NUR 325 Exam 4 New Latest Version Updated 2024-2025 Best Studying Material, Exams of Nursing

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NUR 325 Exam 4 New Latest Version Updated 2024- 2025

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Which patient is most at risk for developing septic shock? A - 45 year old patient 12 days post op from a lumbar fusion with a heart rate of 95 and a temp of 100.1F B - 27 year old patient with a UTI and WBC 13, C - 87 year old patient admitted for frequent falls with a blood pressure of 105/ D - 58 year old patient with cellulitis and a lactic acid of 3.9 ---------- Correct Answer ---------- D active infection and lactic acid > Your patient has been diagnosed with sepsis. Which orders would you expect to see? SATA A - Draw blood cultures B - 0.9% NaCl infusion at 125ml/hr continuous C - CBC and CMP D - Piperacillin-Tazobactam IV 25ml/hr Q 8 hours E - Protonix 40mg IV daily ---------- Correct Answer ---------- all of the above Your patient has sepsis with the following vital signs: BP 75/34, HR 120, RR 22, temp 98.9F, O2 95%. Which order would the nurse implement first? A - Docusate Sodium 100mg B - Norepinephrine 0.5mcg IV continuous, titrate to effect C - 12 lead EKG D - 1000ml 0.9% NaCl IV bolus ---------- Correct Answer ---------- D - fluids first then vasopressors What position is seen in the passive leg raise? A - Trendelenberg B - Lithotomy C - Prone D - Semi-recumbent ---------- Correct Answer ---------- D Which patient is at risk for multi-organ dysfunction syndrome (MODS)? A - Patient with diminished lung sounds and BP 105/ B - Patient on hemodialysis and takes epoetin C - Patient with jaundice and venous jugular distention D - Patient with lymphedema and cellulitis ---------- Correct Answer ---------- C Your patient has the following labs and vital signs: hemoglobin 6.0g/dL, platelets 50,000, BP 84/57, HR 115, RR 17, SpO2 94% on 6L O2. The nurse receives the following orders. Which should the nurse implement first? A - Heparin IV infusion started at 10unit/kg/hr continuous B - Norepinephrine 0.5mg IV once C - 2 units PRBCs D - Nimodipine 60mg oral BID ---------- Correct Answer ---------- C - increase hemoglobin, increase blood pressure, hopefully wean off oxygen Your patient had a severe burn and has urine that is positive for a significant amount of myoglobin. Which complication is this a sign of? A - Rhabdomyolysis

B - Carbon monoxide poisoning C - Hypoxia D - Cardiogenic shock ---------- Correct Answer ---------- A There was a fire at a nearby apartment complex. Four people were injured and brought into the ED. Which one should you see first? A - Patient with a third degree18% TSBA burn of the right leg with tingling B - Patient with a circumferential second degree burn to the abdomen asking for pain medication C - Patient with an epidermis layer burn to the entire back that's peeling D - Patient with second degree burns to the face and neck and requiring 5L of O2 ---------- Correct Answer ---------- D Alteration in which of the following does not contribute to shock? A - Blood volume B - Myocardial contractility C - Capillary refill D - Vascular resistance ---------- Correct Answer ---------- C rationale: alterations in all other options contribute to shock SIRS can be caused by... (SATA) A - Trauma B - Infection C - Singultus D - Ischemia E - 0.8 Lactic acid ---------- Correct Answer ---------- A, B, D C - hiccups E - normal lactic acid level Anaerobic metabolism is seen in which phase of shock? A - Refractory B - Progressive C - Initiation D - Compensatory ---------- Correct Answer ---------- B Which of the following are symptoms seen in the compensatory phase? A - ARDS, DIC, AKI B - Anuria, acidosis, hyperglycemia C - No apparent symptoms D - Oliguria, restlessness, hypotension responsive to fluids ---------- Correct Answer ---------- D A - refractory B - progressive C - initiation A patient with the following vital signs: HR 118, RR 18, temp 99.3F, O2 92%, BP 74/43. The patient has received 2L of 0.9% NaCl fluid boluses. Which of the following orders should the nurse implement first? A - Tylenol 625mg rectal suppository B - Fentanyl IV 0.5-1.0 mcg/hr continuous infusion, titrate to effect C - 1000ml Lactated Ringer's bolus

D - Norepinephrine 0.5-1.0 mcg/hr continuous infusion, titrate to effect ---------- Correct Answer ---------- D Rationale: Blood pressure not responding to fluids alone. Need to begin pressors. A patient is diagnosed with septic shock. As the nurse you know this is a _______ form of shock. In addition, you're aware that _____ and ______ are also this form of shock. A - Obstructive; hypovolemic and anaphylactic B - Distributive; anaphylactic and neurogenic C - Obstructive; cardiogenic and neurogenic D - Distributive; hypovolemic and obstructive ---------- Correct Answer ---------- B Your patient has 73% TBSA burns and weighs 128kg. Using the Parkland Formula, how much Lactated Ringer's would they get in the first 8 hours? (2 mL/kg/%TBSA) A - 4672ml B - 9344ml C - 18688ml D - 6229ml ---------- Correct Answer ---------- B What is shock? ----------- Correct Answer ------------ - Life-threatening response to alterations in circulation

• Inadequate tissue perfusion
• Imbalance between cellular oxygen supply and demand
• Can lead to organ failure and death
• Hypoperfusion of tissues, hypermetabolism, & activation of inflammatory response What is the first system to be affected by shock and what are the early and late signs and symptoms? ------ ----- Correct Answer ------------ - CNS affected first by changes in cell perfusion
• Early: restless, agitated, and anxious
• Later: confused & lethargic What would we want our MAP to be at? What is the normal range? ----------- Correct Answer ------------ - 65 or higher
• Normal is 60 to 100 How does our respiratory system respond to shock? ----------- Correct Answer ------------ - Early: rapid and deep resps (like metabolic acidosis)
• Poor gas exchange
• May need to intubate
• ABGs What would a patients urine output be if they have oliguria? ----------- Correct Answer ------------ Less than 0.5 ml/kg/h Why would a patient have oliguria from sepsis? ----------- Correct Answer ------------ Urine output decreases because the body retains sodium and keeps water in the kidneys How does shock affect the liver? ----------- Correct Answer ------------ - Prolonged clotting
• Petechiae
• Ecchymosis may occur

