Shock
Name two drugs that increase contractility
Name two drugs that increase BP
Name two drugs that decrease BP
Inotropic - Force of contraction or ability to squeeze (D drugs squeeze)
Dobutamine
Dopamine
Vasopressors: Levophed (Norepinephrine) and vasopressin
Vasodilators (N drugs): Nitroglycerin and nicardipine
SIRS criteria
Meeting two or more of the criteria can indicate SIRS.
Temp greater than 38 C
HR over 90
RR over 20
WBC count greater than 12 or less than 4
Low preload causes:
Low preload interventions:
High preload causes:
High preload interventions:
Low preload causes: dehydration and bleeding
Low preload interventions: give fluids
High preload causes: Could be that pt is tachy and you need to slow down the rate to allow for filling and stretch, Renal failure, fluid retention
High preload interventions: diuretics
The oxyhemoglobin dissociation curve describes how
hemoglobin binds and releases oxygen at different partial pressures of oxygen (pO₂). Shifts in this curve can indicate various physiological or pathological conditions.
What is the goal of treating mood disorders?
Get them back to baseline functioning to work, maintain relationships, and live healthy life
Educate to adhere to meds/therapy
Name the stages of shock and what they mean
Initial: oxygen delivery decreases, subtle & often missed signs
Compensatory: RASS activation, SIRS signs
Tachycardia, changes in ABGs, oliguria, possible hyperglycemia, weak pulse and cool skin, decreased bowel sounds. Changes in LOC. Signs of blood flow redistribution
Progressive: blood shunted from nonessential organs
decreased LOC to coma, hypotension, metabolic acidosis, cold extremities and possibly absent pulses
Refractory: extreme tissue hypoxia
coma, severe hypotension, severe acidosis, hepatic and renal failure, peripheral necrosis.
Watch end organ function – level of consciousness, skin tone/tissue perfusion, urine output
What are crucial actions in the next hour for the patient who just presented with a source of infection and SIRS?
Draw a lactate – greater than 2 indicates poor tissue perfusion – redraw if >2 on initial draw
Draw blood cultures (urine and sputum if indicated)
Give broad spectrum antibiotics- to control the potential primary source of infection
Rapid admin of 30 mL/kg crystalloid if hypotensive or lactate > 4– would you really for a patient with CRF, CHF, or morbid obesity? – cannot squeeze an empty tank
Give vasopressors after fluid resuscitation if MAP <65 – perfusion to vital organs is essential for preventing MODS
Low afterload causes:
Low afterload interventions:
High afterload causes:
High afterload interventions:
Low afterload causes: Shock, especially distributive shock causes low afterload
Low afterload interventions: Give pressors if there’s enough fluid
High afterload causes: HTN
High afterload interventions: vasodilators
High V/Q Ratio vs Low V/Q Ratio
High V/Q Ratio: Ventilation > Perfusion, airflow is normal but pulmonary blood flow is restricted
Low V/Q Ratio: Perfusion > Ventilation, airflow is restricted but pulmonary blood flow remains normal
Which actions are required when placing a patient in behavioral health restraints?
A. Obtain a provider order within 1 hour
B. Perform and document Q15 min checks
C. Use restraints to prevent patient from leaving AMA
D. Educate patient and family about reason for restraint
E. Renew order Q4h for adults if still needed
Answer: A, B, D, E
Rationale: Orders and reassessments are required by policy, and education is essential. Restraints cannot be used to control behavior or prevent leaving AMA unless the patient is a danger to self/others.
Name the types of shock and how to care for them
Hypovolemia: stop fluid loss, replace fluids
Distributive
Sepsis: cultures, anti-infective medications
Neurogenic: fluids, vasopressors
Anaphylactic: epinephrine, corticosteroids, antihistamines
Obstructive
Pulmonary Embolism: heparin, fibrinolytics if indicated, surgical intervention
Tension Pneumothorax: needle thoracotomy to chest tube
Cardiac Tamponade: pericardiocentesis, surgery
How do you know a pt has sepsis?
How do you know it turned into shock?
How do you know its MODS?
Sepsis: Some sort of sign of infection: redness, nasty cough, crackles, xray, wound
Shock: Hypotension below 90, Lactate over 2, End organ failure, Decreased LOC, pale, clammy skin, poor urine output (takes longer)
MODS: Absolute failure of two or more organs
Vent: failure of lungs
CRRT: failure of kidneys
A patient with acute decompensated heart failure has high blood pressure and pulmonary congestion. Which medication would help decrease afterload and blood pressure?
A. Dobutamine
B. Dopamine
C. Nicardipine
D. Norepinephrine
Answer: C. Nicardipine
Rationale: Nicardipine is a vasodilator that reduces systemic vascular resistance (afterload), improving cardiac output and lowering BP.
Name the cause and examples of the following:
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis: hypoventilation ex: COPD
Respiratory Alkalosis: hyperventilation ex: panic attack
Metabolic Acidosis: ex: DKA, renal failure (can't secrete acids)
Metabolic Alkalosis: ex: prolonged vomiting
What is psychosis?
What are the goals of treatment?
