Chapter 42: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

The nurse is caring for a patient who was admitted 1 week ago with multiple rib fractures, pulmonary contusions, and a left femur fracture from a motor vehicle crash. The provider states the patient has developed sepsis, and the family members have many questions. Which information would the nurse include when explaining the early stage of sepsis?

Large amounts of IV fluid are required in sepsis to fill dilated blood vessels.

The patient has hypovolemic shock. By compensatory mechanisms, the decreased blood pressure (BP) has led to decreased capillary hydrostatic pressure, activation of the sympathetic nervous system and α- and β-adrenergic stimulation, decreased blood flow, and increased cardiac output (CO). Arrange in order the pathophysiologic mechanisms that occur next during the compensated stage of hypovolemic shock.

1. 1. Increased renal sodium reabsorption leads to increased serum osmolality that leads to release of ADH.

2. 2. Increased angiotensin II leads to aldosterone secretion and results in increased renal sodium reabsorption

3. 3. Increased angiotensin II leads to venous and arterial vasoconstriction, increased venous return to the heart, and increased BP.

4. 4. Decreased kidney perfusion leads to renin released and increased angiotensin I.

5. 5. Increased ADH leads to renal water reabsorption and increased blood volume.

The nurse is caring for several patients on the stepdown unit. Which patient is most at risk for developing multiple organ dysfunction syndrome (MODS)?

A 82-year-old patient with type 2 diabetes and chronic kidney disease admitted for peritonitis from a peritoneal dialysis catheter infection

Which assessment finding is suggestive of sepsis?

Hyperglycemia in the absence of diabetes

After coronary artery bypass graft (CABG) surgery, a patient has bleeding that requires returning to surgery for repair. During surgery, the patient has a myocardial infarction (MI). After restoring the patient's body temperature to normal, which patient parameter is the most important for planning nursing care?

Pulmonary artery pressure (PAP) of 28/14 mm Hg

A nurse is caring for a patient in cardiogenic shock who is receiving oxygen via non-rebreather mask at 10 L/min. Which assessment finding requires immediate intervention?

Patient becomes increasingly restless and anxious

A patient with a massive gastrointestinal (GI) bleed has developed hypovolemic shock. What is the priority clinical problem?

Ineffective tissue perfusion

A nurse is caring for a patient in the early stages of shock. Which assessment finding would be the most important to report to the health care provider?

Urine output of 15 mL/hr

A patient in the emergency department vomits bright red blood. Vital signs are BP of 78/58 mm Hg, pulse of 124 beats/min, respirations of 28 breaths/min, and temperature of 97.2°F (36.2°C). Which provider order would the nurse complete first?

Rapidly administer 1000 mL normal saline solution IV.

A new nurse is reviewing the pathophysiology of various types of shock with their preceptor. Which statement indicates a need for further teaching?

Neurogenic shock is caused by an allergic reaction leading to widespread vasodilation.

Which assessment findings would be most concerning in a patient in cardiogenic shock after an acute myocardial infarction (MI).?

PaO₂ of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and puncture site bleeding

A nurse has given corticosteroids to a patient with multiple organ dysfunction syndrome (MODS). Arrange the order in which the results of this medication would occur in this situation by assigning each option a number.

1. 1. Improved capillary permeability

2. 2. Increased intravascular volume

3. 3. Enhanced renal artery perfusion

4. 4.Renal excretion of potassium

Which finding would alert the nurse that a critically ill patient may be developing multiple organ dysfunction syndrome (MODS)?

Decreased respiratory compliance

The nurse is caring for a critically ill patient with Multiple Organ Dysfunction Syndrome (MODS). Which assessment findings are indicators of impaired tissue perfusion? (Select all that apply.)

Capillary refill time 5 sec

Confusion, combativeness

Mean arterial pressure (MAP) of 58 mmHg

Urine output of 10 mL/hr over the past 2 hours

What prescription prescribed by the provider would the nurse anticipate when caring for a patient in acute septic shock?

Infusing large amounts of IV fluids

A patient's local infection has become systemic and septic shock is suspected. What medication would be given to treat septic shock refractory to fluid management?

Norepinephrine administered by titration

If the patient in shock is to receive 1000 mL of normal saline in 2 hours, at what rate will the infusion pump be set?

500

What laboratory finding is consistent with cardiogenic shock?

Increased blood urea nitrogen (BUN) and creatinine levels