What are the normal lactate levels? ----------- Correct Answer ------------ Less than 2 Why is it important to assess serum lactate levels for patients with suspected shock? ----------- Correct Answer ------------ Indicate decreased oxygen delivery to the cells What are the stages of shock? ----------- Correct Answer ------------ Initial Compensatory Progressive Refractory What is the initiation phase of shock? ----------- Correct Answer ------------ - Inadequate delivery of oxygen leads to hypoperfusion

• No obvious clinical signs noted but might see decreased CO
• Reversible What is the compensatory phase of shock? ----------- Correct Answer ------------ - Sustained reduction in tissue perfusion initiates responses to maintain blood flow to organs
• Initiation of compensatory mechanisms
• Reversible What are the manifestations of the compensatory stage of shock? ----------- Correct Answer ------------ - Increased HR
• Narrowed pulse pressure
• Thirst
• Cool, moist skin
• Oliguria
• Diminished bowel sounds
• Restlessness progressing to confusion
• Hyperglycemia
• Increase urine specific gravity
• Rapid deep resps causing respiratory alkalosis What is normal urine specific gravity? ----------- Correct Answer ------------ 1.005-1. How would you treat a patient in the compensatory stage of shock? ----------- Correct Answer ------------ - Treat underlying cause
• Fluids & O
• Maintain BP and tissue perfusion
• Frequent assessment (subtle changes in LOC, I&O, respiratory and heart rate, BP or MAP) What is the progressive phase of shock? ----------- Correct Answer ------------ - Sustained hypo-perfusion and vasoconstriction results in significant peripheral tissue ischemia
• Failure of compensatory mechanisms
• Treatment will require more than just fluid resuscitation What are the manifestations of a patient in the progressive stage of shock? ----------- Correct Answer ------ ------ - BP no longer compensated
• MAP below normal limits (60-100)
• Decreased mental status
• Rapid and shallow resps

• Chest pain
• Acute kidney injury
• If cause is not reversed then progress to MODS and then death How would you treat a patient in the progressive stage of shock? ----------- Correct Answer ------------ - Treat underlying cause
• Restore tissue perfusion with fluid management
• Respiratory support
• Nutritional support for energy
• Assessment (subtle changes) including ABGs, hemodynamic monitoring, ECG monitoring, mental status changes, and serum electrolytes What is the refractory phase of shock? ----------- Correct Answer ------------ - End stage phase of shock resulting in permanent disability or death
• Unresponsive to therapy
• Irreversible What are the manifestations of the refractory stage of shock? ----------- Correct Answer ------------ - Increase in acidosis
• Severe hypotension
• Decreased heart rate, impaired cardiac contractility, decrease in CO and tissue perfusion
• Bradycardia
• Decline in mental status
• MODS, brain death, cardiac arrest
• Patient unable to respond to treatment What things can lead to SIRS and MODS? ----------- Correct Answer ------------ - Infection
• Trauma
• Surgery
• Ischemia
• Autoimmune disorders
• Pancreatitis What is SIRS? ----------- Correct Answer ------------ - Systemic inflammatory response syndrome
• Release of mediators
• Hypovolemia What are the manifestations of SIRS? ----------- Correct Answer ------------ - Increased HR
• Increased RR
• Decreased urine output
• Restlessness
• Confusion
• Cool, moist skin What is cardiogenic shock? ----------- Correct Answer ------------ - Inadequate myocardial contractility
• Heart fails to act as an effective pump (decreased cardiac output; impaired perfusion) What is the most common cause of cardiogenic shock? ----------- Correct Answer ------------ Left ventricular MI What are the clinical manifestations of cardiogenic shock? ----------- Correct Answer ------------ -

Hypotension

• Tachycardia
• Oliguria
• Decreased mentation
• Tachypnea
• Dysrhythmias
• Chest pain
• Left and right ventricular failure (crackles, SOB)
• Dysrhythmias What are the treatments for cardiogenic shock? ----------- Correct Answer ------------ - Improve contractility
• Revascularization
• Prevent or treat dysrhythmias
• Heart transplant/ECMO
• Focus on underlying cause
• IABP (improves coronary artery perfusion, reduces afterload, and improves perfusion to organs)
• Mechanical intra aortic balloon pump used to pump out blood from the heart when the heart cant do so effectively
• Goal of IABP (diminished symptoms (chest pain etc) and increased stroke volume and cardiac output) What are the pharmacological interventions for cardiogenic shock? ----------- Correct Answer ------------ - Decrease preload (diuretics, venous vasodilators)
• Increase cardiac output (positive inotropes)
• Decrease afterload (arterial vasodilators) What is obstructive shock? ----------- Correct Answer ------------ - Obstruction of blood flow
• Physical impairment to adequate circulatory blood flow What are the clinical manifestations of obstructive shock? ----------- Correct Answer ------------ - Chest pain & dyspnea
• JVD
• Hypoxia
• Cause-dependent findings What are the potential causes of obstructive shock? ----------- Correct Answer ------------ 1. Cardiac tamponade

2. Tension pneumothorax
3. Constrictive pericarditis
4. Compression of great vein
5. Pulmonary embolism
6. Severe pulmonary hypertension
7. Increased intrathoracic pressure What are the treatments for obstructive shock? ----------- Correct Answer ------------ - Eliminate source of obstruction

• Pericardiocentesis for cardiac tamponade
• Fibrinolytic, anticoagulants for PE
• Emergency decompression for tension pneumothorax What is distributive shock? ----------- Correct Answer ------------ - Widespread vasodilation and decreased

vascular tone (relative hypovolemia)

