PCCN Multisystem Conditions and Shock Flashcards

A progressive care patient meets SIRS criteria and has a suspected infection. According to current definitions, this patient has:

Answer: Sepsis

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; SIRS + infection meets the older sepsis definition and warrants treatment.

A patient with MODS (multiple organ dysfunction syndrome) has the following: creatinine 3.1, bilirubin 4.2, PaO2/FiO2 ratio of 180, and GCS of 12. How many organ systems are affected?

Answer: Four

Renal (creatinine), hepatic (bilirubin), pulmonary (PaO2/FiO2 < 300), and neurological (GCS) dysfunction indicate four organ systems are failing.

Which lactate level is most consistent with significant tissue hypoperfusion in a critically ill patient?

Answer: 4.5 mmol/L

A lactate ≥ 4 mmol/L indicates severe tissue hypoperfusion and is associated with increased mortality, meeting the threshold for septic shock workup.

A patient in neurogenic shock following a cervical spine injury presents with hypotension and bradycardia. This pattern is caused by:

Answer: Loss of sympathetic nervous system tone below injury level

Cervical cord injury disrupts sympathetic outflow, causing loss of vasomotor tone and cardiac acceleration, resulting in hypotension and bradycardia.

Which assessment finding indicates the progressive care patient with systemic inflammatory response is developing organ hypoperfusion?

Answer: Urine output of 0.3 mL/kg/hr for 3 hours

Oliguria (< 0.5 mL/kg/hr) is an early indicator of renal hypoperfusion and impending organ dysfunction in sepsis.

A patient in obstructive shock due to a massive pulmonary embolism is hemodynamically unstable. The nurse anticipates which intervention?

Answer: Systemic thrombolysis with alteplase

Massive PE with hemodynamic instability is an indication for systemic thrombolytic therapy to rapidly dissolve the clot and restore perfusion.