Distortion of reality and difficult for patients to understand what is real. Not related to intelligence
Goals: Absence of psychotic symptoms is not a reality before discharge. The focus is on return to baseline functioning and maintaining safety
A patient in the ICU is receiving norepinephrine for septic shock. The nurse notices mottled skin, a MAP of 58 mmHg, and decreased urine output. Which action is the priority?
A. Increase the norepinephrine infusion per protocol
B. Notify the provider of worsening perfusion
C. Administer an IV fluid bolus if ordered
D. Place the patient in Trendelenburg position
Answer: C. Administer an IV fluid bolus if ordered
Rationale: Norepinephrine is effective only when adequate intravascular volume is present. Worsening perfusion suggests inadequate preload—fluids should be given first (if not contraindicated) to optimize circulating volume before escalating vasopressor dose. Trendelenburg is outdated for shock.
A 72-year-old patient presents with a temperature of 38.5°C, HR 112, RR 24, WBC 15,000. There is purulent drainage from a leg wound with surrounding erythema. What is the most appropriate interpretation of these findings?
A. SIRS
B. Sepsis
C. Severe Sepsis
D. Septic Shock
Answer: B. Sepsis
Rationale: The patient meets ≥2 SIRS criteria (T, HR, RR, WBC) plus evidence of infection (wound) → this is sepsis. No organ failure or hypotension yet, so it is not severe sepsis or septic shock.
A patient develops acute kidney injury after being treated with high-dose aminoglycosides. What type of AKI is this?
A. Prerenal
B. Intrarenal
C. Postrenal
D. Functional
Answer: B. Intrarenal
Rationale: Nephrotoxic medications like aminoglycosides directly damage the kidney, causing intrarenal AKI.
ABG results: pH 7.50, PaCO₂ 28 mmHg, HCO₃⁻ 22 mEq/L
A patient is hyperventilating due to panic attack.
Which is the most likely imbalance?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
Answer: A. Respiratory alkalosis
Rationale: High pH + low PaCO₂ indicates CO₂ loss from hyperventilation. HCO₃⁻ is normal (acute).
Name the correct definition: “I got a new shirt but the buttons came loose. Do you suppose Lucifer’s buttons became lucent or are they lucid like Lucy’s lucky ducky? I like to sing ping pong that song wong kong long today hey way.”
Clang association
You are caring for four patients. Which patients need immediate intervention? SATA
A. Patient in hypovolemic shock with HR 140, BP 78/40, receiving second liter of NS
B. Patient with anaphylaxis given epinephrine 15 minutes ago, still has wheezing and hives
C. Patient with neurogenic shock, HR 48, MAP 70, warm flushed skin
D. Patient with cardiogenic shock on dobutamine, BP 84/60, urine output 15 mL in past hour
E. Patient with septic shock, lactate 2.1, MAP 72, receiving first dose of antibiotics
Answer: A, B, D
Rationale:
A: Persistent hypotension after fluids = progressing shock → needs more aggressive resuscitation or vasopressors.
B: Persistent symptoms = inadequate response → repeat epinephrine or adjunct meds.
D: Low urine output despite inotropes = poor perfusion → provider notification for titration or additional support.
C: MAP acceptable; bradycardia can be treated but not emergent.
E: Early goal-directed therapy is being followed — no immediate intervention needed.
Which interventions should be performed within the first hour of recognizing sepsis?
A. Obtain lactate level and repeat if >2
B. Obtain blood cultures before antibiotics
C. Administer broad-spectrum antibiotics
D. Give 30 mL/kg crystalloid for hypotension or lactate >4
E. Start norepinephrine before fluids if MAP <65
Answer: A, B, C, D
Rationale: Hour-1 bundle includes lactate, cultures, antibiotics, fluid resuscitation. Vasopressors (like norepinephrine) are started after fluids if hypotension persists.
What imbalances are caused by renal issues? What do nurses do to fix them?
Electrolyte balance (replacement or diuretics)
Insulin
I’s and O’s
MODES OF VENTILATION and what they do:
Volume Control (VC)
Pressure Control (PC)
Pressure Support (PS)
CPAP
BIPAP
Volume Control (VC):
Delivers a set tidal volume each breath; used to ensure consistent ventilation.
Watch airway pressures to prevent barotrauma.
Pressure Control (PC):
Delivers breaths until a set pressure is reached; tidal volume varies.
Used for stiff lungs or poor compliance to improve oxygenation safely.
Pressure Support (PS):
Patient-initiated breaths with added pressure to decrease work of breathing.
Commonly used for weaning from the ventilator.
CPAP (Continuous Positive Airway Pressure):
Continuous pressure to keep alveoli open; patient breathes spontaneously.
Improves oxygenation, often for mild respiratory failure or sleep apnea.
BiPAP (Bilevel Positive Airway Pressure):
Two pressures: higher for inspiration (ventilation) and lower for expiration (oxygenation).
Helps patients with hypercapnic respiratory failure or COPD exacerbations.
Circumstantiality vs Tangentiality
The main difference is that circumstantial speech eventually returns to the original topic, while tangential speech does not.
Circ: Someone is asked about their day and starts by describing the weather, then talks about a trip they took last year, then mentions what they had for breakfast, before finally answering the question about their day
Tang: When asked "Can I pet your dog?", someone with tangentiality might give a lengthy description of their other pets, their fears of dogs, or their favorite types of animals, but never actually answer the question about their current dog