• Types: anaphylactic, neurogenic, septic
• Inadequate vascular tone What is neurogenic shock? ----------- Correct Answer ------------ - Loss of sympathetic tone
• Interruption of sympathetic nervous system impulse transmission
• From upper SCI, spinal anesthesia, NS damage, vasomotor depression What are the clinical manifestations of neurogenic shock? ----------- Correct Answer ------------ - Bradycardia with hypotension
• Warm, dry, and flushed skin
• Hypothermia due to impaired thermoregulation What is the treatment for neurogenic shock? ----------- Correct Answer ------------ - Immobilization of spinal injuries
• Positioning of spinal-blocked patients
• IV fluids for hypotension
• Vasopressors (only after volume is replaced)
• Slow rewarming to prevent further vasodilation What is anaphylactic shock? ----------- Correct Answer ------------ - Trigger that releases histamine
• Introduction of an antigen into a sensitive individual, initiating an antigen-antibody response (release of vasoactive mediators and histamine)
• From severe allergic reaction What are the clinical manifestations of anaphylactic shock? ----------- Correct Answer ------------ - Airway (upper/lower)
• Angioedema (meds like tPA)
• Cardiovascular
• Integumentary What is the management for anaphylactic shock? ----------- Correct Answer ------------ - Removal of offending agent
• Airway
• Medications and fluid replacement What is septic shock? ----------- Correct Answer ------------ - Invasion of microorganism
• Follows invasion of a host by a microorganism (progressive)
• From immunosuppression or significant bacteremia What are the clinical manifestations of septic shock? ----------- Correct Answer ------------ - Metabolic acidosis
• Acute encephalopathy
• Oliguria
• Hypoxemia
• Coagulation disorders
• Hypotension
• Decreased skin perfusion/mottling
• Petechiae What is the management for septic shock? ----------- Correct Answer ------------ - Antibiotic therapy

• Early goal-directed therapy (first 6 hours)
• ACTH
• Glycemic control
• Temperature control What is hypovolemic shock? ----------- Correct Answer ------------ - Inadequate intravascular/circulating volume
• Internal or external losses of blood or fluid (hemorrhage, diarrhea, burns, ascites, fracture, edema) What are the clinical manifestations of hypovolemic shock? ----------- Correct Answer ------------ - Hypotension
• Tachycardia
• Oliguria
• Altered mental status
• Tachypneic
• Cool, pale skin
• Decreased mentation
• Flat neck veins What are the nursing interventions for hypovolemic shock? ----------- Correct Answer ------------ - Eliminate and treat the cause (internal or external loss of fluid or blood)
• Replace lost volume with appropriate fluid (restore circulating volume)
• May need to replace electrolytes and/or give blood products
• Monitor for bleeding
• I & O/daily weights What are the labs for hypovolemic shock? ----------- Correct Answer ------------ - Decreased blood pressure/MAP
• Decreased hemodynamic values
• Decreased urine output
• Decreased sodium
• Potassium
• Increased BUN
• Increased creatinine (dehydration) What is the normal range for sodium? ----------- Correct Answer ------------ 135 - 145 What is the normal range for potassium? ----------- Correct Answer ------------ 3.5-5. What is the normal range for BUN? ----------- Correct Answer ------------ 10 - 20 What is the normal range for creatinine? ----------- Correct Answer ------------ 0.6-1. What is sepsis? ----------- Correct Answer ------------ - Life threatening organ dysfunction
• Caused by host response to infection
• Risk factors: immunosuppression or significant bacteremia
• Can result in septic shock What is the diagnostic criteria for sepsis? ----------- Correct Answer ------------ Finding the source of infection

What are the clinical manifestations of sepsis? ----------- Correct Answer ------------ - Sepsis and end-organ dysfunction as evidenced by two or more of the following:

• SBP < 90 mm Hg or MAP < 65 mm Hg
• Urine output < 0.5 ml/kg/hr for 2hrs or creatine > 2 mg/dl
• Creatine > 0.5 mg/dl above baseline if history of CKD
• PLT < 100,000 mm
• INR > 1.5 or aPTT > 60 sec
• Serum lactate > 2 mmol/L
• Increasing oxygen requirements
• Altered mental status What is the normal range for white blood cells? ----------- Correct Answer ------------ 5,000-10, What is the normal range for platelets? ----------- Correct Answer ------------ 150,000-400, What is the normal INR range? ----------- Correct Answer ------------ 0.8-1.2 sec What is the normal PTT range? ----------- Correct Answer ------------ 25 - 35 sec (if greater, takes longer to clot) What are the nursing interventions for septic shock? ----------- Correct Answer ------------ - Infection prevention!!
• Be aware of the patient's baselines
• Frequently monitor for any changes in vitals/mentation
• Review lab results
• Implement bundles (central line)
• Monitor wounds for signs of infection What is the management for sepsis? ----------- Correct Answer ------------ - Obtain blood cultures
• Administer antibiotics
• Obtain lactate; repeat lactate within 6 h of identification
• Administer fluids
• Maintain ventilation and oxygenation
• Remove source of infection
• Administer vasopressors to maintain MAP > 65, if BP not responsive to fluids What is the treatment for septic shock? ----------- Correct Answer ------------ 1. Obtain blood cultures

2. Administer antibiotics
3. Obtain lactic acid
4. Administer fluids
5. Maintain oxygenation and ventilation
6. Remove source of infection
7. Administer vasopressors to maintain MAP > 65 (if BP not responsive to fluids) What is MODS? ----------- Correct Answer ------------ - Multiple organ dysfunction syndrome

• Progressive dysfunction of two or more organ systems
• Maldistribution of volume, tissue hypoxia, & metabolic alterations What can cause MODS? ----------- Correct Answer ------------ - Most common cause is sepsis and septic

