NURS 432 EXAM 4 BLUE PRINT
BARRY UNIVERSITY
, NUR 432 Exam 4
Study Guide
Shocks
Hypovolemic shock signs and symptoms
- Metabolic acidosis (due to hypoperfusion the cell commit to anaerobic metabolism in an
effort to meet their ATP requirements; this results in lactid acid production and metabolic
acidosis)
- caused by poor organ perfusion:
o Altered mentation, ranging from lethargy to unresponsiveness
o Rapid and deep respirations, which gradually become labored and more shallow
as the patient’s condition deteriorates
o Cool and clammy skin, with weak and thready pulses
o Tachycardia from activation of the sympathetic nervous system
o Hypotension
o Decreased urine output; urine is darker and more concentrated because the
kidneys are conserving fluid.
o A serum lactate level that remains elevated after initial resuscitation is a poor
prognostic indicator
, o Increase HR, low BP, increase SVR, low CVP, low PAP, low PAWP, low CO
o
Patients at most significant risk for Cardiogenic shock
- Most common cause is an extensive left ventricular MI
-
Cardiogenic shock treatment (Medications)
- Elevate HOB to reduce afterload
- Inotropic meds (dobutamine-dobutrex) helps increase contractility and reduce afterload
- Diuretics to relive pulmonary congestion/edema
- Hemodynamic therapy to try and reduce workload of the heart through drug therapy or
mechanical intervention (intraaortic ballon pump or VSD)
BARRY UNIVERSITY
, NUR 432 Exam 4
Study Guide
Shocks
Hypovolemic shock signs and symptoms
- Metabolic acidosis (due to hypoperfusion the cell commit to anaerobic metabolism in an
effort to meet their ATP requirements; this results in lactid acid production and metabolic
acidosis)
- caused by poor organ perfusion:
o Altered mentation, ranging from lethargy to unresponsiveness
o Rapid and deep respirations, which gradually become labored and more shallow
as the patient’s condition deteriorates
o Cool and clammy skin, with weak and thready pulses
o Tachycardia from activation of the sympathetic nervous system
o Hypotension
o Decreased urine output; urine is darker and more concentrated because the
kidneys are conserving fluid.
o A serum lactate level that remains elevated after initial resuscitation is a poor
prognostic indicator
, o Increase HR, low BP, increase SVR, low CVP, low PAP, low PAWP, low CO
o
Patients at most significant risk for Cardiogenic shock
- Most common cause is an extensive left ventricular MI
-
Cardiogenic shock treatment (Medications)
- Elevate HOB to reduce afterload
- Inotropic meds (dobutamine-dobutrex) helps increase contractility and reduce afterload
- Diuretics to relive pulmonary congestion/edema
- Hemodynamic therapy to try and reduce workload of the heart through drug therapy or
mechanical intervention (intraaortic ballon pump or VSD)
