Shock/Sepsis/SIRS
Trauma
Cervical and spinal
Diabetics
Anything goes!!
100
o Temp greater than 100.4 or 38.6 o HR greater than 90 o RR rate greater than 20 o WBC over 12,000 or < 4,000 or 10% bands
What is • What are the SIRS criteria
100
• For a trauma patient, what condition is most likely to decrease cardiac output?
What is • Hypovolemia
100
• If I patient has a cervical injury, what is your greatest concern
What is Respiratory/airway/ventilation
100
0.1units/kg/hr until glucose reaches a certain level (usually 250). Bolus prior to infusion.
What is • What is the dose for an insulin infusion?
100
4ml x TBSA (%) x body weight (kg) How much is given in the first eight hours? 50% What is the timeframe for the next 50%? 16 hours
What is • What is the Parkland formula for adult clients?
200
o Use aseptic technique with lines and devices o Promote use of incentive spirometry o Remove urinary catheter and invasive lines ASAP o Administer antibiotics within 1 hour for patients who meet SIRS criteria o Complete sepsis bundle within 6 hours of time zero (time of arrival/identification)
What is • What are some things YOU can do as the nurse to prevent sepsis?
200
Hemmorhage
What is • What is the most likely cause of hypovolemia in a trauma patient?
200
• What is normal ICP?
What is The normal ICP is 5 - 15 mmHg
200
Decrease in serum glucose (slow) but monitor for hypokalemia. Tx: Infusion of fluids and insulin infusion as needed. Goal is TISSUE PERFUSION and improve circulating volume. Restore renal perfusion ASAP. First liter of fluid in 1 hour.
What is treatment for DKA
200
• After trauma, what is a common respiratory complication?
What is ARDS
300
o Elevated CVP o Pulmonary edema o Peripheral edema o JVD o RAAS symptom activated and body trying to compensate
What is are some clinical symptoms of a person in cardiogenic shock? (extreme heart failure)
300
• What is the FIRST step in the nursing process for any patient who presents with a complex care issue, such as in the emergency department, or a change in status?
What is Assess
300
• What is normal CPP?
What is CPP varies between 60 and 140 mm Hg.
300
Metabolism of fat leads to ketone production and acidosis. Acidosis is secondary to ketoacidosis. Lipase causes breakdown of triglycerides into glycerol and free fatty acids. Liver oxidizes them to form ketones, secondary to insulin deficiency leading to ketoacidosis.
What is • Acidosis
300
Petechiae and ecchymosis, cyanosis from impaired clotting
What is • symptom of the skin might lead you to suspect DIC after trauma or clotting disorder?
400
o Decreased preload, cardiac output and stroke volume o Decreased cap refill o Tachypnea o Hypotension o Decreased urine output o Tachycardia (body trying to compensate) o Increased
What is would you expect to see in a patient with hypovolemic shock?
400
Fluid resuscitation, antibiotic administration, adequate tissue perfusion/oxygenation.
What is the treatment for shock
400
• Besides BLS, what is a priority for anyone who may have a SCI
What is Spinal immobilization
400
DKA patient reports feeling sweaty, nauseous, anxious, or other abnormality, what is the priority intervention after assessment?
What is ? Glucose check—finger stick (hypoglycemia suspected
400
Restore blood flow to the myocardium. Fluid resuscitation, vasopressors/inotropes if prescribed for shock, monitor ABGs to treat imbalances, monitor urine output hourly.
What is • What is the goal of cardiogenic shock?
500
o Change in neuro status such as agitation and restlessness o Increased HR o Increase in blood glucose (all stages of shock)
What is Compensatory Shock
500
Loss of consciousness followed by wakefulness and then confusion or ALOC.
What is • What is the classic neuro symptom of an epidural hematoma?
500
• If a patient has a T1 SCI, where would you anticipate the loss of function?
What is Below the level of injury. Maintain control of upper body, not lower.
500
• What can happen when a patient is taking corticosteroids?
What is increased glucose
500
(renal dysfunction, coag abnormalities, what it does to the gut, increased bilirubin due to liver dysfunction)
What is MODS