shock

• SIRS
• Severe injury or illness
• Shock
• Trauma
• Burns
• Injury
• Infection What are the clinical manifestations of MODS? ----------- Correct Answer ------------ - Lungs (ARDS): tachypnea and hypoxemia despite oxygen
• Hematology: petechiae, bleeding, thrombocytopenia, positive D-dimer, prolonged PT and PTT
• Liver: jaundice, increased liver enzymes
• Renal (acute tubular necrosis): oliguria to anuria, increased BUN and creatinine, fluid/electrolyte imbalance
• Cardiac (hyper/hypodynamic) increased O2 consumption, increased CO, & tachycardia. Hypo: myocardial depression, decreased O2 consumption, and decreased CO
• CNS (cerebral ischemia or infarct): confusion, change in LOC, hemiparesis
• Metabolic (lactic acidosis): elevated serum lactate levels What labs would indicate MODS? ----------- Correct Answer ------------ - Thrombocytopenia (low platelets)
• Positive D dimer (there is a clot)
• Long PTT (normal 25-35)
• Increased bilirubin, AST and ALT
• Increased BUN and creatinine
• Elevated lactate What is the treatment for MODS? ----------- Correct Answer ------------ - Control infection (antibiotics)
• Provide adequate tissue oxygenation (maintain 88% to 92% arterial oxygen saturation, maintain hemoglobin above 7 to 9 g/dL)
• Restore intravascular volume (aggressive fluid resuscitation with isotonic crystalloids like lactated ringers and NS)
• Support organ function What are the normal Hgb levels? What range of Hgb should be maintained for patients with MODS? ----- ------ Correct Answer ------------ - 12 to 16
• Patients with MODS should have 7-9 (to carry oxygen) What is the goal of treatment of shock? ----------- Correct Answer ------------ Improved tissue perfusion (and O2 delivery) What blood pressure would be considered hypotension? ----------- Correct Answer ------------ Systolic below 90 What should we assess for in the cardiovascular system for patients with suspected shock? ----------- Correct Answer ------------ - Early (compensatory): BP slightly elevated, narrow pulse pressure
• Late: pulses What should we assess for in the CNS system for patients with suspected shock? ----------- Correct Answer ------------ - Early: anxiety, restlessness

• Late: coma What should we assess for in the pulmonary system for patients with suspected shock? ----------- Correct Answer ------------ - Early: rapid, deep respirations
• Late: shallow respirations, poor gas exchange What should we assess for in the renal system for patients with suspected shock? ----------- Correct Answer ------------ Decreased glomerular filtration which could lead to sodium retention, water retention, oliguria (low urine output) What should we assess for in the gastrointestinal system for patients with suspected shock? ----------- Correct Answer ------------ Slowing intestinal activity (decreased bowel sounds, distention, nausea, constipation) What should we assess for in the hepatic system for patients with suspected shock? ----------- Correct Answer ------------ Altered liver enzymes (ALT is 4 to 36), clotting disorders, increased susceptibility to infection What should we assess for in the hematological system for patients with suspected shock? ----------- Correct Answer ------------ - DIC
• Enhanced clotting, inhibited fibrinolysis
• Depletion of clotting factors What should we assess for in the integumentary system for patients with suspected shock? ----------- Correct Answer ------------ - Skin color, temp, texture, turgor (should increase with fluids)
• Late: cyanosis What do serum lactate levels tell us? ----------- Correct Answer ------------ - Measure of overall state of shock
• Indicator of decreased oxygen to cells
• Indicator of adequacy of resuscitation What is a fluid challenge? ----------- Correct Answer ------------ - Rapid infusion of a crystalloid solution (lactated ringer or normal saline) of 250 mL up to 2 liters
• Blood products (IV access of 20 gauge or higher), keep vein open with normal saline if reaction occurs Why is a fluid challenge done for patients with shock? ----------- Correct Answer ------------ To assess whether fluids will improve their hemodynamics What are the complications of doing a fluid challenge? ----------- Correct Answer ------------ - Pulmonary edema
• Transfusion reaction Which types of shocks affect preload? What are the interventions? ----------- Correct Answer ------ ------ - Hypovolemic and distributive shock (IV fluid challenge)
• Cardiogenic shock (venous vasodilators) Which types of shocks affect afterload? What are the interventions? ----------- Correct Answer ---- -------- - Distributive shock (vasoconstriction (Norepi, Epi, vasopressin))
• Cardiogenic shock (arterial vasodilators)

Which type of shock affects contractility? What are the interventions? ----------- Correct Answer -----------

• Cardiogenic shock (dobutamine, beta blockers) What are the functions of vasopressor agents? ----------- Correct Answer ------------ - Increase blood pressure by vasoconstriction
• Increase afterload
• Increase cardiac workload
• Compromise perfusion What are some examples of vasopressor agents? ----------- Correct Answer ------------ - Norepinephrine
• Dopamine
• Phenylephrine
• Vasopressin
• Epinephrine
• Angiotensin II What are the functions of inotropic agents? ----------- Correct Answer ------------ - Improve contractility
• Increase stroke volume
• Increase cardiac output
• Increases oxygen demand of the heart What are some examples of inotropic agents? ----------- Correct Answer ------------ - Dobutamine
• Dopamine
• Epinephrine What are the functions of vasodilators? ----------- Correct Answer ------------ - Reduce preload and afterload
• Reduce oxygen demand of heart
• Cause hypotension What is an example of a vasodilator? ----------- Correct Answer ------------ Nitroglycerin Why would we give sedatives to a patient with shock? ----------- Correct Answer ------------ - May need to intubate patient because they have lost their respiratory drive
• Impaired gas exchange
• Impaired perfusion Why would we give insulin to a patient with shock? ----------- Correct Answer ------------ Insulin to cushion their lungs because of inflammatory process, edema, cell death, hemodynamic instability, stress Why would we give H2 receptor antagonists or PPIs to a patient with shock? ----------- Correct Answer --- --------- Risk for gastric ulcer What is DIC? ----------- Correct Answer ------------ - Disseminated intravascular coagulation
• Depletion of clotting factors
• Result is uncontrollable bleeding
• Initially the coagulation time is normal but when the platelet and clotting factors fail, then they become abnormal
• Acute, life-threatening to chronic, low-grade condition

What can DIC lead to? ----------- Correct Answer ------------ - Causes organ ischemia and necrosis (most commonly in skin, lungs, and kidneys and considered a secondary problem of DIC)

