RNSG 2432 Enhanced Concepts of Adult Health

Module 15:  Providing Patient-Centered Care for the Individual with Shock:/Critical Care Nursing

 

Module Objectives:  

Utilizing clinical reasoning and the nursing process the student will:

  1. Analyze comprehensive assessment findings by:

a. Comparing and contrasting risk factors associated with shock.

b. Considering the etiology and pathophysiology for the following disorders:

Shock

  • A. Classification

    1. Low blood flow  2. Maldistribution of blood flow

    B. SIRS- Systemic Inflammatory Response Syndrome

C. MODS- Multiple Organ Dysfunction Syndrome

        c. Considering the signs and symptoms and complications of the disorders:

  • Shock
    • Stages of shock
    • Effect of shock on body systems- MODS
    • Types of shock
        • low blood flow (cardiogenic and hypovolemic)
        • maldistribution (septic, neurogenic and anaphylactic)

         d.  Integrating the diagnostic tests with the etiology, pathophysiology,and          signs and symptoms for the following:

  • Shock
        • Cardiac and hemodynamic monitoring
        • Pulse oximetry- O2 saturation
        • Frequent vital signs
        • Urine output- BUN and Creatinine
        • Lactate level
        • Blood sugar- increased early, decreased later
        • ABG’s
        • Electrolytes
        • Liver enzymes
 

2.  Formulate relevant prioritized nursing diagnosis that address physical, psychosocial, and learning needs.

  • Shock
      • Decreased cardiac output
      • Ineffective tissue perfusion- renal, cerebral, cardiopulmonary, gastrointestinal, hepatic, and peripheral
      • Fear and anxiety

3. Formulate patient and family centered goals and outcomes that facilitate toward health promotion, maintenance, and restoration.

4. Utilize evidence based practice to prioritize, implement and evaluate nursing interventions related to:
  • Safe environment; Risk reduction
  • Medication therapy:
    • Shock
            • Fluid replacement
            • Positive inotropes- dobutamine, dopamine
            • Vasodilators (mainly cardiogenic)
            • Vasopressors/Vasoconstrictors- epinephrine (mainly maldistribution)
            • IV Corticosteroids
            • Xigris- only for septic shock
  • Diet therapy
    • Hypermetabolic states
 
  • Surgical interventions:
    • Shock
      • IAPB
      • VAD
      • Positioning of patient
      • Airway maintenance
      • Other
  • Patient teaching; Discharge teaching; Referrals
  • Therapeutic communication
  • Delegation
  • Other:
    • Organ donations

5. Collaborate with the interdisiplinary health care team when providing patient- centered care.

6. Evaluate patient responses to therapeutic interventions and revise goals and modify the nursing care plan.

7. Integrate associated issues, trends, and informatics into nursing practice.

  • Legal issues
  • Ethical considerations
  • Quality improvement
  • Complementary medicine

Learning Activities:

1. Review module objectives.

2. Learning Resources:

Required: 

    • Read Lewis (hemodynamic monitoring)
    • Shock Power Point
    • SIRS and MODS Power Point
    • PSD Software: Critical Care:Cardiovascular: Ms. Jane Doe with cardiac arrest
    • Complete: Learning Guide:Shock
    • Complete interactive case study of a patient in cardiogenic shock on the Student CD- Rom accompanying text, chapter 67
    • Review Audio Glossary with vocabulary terms on the Student CD-Rom accompanying text, chapter 67

Web sites (opt):

 

3. Complete Critical Thinking Exercises:

  • Shock Tutorial (Select Shock and complete the following units: Introduction, What is Shock and Key Points. Also explore the other units for an in-depth understanding of pathophysiology of shock)
    • Nursing care Plan: Patient in Shock, p. 1742
    • Critical Thinking Exercise, answer questions and evaluate responses, Lewis p. 1742
    Complete shock concept map during lab or simulation day

Interactive exercises:

4. Supplemental Learning:

5. Review module objectives and check for knowledge gaps.

6. Complete module quiz

  • Blackboard: Critical Care/Shock Quiz