Download Nursing 2139 Study Guide for Shock Management *Directions

Nursing 2139
Study Guide for Shock Management
*Directions: Answer all questions on the study guide prior to class. Bring completed study guide to class.
1. Define shock.
2. Describe the basic pathophysiology of shock and the compensatory mechanisms involved to maintain
homeostasis.
3. List the stages of shock.
4. Describe the compensatory stage of shock. Explain its effect on the body and its symptoms.
5. Describe the progressive stage of shock. Explain its effect on the body and its symptoms.
6. Describe the irreversible stage of shock. Explain its effect on the body and its symptoms.
7. Describe the organ damage that can occur in clients with shock.
8. Identify various types of fluid-replacement therapy. List the advantages and disadvantages of each.
9. Discuss the blood components used for the treatment of hypovolemic shock.
10. Identify medical and nursing management priorities in treating patients in shock.
11. Describe the action and effect of vasoactive medications used for shock.
12. Specify the nursing interventions required related to the administration of vasoactive medications.
13. Define titration. Why is it important for nurses to understand this concept when administering
vasoactive medications?
14. List and explain specific medications that may be used when treating clients with shock.
15. Describe the importance of nutritional support for patients in shock .
16. Explain the reasons for the administration of glutamine and H2 blockers or proton-pump inhibitors
to clients who are experiencing shock.
17. Identify the five types of shock. For each type of shock, complete the following:
A. Identify the pathophysiologic sequence of events for clients with the specific type of shock.
B. Identify clinical manifestations in clients with the specific type of shock.
C. Describe the management of clients with the specific type of shock
18. Discuss the role of nurses in psychological support of patients experiencing shock. Describe the role
of the nurse in supporting the client’s family as well.
19. Define multiple organ dysfunction syndrome.
20. List the RT (related to) and AMB (as manifested by) data for “each” of the following Nursing
Diagnoses:
a. Ineffective breathing pattern
b. Impaired gas exchange
c. Decreased cardiac output
d. Risk for fluid volume deficit
e. Risk for fluid volume overload
f. Alteration in sensorium
g. Risk for injury
h. Risk for immobility
i. Imbalanced nutrition
j. Alteration in thought processes
k. Knowledge deficit
l. Ineffective Coping
m. Alteration in self esteem
21. Case Study Assignments:
Case Study #1—Hypovolemic Shock
presentation to the Emergency Department, his vital signs are: Temperature 100.9, pulse 120,
respirations 20, blood pressure 90/54. His abdomen is firm with bruising around the umbilicus. He is
alert and oriented, but complains of dizziness when changing positions.
re written for the patient:
te of the abdomen stat
a. Describe the pathophysiologic sequence of events seen with hypovolemic shock.
b. What are the major goals of medical management in this patient?
c. What is the rationale for placing two large bore IV’s?
d. What are advantages of using 0.9% normal saline in this patient?
e. What is the rationale for placing the patient in a modified Trendelenburg position?
Case Study #2—Septic shock
-year history of Parkinson’s disease is admitted with sudden, increasing
confusion and combative behavior. You know that changes in mental status may be an early sign of
sepsis in the elderly.
?
experiencing sepsis?
a younger client?
Case Study #3—Septic Shock
A 32-year-old man is admitted with severe pancreatitis. He has a long history of addiction to alcohol and
was recently on a “drinking binge.” The patient is agitated and exhibiting nervous behavior. His BP is
106/88, HR 126, RR 32, and he has not voided for the past 3 hours.
1. Is the patient most likely experiencing withdrawal from alcohol or a type of shock?
2. Describe the type of shock that poses the greatest risk for this patient.
3. What interventions should the nurse anticipate to prevent the progression of shock or development
of MODS?
4. Given the patient’s history, what organ(s) is least likely to tolerate prolonged tissue hypoperfusion?
5. What assessment data would you look at to monitor organ dysfunction in this patient?
Case Study #4—Neurogenic Shock
A 23-yer old client underwent surgical repair of her shoulder. She had spinal anesthesia for the surgery
and currently has a patent epidural catheter for pain management.
1. What types of shock are possible in this client?
2. What therapy directed at prevention or treatment of shock should the nurse anticipate?
3. Describe the rationale for the therapies that you have identified.
4. How should the nurse use the client’s history and symptom presentation to help identify shock
states?
5. Describe likely symptoms and the underlying pathophysiology of the shock state?
Case Study #5—Anaphylactic Shock
A client with a history of severe osteoarthritis is prescribed glucosamine and chondroitin supplements.
The client’s chart states that he has no known drug allergies, but he does have food allergies that
include shell fish and avocados. Fifteen minutes after the first dose of the medication is administered,
the client complains of anxiety, shortness of breath, and chest discomfort. He is flushed and visibly
uncomfortable.
1. What are the nurse’s priorities in providing care to this client?
2. What assessment data does the nurse need to obtain to determine if this client is experiencing
cardiogenic or anaphylactic shock?
3. What nursing interventions and medical treatments should the nurse anticipate for cardiogenic
shock?
4. What risks did the client have that may have increased his likelihood of experiencing anaphylactic
shock?
5. What nursing interventions and medical treatments should the nurse anticipate for anaphylactic
shock