• May result in MODS What is the most common cause of DIC? ----------- Correct Answer ------------ Sepsis What are the clinical manifestations for DIC? ----------- Correct Answer ------------ - Petechiae
• Bleeding from mucous membranes (gingival bleeding)
• Infarction of fingers and toes
• Occult blood in stool, emesis, urine
• Ecchymosis
• Mild oozing to massive hemorrhage What are the labs for DIC? ----------- Correct Answer ------------ - ABG's
• Platelet counts
• PT
• PTT
• D dimer levels What is the medical management for DIC? ----------- Correct Answer ------------ - Identify and treat underlying cause
• Stop abnormal coagulation and control bleeding
• Blood therapy to replace deficit platelets, clotting factors, and treat hemorrhage (platelets are priority for clotting factors)
• Correct secondary effects of tissue ischemia (respiratory support- due to altered oxygen carrying capacity of blood) What are the nursing interventions for patients with DIC? ----------- Correct Answer ------------ - Promote gas exchange (monitor resp patterns, vitals, position patient to optimize ventilation and maintain proper fluid balance
• Treat infections or address coagulation abnormalities
• Enhance tissue perfusion (monitor vitals, urine output, fluid resuscitation, administer vasopressor meds, and address underlying cause of DIC)
• Assess: signs and symptoms of DIC, chest pain/SOB, urine output and color, and LOC
• Prevent bleeding risk and injury (gentle oral care) What are the characteristics of a superficial burn? ----------- Correct Answer ------------ - First degree
• Epidermis only or small depth of dermis
• Heals in 3 to 5 days without treatment
• Erythema
• Not calculated for fluid resuscitation What are the characteristics of a partial thickness burn? ----------- Correct Answer ------------ - Second degree
• Epidermis and most of dermis
• Superficial partial thickness (epidermis and limited portion of the dermis, heals in 7-10 days)
• Deep partial thickness (epidermis and most of dermis, heals within 2-4 weeks) What are the characteristics of a full thickness burn? ----------- Correct Answer ------------ - Third degree
• Destruction of all layers down to or past fat, fascia, muscle, or bone

• Thick, dry, leathery appearance
• Insensate (no pain) What is the rule of 9's? ----------- Correct Answer ------------ Helps to calculate the total body surface area of burn What is the treatment for burns? ----------- Correct Answer ------------ - Fluid resuscitation based on %TBSA (need greater than 20% TBSA)
• Administer half of total fluids during first 8 hours from time of injury
• Administer the other half over the next 16 hours from time of injury What is the Parkland Formula? ----------- Correct Answer ------------ - Lactated ringers
• 4 mL/kg/%TBSA burned
• 1/2 given in 8 hrs, the other 1/2 in 16 hrs What are electrical burns? ----------- Correct Answer ------------ - Electrical lines, lightning, car batteries
• Important to know circumstances
• Tissue damage occurs during process of converting electrical energy to heat What are examples of thermal burns? ----------- Correct Answer ------------ - Flame (fire, explosion of gases
• Scald (water, oil)
• Steam (car, radiators, cooking pot)
• Contact (metal, glass, space heater) What are examples of chemical burns? ----------- Correct Answer ------------ - Alkalis/bases (oven cleaners, lye, wet cement, fertilizers)
• Acids (bathroom cleaners, pool chemicals)
• Organic compounds (gasoline, kerosene, disinfectants)
• Have them rinse their chemical burn out What is an inhalation injury? ----------- Correct Answer ------------ - Inhalation of hot smoke, chemical toxins, and products of incomplete combustion
• Carbon monoxide and cyanide poisoning
• Systemic injury due to exposure to toxic gases (supraglottic injury and subglottic injury) What are the nursing diagnosis' for burns? ----------- Correct Answer ------------ - Impaired gas exchange
• Impaired airway clearance
• Hypovolemia
• Hypothermia
• Pain
• Impaired nutrition
• Risk for infection When are skin grafts done? ----------- Correct Answer ------------ For deep partial-thickness and full- thickness burns What are some complications of burns? ----------- Correct Answer ------------ - Acute respiratory failure
• Distributive shock
• Acute kidney injury
• Compartment syndrome (from impaired perfusion, common with electrical burns and third-degree burns)

• Paralytic ileus (GI circulation compensating)
• Rhabdomyolysis What is the normal urine output? ----------- Correct Answer ------------ 30 - 50 mL/hr 1 liter/day What is the function of renin and which organ excretes renin? ----------- Correct Answer ------------ Renin regulates blood pressure so if they kidneys arent working properly and they produce renin, then BP alterations may result What is prerenal acute kidney injury? ----------- Correct Answer ------------ - Involve sufficient reduced blood flow to kidneys to impair function
• Most common causes are dehydration, shock, or blockage of renal arteries
• Body attempts to normalize renal perfusion
• Can be reversed if cause treated
• Can give antiarrhythmics? I DIDNT GET WHAT SHE SAID ON SLIDE 7 What is intrarenal acute kidney injury? ----------- Correct Answer ------------ - Direct damage to kidney tissue
• Most common condition acute tubular necrosis (ATN) but also genetics and nephrotic drugs What blood values would you be looking at to see if a patient can tolerate contrast? ----------- Correct Answer ------------ If BUN is high then you would expect the provider to order fluid bolus before and after contrast What is postrenal acute kidney injury? ----------- Correct Answer ------------ - Results from obstruction of urine flow or renal injury
• Treatment: bladder cath, urethral stenting, or nephrostomy tubes What are ways to prevent acute kidney injury? ----------- Correct Answer ------------ - Avoid nephrotoxins (NSAID like ibuprofen, naproxen)
• Optimize volume status
• Reduce incidence of nosocomial infections
• Aggressive sepsis management What is the initiation phase of acute kidney injury? ----------- Correct Answer ------------ - Period from occurrence to beginning of urine output changes
• Lasts several hours to 2 days
• Normal renal processes deteriorate
• Patient shows symptoms of AKI
• Reversible What is the maintenance phase of acute kidney injury? ----------- Correct Answer ------------ - Oliguric/anuric (also referred to in other sources) What occurs in this phase:
• BUN and creatinine increase daily
• Oliguria is common (urine output less than 400 mL/day)
• Fluid overload, electrolyte imbalances, and acidosis
• Renal replacement therapy required What are some complications of the maintenance phase? ----------- Correct Answer ------------ -

Hyperkalemia

• Infection What is the recovery phase of acute kidney injury? ----------- Correct Answer ------------ - Return of tubular function
• 4 to 6 months for BUN and creatinine to return to normal
• Impairment of GFR
• Early dialysis may prevent the traditional "diuretic" phase of AKI What are the clinical manifestations of acute kidney injury? ----------- Correct Answer ------------ - Azotemia (nitrogen/BUN waste in blood), oliguria, & anuria
• Hypertension
• Confusion
• Pallor
• Uremia
• Hyperventilation (meta acidosis)
• Altered temp
• Altered fluid volume
• Bruising, petechiae, edema What is uremia? ----------- Correct Answer ------------ - Urine in the blood
• Malaise
• Disorientation
• Drowsiness When patients have azotemia, which lab levels correspond to this manifestation? ----------- Correct Answer ------------ Increased BUN and creatinine What are the complications of acute kidney injury? ----------- Correct Answer ------------ - Metabolic acidosis
• Fluid and electrolyte imbalances
• Listen to signs and symptoms of complicatinn again

