daily weight, and nutritional
status. Close monitoring of serum albumin and prealbumin levels
helps determine the patient's protein requirements
MODs
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In MODS, the sequence of organ dysfunction varies depending on
the patient's primary illness and comorbidities before experiencing
shock. Advanced age, malnutrition, and coexisting disease
appear to increase the risk of MODS in acutely ill patients. For
simplicity of presentation, the classic pattern is described.
Typically, the lungs are the first organs to show signs of
dysfunction. The patient experiences progressive dyspnea and
respiratory failure that are manifested as ALI or ARDS, requiring
intubation and mechanical ventilation. The patient usually remains
hemodynamically stable but may require increasing amounts of IV
fluids and vasoactive agents to support BP and cardiac output.
Signs of a hypermetabolic state, characterized by hyperglycemia
(elevated blood glucose level), hyperlactic acidemia (excess lactic
acid in the blood), and increased BUN, are present. The
metabolic rate may be 1.5 to 2 times the basal metabolic rate. At
this time, there is a severe loss of skeletal muscle mass
(autocatabolism) to meet the high energy demands of the body.
After approximately 7 to 10 days, signs of hepatic dysfunction
(e.g., elevated bilirubin and liver function tests) and renal
dysfunction (e.g., elevated creatinine and anuria) are evident. As
the lack of tissue perfusion continues, the hematologic system
becomes dysfunctional, with worsening immunocompromise,
increasing the risk of bleeding. The cardiovascular system
becomes unstable and unresponsive to vasoactive agents, and
the patient's neurologic response progresses to a state of
unresponsiveness or coma.
The goal of all shock states is to reverse the tissue hypoperfusion
and hypoxia.
Shock Symptoms
The sequence of events in hypovolemic shock begins with a
decrease in the intravascular volume. This results in decreased
NSG 233 MED SURGE 3 FINAL EXAM
2026 LATEST QUESTIONS AND
ANSWERS| ACE YOUR GRADES.
Sepsis- Nursing Support During Weaning
Nursing Support During Weaning:
Soon after the patient is admitted, a consultation with a dietitian or
nutrition support team should be arranged to plan the best form of
nutritional replacement. Adequate nutrition may decrease the
duration of mechanical ventilation and prevent other
complications, especially sepsis. Sepsis can occur if bacteria
enter the bloodstream and release toxins that, in turn, cause
vasodilation and hypotension, fever, tachycardia, increased
respiratory rate, and coma. Aggressive treatment of sepsis is
essential to reverse this threat to survival and to promote weaning
from the ventilator when the patient's condition improves
Sepsis- Interventions
Nurses caring for patients in any setting must keep in mind the
risks of sepsis and the high mortality rate associated with sepsis
and septic shock. All invasive procedures must be carried out with
aseptic technique after careful hand hygiene. In addition, IV lines,
arterial and venous puncture sites, surgical incisions, traumatic
wounds, and urinary catheters must be monitored for signs of
infection. Nursing interventions to prevent infection need to be
implemented in the care of all patients. Nurses should identify
patients who are at particular risk for sepsis and septic shock (i.e.,
older adults and immunosuppressed patients and those with
extensive trauma, burns, or diabetes), keeping in mind that these
, Page | 2
high-risk patients may not develop typical or classic signs of
infection and sepsis. However, confusion with or without agitation
along with an increased respiratory rate may be the first sign of
infection and sepsis in any adult patient
When caring for a patient with sepsis or septic shock, the nurse
collaborates with other members of the health care team to
identify the site and source of sepsis and the specific organisms
involved. The nurse often obtains appropriate specimens for
culture and sensitivity. Prescribed antibiotics are not given until
these specimens are obtained. Hyperthermia (elevated body
temperature) is common with sepsis and raises the patient's
metabolic rate and oxygen consumption. Efforts may be made to
reduce the temperature by administering acetaminophen or
applying a hypothermia blanket. During these therapies, the nurse
monitors the patient closely for shivering, which increases oxygen
consumption. Efforts to increase comfort are important if the
patient experiences fever, chills, or shivering.
The nurse administers prescribed IV fluids and medications,
including antibiotic agents and vasoactive medications, to restore
vascular volume. Because of decreased perfusion, serum
concentrations of antibiotic agents that are normally cleared by
the kidneys and liver may increase and produce toxic effects.
Therefore, the nurse monitors blood levels (serum levels of
antibiotic agents, procalcitonin, CRP, BUN, creatinine, WBC
count, hemoglobin, hematocrit, platelet levels, coagulation
studies) and reports changes to the primary provider. As with
other types of shock, the nurse monitors the patient's
hemodynamic status, fluid I&O, daily weight, and nutritional
status. Close monitoring of serum albumin and prealbumin levels
helps determine the patient's protein requirements
MODs
, Page | 3
In MODS, the sequence of organ dysfunction varies depending on
the patient's primary illness and comorbidities before experiencing
shock. Advanced age, malnutrition, and coexisting disease
appear to increase the risk of MODS in acutely ill patients. For
simplicity of presentation, the classic pattern is described.
Typically, the lungs are the first organs to show signs of
dysfunction. The patient experiences progressive dyspnea and
respiratory failure that are manifested as ALI or ARDS, requiring
intubation and mechanical ventilation. The patient usually remains
hemodynamically stable but may require increasing amounts of IV
fluids and vasoactive agents to support BP and cardiac output.
Signs of a hypermetabolic state, characterized by hyperglycemia
(elevated blood glucose level), hyperlactic acidemia (excess lactic
acid in the blood), and increased BUN, are present. The
metabolic rate may be 1.5 to 2 times the basal metabolic rate. At
this time, there is a severe loss of skeletal muscle mass
(autocatabolism) to meet the high energy demands of the body.
After approximately 7 to 10 days, signs of hepatic dysfunction
(e.g., elevated bilirubin and liver function tests) and renal
dysfunction (e.g., elevated creatinine and anuria) are evident. As
the lack of tissue perfusion continues, the hematologic system
becomes dysfunctional, with worsening immunocompromise,
increasing the risk of bleeding. The cardiovascular system
becomes unstable and unresponsive to vasoactive agents, and
the patient's neurologic response progresses to a state of
unresponsiveness or coma.
The goal of all shock states is to reverse the tissue hypoperfusion
and hypoxia.
Shock Symptoms
The sequence of events in hypovolemic shock begins with a
decrease in the intravascular volume. This results in decreased
