Exam (elaborations)
NSB236 EXAM QUESTIONS AND CORRECT ANSWERS
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NSB236 EXAM QUESTIONS AND CORRECT ANSWERS...
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SituationMr. Johnson Butterworth is a 72-year-old man who was initially admitted 3
days ago for the conservative managed of a small bowel obstruction, which has
now required surgical intervention. Mr Butterworth is being admitted to your
ward post-operatively and has undergone a left hemicolectomy with
approximately 15cm of necrotic small bowel resected and a double-barreled
ileostomy brought out, a peritoneal washout performed, times two Redivacs in
situ to drain the pericolic gutter (Right side 100mls, Left side 80mls of
haemoserous fluid) and mid-line abdominal closure performed. Intra-
operatively, Mr. Butternut received 4 units of blood and an additional 2 litres of
Hartman's solution. A quad (4) lumen central venous line, a Salem sump
nasogastric tube (NGT) and an indwelling urinary catheter (IDC) were inserted.
On admission at 16:15 hours he has Hartman's solution running at 125mls/hour,
and an urinary output - ANSWER Key points:
Decreased urinary out indicator of decreased organ perfusion as evidenced by
decreased blood pressure.
Hypotension - related to the inflammatory process associated with sepsis and
vasodilatory effects of the inflammatory mediators.
Tachycardia - compensatory response to decreased blood pressure and the
bodies attempt to improve cardiac output (stroke volume x heart rate) secondary
to the decreased blood pressure and organ perfusion.
Tachypnea - an incresed respiratory effort to improve oxygenation secondary to
compromise organ perfusion and decreased Oxygenation (supplemented via
Hudson mask)
,Mr. Johnson Butterworth is a 72-year-old man who was initially admitted 3
days ago for the conservative managed of a small bowel obstruction, which has
now required surgical intervention. Mr Butterworth is being admitted to your
ward post-operatively and has undergone a left hemicolectomy with
approximately 15cm of necrotic small bowel resected and a double-barreled
ileostomy brought out, a peritoneal washout performed, times two Redivacs in
situ to drain the pericolic gutter (Right side 100mls, Left side 80mls of
haemoserous fluid) and mid-line abdominal closure performed. Intra-
operatively, Mr. Butternut received 4 units of blood and an additional 2 litres of
Hartman's solution. A quad (4) lumen central venous line, a Salem sump
nasogastric tube (NGT) and an indwelling urinary catheter (IDC) were inserted.
On admission at 16:15 hours he has Hartman's solution running at 125mls/hour,
and an urinary output of 70-90ml - ANSWER Elevated white cell count:
indication of increased white cell activity in response to a systemic infection, in
order to fight the invading bacteria.
Increased creatinine - indication of decreased renal function secondary to
decreased blood pressure and renal perfusion, that has occurred secondary to the
vasodilatory effects of sepsis and evidenced by decreased urinary output.
Increased Alanine Aminotransferase (ALT) - liver enzyme: increased levels
secondary to decreased organ perfusion as a result of hypotension and decreased
end-organ perfusion, as a result of the vasodilatory effects of sepsis. In low
blood pressure states, blood is shunted to support critical organs such as the
heart, respiratory system and brain.
Mr Williams is day 2 postoperatively (appendectomy) on assessment this
morning, he is reporting abdominal discomfort with a pain score of 5/10, is has
hypoactive bowel sounds, you note his urinary output has decreased from an
acceptable 40mls/hr to 20ml/hr. You perform a set of vital signs which reveal
the following:
HR 122 beats/min, BP 95/65mmHg, RR 28 breaths/min, Temp: 38.8, SpO2
95% on 4L/min
, Based on the above assessment findings outline the compensatory processes that
have been initiated. - ANSWER Heart rate has increased as a compensatory
process to improve cardiac output and in turn blood pressures (CO = HRX SV)
Increase respiratory rate to compensate for decreased oxygenation as a result of
decreasing blood pressure and oxygenation
Decreased blood pressure and perfusion to the kidney results in decreased
urinary out which would trigger the renin-angiotensin aldosterone system
resulting in fluid retention as a means to try and improve circulating volume and
blood pressure.
Which two underlying shock-related factors cause the majority of clinical
manifestations associated with shock? - ANSWER Activation of compensatory
mechanisms
Inadequate oxygen delivery
Which clinical situation could result in a relative fluid volume deficit? -
ANSWER Acites
Which condition characterises cardiogenic shock? - ANSWER Impaired cardiac
contractility and cardiac output
The various forms of distributive shock have which characteristic in common? -
ANSWER Massive vasodilation
Preload is used as a measure of? - ANSWER fluid volume status
Mr. Ryan, (45-year-old male), is brought into the emergency department
following a motor vehicle crash where he was an unrestrained driver. He was
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