---

What are the signs of uremia? What does uremia indicate? ----------- Correct Answer ------------ - Malaise

• Fatigue
• Disorientation
• Drowsiness
• Could indicate acute kidney injury What lab values would you check for acute kidney injury? (ON EXAM) ----------- Correct Answer ------------ - Creatinine levels rise
• GFR will decrease (normal 90-125) (30-59 moderate decrease)
• BUN
• Urine creatinine clearance
• K+ (hyperkalemia)
• Na (hyponatremia) Which blood pressure med increases potassium? ----------- Correct Answer ------------ Lisinopril What is chronic kidney disease? ----------- Correct Answer ------------ - A gradual loss kidney function

(stages)

• Decrease in GFR lasting 3 months or more
• Untreated can lead to end stage kidney disease What are the causes of chronic kidney disease? ----------- Correct Answer ------------ - Severe AKI
• Hypertension
• Diabetes
• Infection What are the symptoms and complications of chronic kidney disease? ----------- Correct Answer -----------
• • Elevated creatinine levels
• Anemia (decreased erythropoietin production by kidneys)
• Metabolic acidosis
• Abnormalities in Ca and PH
• Fluid retention (edema & CHF)
• Electrolytes What are the treatments for chronic kidney disease? ----------- Correct Answer ------------ - Treat underlying cause
• Lab assessment
• Control cardiovascular risks
• Treat hyperglycemia
• Manage anemia
• Reduce salt and alcohol intake What is end-stage kidney disease? ----------- Correct Answer ------------ Kidneys permanently unable to remove enough wastes and water What are the signs and symptoms of end-stage kidney disease? ----------- Correct Answer ------------ - GFR less than 15
• Anuric
• Need dialysis or transplant
• Cannot live without one or the other What are the nursing diagnosis' of end-stage kidney disease? ----------- Correct Answer ------------ - Hypovolemia r/t decreased u/a output & sodium and water retention
• Impaired nutrition r/t anorexia, vomiting, and fluid restriction What are the collaborative problems of end-stage kidney disease? ----------- Correct Answer ------------ - Hyperkalemia
• Hypertension
• Anemia What are the indications for dialysis? ----------- Correct Answer ------------ 1. Advanced CDK & end stage renal

2. Oliguria (urine output less than 400 ml/day or less than 20 ml per hour)
3. Fluid overload (increasing acidosis)
4. Nephrologist recommendation What are some common meds for dialysis? ----------- Correct Answer ------------ - Sevelamer and calcium acetate reduce phosphate levels and you should give with meals

• Protamine sulfate reverse effects of heparin for increased bleeding during shunting
• Erythropoietin for anemia What are AV fistulas? ----------- Correct Answer ------------ - Created surgically joins an artery to a vein, side to side or end to end
• Needs time to mature before use (4-6 weeks)
• Type of hemodialysis What are AV grafts? ----------- Correct Answer ------------ - Created using Teflon grafts under skin
• Connection between artery and vein
• Heal 2-4 weeks
• Type of hemodialysis What is the nursing care for patients with AV fistulas or AV grafts? ----------- Correct Answer ------------ - Protect site
• Auscultate for a bruit
• Do not use site for B/P, blood draw, or IV placement
• Communicate to healthcare team that patient has fistula or graft What is a percutaneous venous cath? What are some complications? ----------- Correct Answer ------------
• Internal jugular vein preferred
• Risk: hematoma, bleeding, pneumo, infection and thrombosis
• Double lumen so less chance of infection What are the nursing interventions for patients receiving hemodialysis? ----------- Correct Answer --------- --- - Monitor lab values
• Weigh patient daily
• No water soluble meds until after
• HTN meds avoided for 4-6 before (bc will get flushed through)
• Narcotics and sedatives reduced
• Fistula: report loss of bruit or s/s infection
• Assess for bleeding, hypovolemia What are the complications of dialysis? ----------- Correct Answer ------------ - Volume depletion
• Dysrhythmias
• Hypoxemia
• Disequilibrium syndrome
• Vascular access infections What is CRRT? What are the advantages and disadvantages? ----------- Correct Answer ------------ - Used with patients too unstable for hemodialysis, continuous
• Advantages (more gradual solute removal, flexible fluid administration, minimal heparin, can be done by staff nurses at the bedside)
• Disadvantages (bed rest, blood clots, one-to-one nursing care) What are the nursing responsibilities for patients during CRRT? ----------- Correct Answer ------------ - Monitor hemodynamic status
• Monitor temperature (fluids are cold)
• Monitor for clotting or bleeding
• Monitor machine for complications
• Monitor lines and make them visible

What is peritoneal dialysis? What are the advantages or disadvantages? ----------- Correct Answer --------- --- - Removal of solutes and fluids using the peritoneal membrane as a filter

• Rarely used in the critical care setting because it is less efficient
• Advantage (easy to use, inexpensive, minimal electrolyte imbalances or hemorrhage)
• Disadvantage (requires 36 hours for effect, access difficult and risk for peritonitis) What are the complications of peritoneal dialysis? What are some signs and symptoms of that complication? (ON EXAM) ----------- Correct Answer ------------ - Peritonitis
• Cloudy output
• Abd pain
• Fever
• Stiffness
• Chills
• Difficulty draining
• WBC What glucose level is considered hypoglycemia? What should you do if someone is hypoglycemic ----------- Correct Answer ------------ - Under 70
• Give them sugar, give them protein, recheck sugar What glucose level is considered hyperglycemia? ----------- Correct Answer ------------ 200 or higher What is DKA? ----------- Correct Answer ------------ - Relative or absolute insulin deficiency
• Increase in counterregulatory hormones: glucagon, cortisol, catecholamines, and growth hormone What are the clinical manifestations of DKA? ----------- Correct Answer ------------ - Classic signs of dehydration
• Orthostasis
• Polyuria, polydipsia, polyphagia
• Hyperventilation/Kussmaul's respirations
• Fruity odor to breath
• Flushed/dry skin
• Lethargy/altered consciousness
• Blood glucose greater than 250mg/dL
• Ketonuria/glucosuria
• Weight loss (may be profound)
• Blood gas changes (metabolic acidosis) What can cause DKA? ----------- Correct Answer ------------ - Initial presentation of type 1 diabetes
• Infections
• Insufficient insulin relative to need
• Severe stress (trauma, surgery, acute myocardial infarction)
• Pregnancy in type 1 diabetes mellitus (DM)
• Missed or reduced insulin
• Glucocorticoids
• Mismanagement of sick days What are the labs for DKA? ----------- Correct Answer ------------ - Hypokalemia (even if serum K+ is normal or high, insulin pushes potassium into cells)
• Phosphate depletion (enhanced by insulin)

