HESI MED SURG STUDY GUIDE

Respiratory Failure - PCO2 > 45 or PO2 < 60 on 50% O2; a child in severe distress should be on 100%
O2

Shock - Widespread, serious reduction of tissue perfusion which, if prolonged, leads to generalized
impairment of cellular functioning

System Hypotension - Marked reduction in either cardiac output or peripheral vasomotor tone, without a
compensatory elevation in the other results in this

Early signs of shock - Agitation and restlessness that results from cerebral hypoxia

Hypovolemic Shock - Related to external or internal blood or fluid loss

Cardiogenic Shock - Related to ischemia or impairment in tissue perfusion resulting from MI, serious
arrhythmia, or HF; all cause decrease CO

Vasogenic Shock - Related to allergens, spinal cord injury, or peripheral neuropathies, all resulting in
venous pooling and decreased blood return to the heart, which decreases cardiac output over time

Septic Shock - Related to endotoxins released by bacteria, which cause vascular pooling, diminished
venous return, and reduced CO

High fowler position with legs down - Position to reduce venous return in order to decrease further
venous return to the left ventricle

Medical treatment for shock - Rapid infusion of volume-expanding fluids such as whole blood, plasma,
plasma substitutes; isotonic, electrolyte IV solutions; CVP artery catheters; CVP measurements, urine
output, HR, clinical and mental state; immediate attendtion to improvement of perfusion; administration
of drugs is withheld until circulating volume has been restores; O2 administration

Pulmonary edema - If shock is cardiogenic in nature, the infusion of volume-expanding fluids may result
in this

Cardiac Function - When treating a patient with shock, the restoration of what should take priority

Increase Cardiac Contractility - Administration of cardiotonic drugs such as digitalis does what?

Dopamine and digitalis - Increases the contractility

Dopamine (Dopram) and norepinephrine (Levophed) - Vaso-constricting agents that may be used in
cardiogenic shock

Nursing Assessment of patient in shock - Tachycardia, tachypnea, decrease in BP (systolic <80mmHg) ;

mental status changes; cool, clammy skin; diaphoresis, paleness; urine output decreases; CVP <4cm of
H2O; urine SG >1.020

Hypovolemia - Urine SG >1.020 indicates?

Early shock mental status changes - Restless, hyper-alert

Late shock mental status changes - Decreased alertness, lethargy, coma