NRNP 6566 Week 4 Knowledge Check Q&A

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NRNP 6566 Week 4 Knowledge Check Q&A NRNP 6566 Week 4 KC • Question 1 A 47 year old male admitted with an infected elbow wound. On his second day in the hospital you find him in his room confused and agitated. Vital signs are as follows: Temperature – 96.2 °F Pulse -140 beats per minute Respirations – 40 breaths per minute Blood Pressure – 90/40 mmHg Labs include a WBC count of 3,000 Pt weighs 185 pounds Further assessment of him includes: • Urine output of 100cc for the last 8 hours • Pulse oximetry of 88% on room air • Pallor What is your working diagnosis? Correct Answer: There are 4 stages of sepsis. Systemic Inflammatory Response Syndrome (SIRS) Sepsis Severe Sepsis Septic Shock Criteria – any 2 of the following: *Temperature over 100.9 or less than 96.8 *Heart rate over 90 *Respirations over 20 per minute *WBC over 12,000 or less than 4,000 Meet SIRS criteria and have a possible or documented source of infection *positive cultures or possible infection site Sepsis criteria plus evidence of organ system dysfunction *new need for invasive or non-invasive respiratory intervention *BP less than 90 systolic, MAP less than 65, or Systolic BP 40 mmHg less than previous documented BP *New altered mental status *Cr greater than 2 or urine output less than 0.5cc/kg/hour for 2 hours *Plateletssless than 100,000 *Lactate greater than 2 mm/L Severe sepsis criteria plus any one of the following: *Tissue hypoperfusion persists despite crystalloid fluid administered. *need for vasopressors documented by BP less than 90 systolic, MAP less than 65, or Systolic BP 40 mmHg less than previous documented BP * Lactate greater than 4 mm/L This patient meets the criteria for septic shock Temp – 96.2 Heart Rate 140 Respirations 40 WBC 3000 Source of infection – elbow wound Organ dysfunction – confused, urine output of 12 cc per hour (min 42 per weight) Blood pressure of 90/40 with a MAP of 56.5 • Question 2 A 50 year old woman is thought to be in septic shock. What physical assessment findings would you expect to find to confirm this type of shock? Correct Answer: Hypotension is the common finding in all shock states. In septic shock, you would also expect to find: Tachycardia Full bounding pulses Pink, warm, flushed skin Tachypnea Decreased urine output Fever Hemodynamic measures would indicate a decreased cardiac output, decreased systemic vascular resistance, and a decreased central venous pressure. • Question 3 A 56 year old man is thought to be in hypovolemic shock. What are the initial interventions for a patient in hypovolemic shock? Correct Answer: Initial treatment would include: *identify and stop fluid loss / bleeding if possible *Crystalloid fluid replacement – 0.9% NS or LR initially infuse 2 L of fluid and then reassess. *Hemorrhagic shock should be treated with a balanced infusion of packed red blood cells, plasma, and platelets. Type O negative PRBC can be administered until cross matched cells are available. *Vasopressors can worsen tissue hypoxia and are not initial treatment in hypovolemia or hemorrhage. *Monitor electrolytes and acid base status* Fluid repletion can be monitored by measuring blood pressure, urine output, mental status, and peripheral edema. ............Continued

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