• Electrolytes
• Mild hyponatremia
• Elevated BUN/creatinine What is hyperglycemic hyperosmolar syndrome (HHS)? ----------- Correct Answer ------------ - Decreased use of glucose and/or increased production
• Hyperglycemia; increased extracellular osmolality
• Osmotic diuresis
• Profound dehydration
• No ketoacidosis (hyperglycemia with hyperosmolarity blocks lipolysis) How does DKA develop versus HHS? ----------- Correct Answer ------------ Onset of DKA develops quickly whereas HHS develops slowly with no obvious symptoms at first What are the clinical manifestations of hyperglycemic hyperosmolar syndrome (HHS)? ----------- Correct Answer ------------ - Blood sugar > DKA; average >1000 mg/dL
• More "normal" arterial blood gases (ABGs)
• More electrolyte imbalances and renal dysfunction
• Higher serum osmolarity than DKA
• Ketosis absent or mild What are the nursing interventions of DKA and HHS? ----------- Correct Answer ------------ - Manage airway
• Fluid replacement (first 0.9% NS, then 0.45% NS, dextrose added when glucose approaches 200 mg/dL)
• Insulin therapy (continuous) When should you transition to subcutaneous insulin therapy for DKA? ----------- Correct Answer ---------- -- - pH greater than 7.
• HCO3 greater than 15
• Ketosis must be resolved before transition How is acidosis corrected in patients with DKA? ----------- Correct Answer ------------ - Fluids and insulin
• Bicarb if pH is less than 7. When we monitor patients with DKA and HHS, what are the goals for hourly glucose monitoring? -------- --- Correct Answer ------------ - Decrease glucose by 50 to 75 mg/dL/hr
• When glucose is less than 200 mg/dL, adjust infusion to maintain values of 150 to 200mg/dL What are the goals of electrolyte stabilization for patients with DKA or HHS? ----------- Correct Answer - ----------- - Increase potassium (establish renal function first, maintain between 4-5)
• Increase phosphorus
• Increase magnesium
• Monitor ECG What is the primary function of ADH? ----------- Correct Answer ------------ Regulates our water balance and serum osmolality When is ADH released? ----------- Correct Answer ------------ - Increased serum osmolality (dehydration)
• Decreased blood volume
• Decreased blood pressure

Which two diseases disturb the production/function of ADH? ----------- Correct Answer ------------ - Diabetes insipidus

• SIDH What is diabetes insipidus? ----------- Correct Answer ------------ - Anti-diuretic hormone deficiency
• Excessive water loss occurs
• Polyuria (> 3L in 24 hrs)
• Polydipsia
• Hypovolemia
• Tachycardia
• Dehydration
• Primary causes: TBI, surgery or cerebral edema What are the clinical manifestations of diabetes insipidus? ----------- Correct Answer ------------ - Urine pale/diluted with high urine output
• Thirst & polydipsia
• Fatigue (from dehydration)
• Hypotension
• Poor skin turgor
• Dry mucous membranes
• Tachycardia
• Neurological signs What are the treatments for diabetes insipidus? ----------- Correct Answer ------------ - Treat cause
• Fluid/electrolyte replacement
• Hormone replacement
• Medications (desmopressin because it has a longer action than vasopressin)
• Monitor for complications (fluid overload)
• Patient/family education What are the diagnostics for diabetes insipidus? ----------- Correct Answer ------------ - Dilute urine with low specific gravity (less than 1.005)
• Increased serum osmolality (greater than 295 from dehydration)
• Increased BUN and creatinine
• Hypokalemia or hypercalcemia
• Water deprivation test
• Vasopressin test (to differentiate) What are the labs that characterize diabetes insipidus? ----------- Correct Answer ------------ - High sodium (greater than 145)
• High serum osmolality (greater than 295) What are some causes of SIDH? ----------- Correct Answer ------------ - Trauma (HI, infection, hemorrhage, stroke)
• Tumor
• Cancer
• Pulmonary disorders (TB, COPD) What medications can cause SIADH? ----------- Correct Answer ------------ - Analgesics (tylenol)
• Tegretol

• Cipro
• Amiodarone What are the clinical manifestations of SIDH? ----------- Correct Answer ------------ - Confusion, HA, seizures (from hyponatremia)
• Increased resp, dyspnea
• HTN
• Edema
• Congestion of GI tract (anorexia, N/V, vomiting, muscle cramps, decreased bowel sounds) What are the labs for SIDH? ----------- Correct Answer ------------ - Hyponatremia (less than 135)
• Decreased serum osmolality (too much water, less than 280)
• Increased urine osmolality (concentrated urine)
• Decreased BUN and creatinine
• Decreased albumin What are the treatments for SIDH? ----------- Correct Answer ------------ - Treat cause
• Restrict fluids (a lot of water retention from excessive ADH)
• Hypertonic solutions (3% NS)
• Medications (furosemide)
• Replace electrolytes
• Patient/family education
• Monitor for fluid overload (crackles, JVD, edema, HTN, tachycardia) What should we remember when replacing sodium for patients with SIADH? ----------- Correct Answer -- ---------- - Increase levels slowly
• We dont want to increase the sodium levels more than 12 mEq in the first 24 hrs What is the goal for treatment of SIDH? ----------- Correct Answer ------------ Increase serum osmolality (bc there is too much water) What are the nursing interventions for SIADH? ----------- Correct Answer ------------ - Fluid restriction (800-1000 mL/day), including fluids high in sodium content
• If needed, hypertonic saline and diuretics
• Intake and output, serum sodium, urine and serum specific gravity, and daily weights
• Loop diuretics (furosemide)
• Mouth and skin care
• Patient and family education What is hypothyroidism and what are some causes? ----------- Correct Answer ------------ - Low levels of T3 and T4
• Hashimoto's thyroiditis (autoimmune)
• Surgical/radiation for Graves disease
• Inadequate hormone replacement therapy
• Medications (iodides, lithium, oral hypoglycemic agents) What are the clinical manifestations of hypothyroidism? ----------- Correct Answer ------------ - Fatigue & lethargy
• Weight gain no increase calories
• Cold intolerance & dry skin
• Severe (subnormal temp & pulse rate)

• Skin thickened
• Hair thinning and fails out
• Face emotionless and mask-like What are the diagnostics for hypothyroidism? ----------- Correct Answer ------------ - Thyroid hormone levels
• Hyponatremia
• Hypoglycemia
• Respiratory acidosis What are the treatments for hypothyroidism? ----------- Correct Answer ------------ - Treat cause
• Thyroid hormone replacement
• Fluid/electrolyte replacement
• Supportive care
• Patient/family education What is hyperthyroidism and what are some of the causes? ----------- Correct Answer ------------ - Goiters
• Radiation
• Cancer
• Medications (amiodarone) What are the clinical manifestations of hyperthyroidism? ----------- Correct Answer ------------ - Anxious & irritable
• Fine tremors of hand
• Tachycardia and palpitations
• Increased appetite
• Diarrhea
• Thin skin
• Exophthalmos (eye popping out) What are the diagnostics of hyperthyroidism? ----------- Correct Answer ------------ - Thyroid hormones levels
• Hyperglycemia
• Hypernatremia
• Increased BUN
• Hypercalcemia What is the treatment of hyperthyroidism? ----------- Correct Answer ------------ - Treat cause
• Surgical intervention
• Inhibit hormone synthesis (propylthiouracil)
• Block thyroid hormone release (potassium iodide)
• Supportive therapy
• Patient/family education What is a myxedema coma? ----------- Correct Answer ------------ Severe hypothyroidism What are the clinical manifestations for myxedema coma? ----------- Correct Answer ------------ - Mucinous edema (face swelling, bogginess)
• Fluid retention
• Intolerance to cold: due to decreased metabolic rate
• Pulmonary disturbances due to CO2 retention may lead to LOC changes

• Cardiovascular disturbances: hypotension, decreased CO What is the treatment for hyperthyroidism? ----------- Correct Answer ------------ - Treat cause
• Surgical intervention
• Inhibit hormone synthesis (propylthiouracil)
• Block thyroid hormone release (potassium iodide)
• Supportive therapy
• Patient/family education
• Cooling blankets (hyperthermia) What is a thyroid storm? What are the clinical manifestations? ----------- Correct Answer -----------
• • Uncontrolled hyperthyroidism
• Hyper metabolic state
• High levels of circulating thyroid hormones
• Severe fever (cooling blanket, acetaminophen)
• Tachycardia
• Hypotension
• Ineffective breathing
• Altered LOC What is the most common cause of acute adrenal insufficiency? ----------- Correct Answer ------------ Abrupt cessation of corticosteroids What is Addison's disease? ----------- Correct Answer ------------ - Destruction of the adrenal gland
• Lack of glucocorticoids (cortisol), mineralocorticoids (aldosterone), or both
• Adrenal crisis: life-threatening absence of cortisol and aldosterone What are the clinical manifestations of Addison's Disease? ----------- Correct Answer ------------ - Vomiting
• Nausea
• Severe weakness
• Headache
• Depression What are the labs for Addison's Disease? ----------- Correct Answer ------------ - Hypoglycemia
• Hyponatremia
• Hyperkalemia
• Plasma cortisol levels < 10mcg/dL
• Serum ACTH levels What are the treatments for Addison's Disease? ----------- Correct Answer ------------ - Treat cause
• Replace fluids/electrolytes
• Replace hormones
• Medications (cosyntropin, dexamethasone)
• Educate family/patient What is Cushing's Disease? ----------- Correct Answer ------------ - Hyperfunction of the adrenal gland cortex
• Excess cortisol
• Excess ACTH which regulates cortisol

What are the clinical manifestations of Cushing's Disease? ----------- Correct Answer ------------ - Moon face

• Buffalo hump
• Purple striae
• Hirsutism
• Fatigue
• Depression
• Hypertension
• Bone loss What are the common things that patients complain of if they have Cushing's Disease? ----------- Correct Answer ------------ - Weakness
• Bruises
• Sleep disturbances What are the labs for Cushing's Disease? ----------- Correct Answer ------------ - Hypokalemia
• Hyperglycemia
• Elevated white count
• Elevated plasma cortisol levels What are the diagnostic tests for Cushing's Disease? ----------- Correct Answer ------------ - Urine/blood tests
• Saliva test
• Petrosal sinus sample What are the treatments for Cushing's Disease? ----------- Correct Answer ------------ - Treat the cause
• Surgical interventions
• Radiation
• Medications What does the liver convert ammonia into? ----------- Correct Answer ------------ Urea What are the assessments for liver function? ----------- Correct Answer ------------ - LFT abnormalities
• Exposure to toxins (IV drugs and alcohol)
• Jaundice, weakness, abd pain What are the diagnostic tests for liver function? ----------- Correct Answer ------------ - Liver function test (LFT)
• PT/INR
• Liver biopsy
• US
• CT and MRI What are the early and late manifestations of hepatic failure? ----------- Correct Answer ------------
• Early: anorexia, dyspepsia, flatulence, nausea, vomiting, and changes in bowel patterns
• Late: jaundice, skin lesions, hematological, endocrine, encephalopathy, ascites What is hepatic encephalopathy? ----------- Correct Answer ------------ - Due to an increase in ammonia in the CNS
• Liver unable to detoxify & portal blood enters blood stream
• Medications to low ammonia (lactulose)