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1.5 CE Test Hours: Assessing Patients During Septic Shock Resuscitation

Contrada, Emily

AJN, American Journal of Nursing: October 2017 - Volume 117 - Issue 10 - pp 41,42
doi: 10.1097/01.NAJ.0000525871.59231.6e
Feature Articles
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TEST INSTRUCTIONS

• To take the test online, go to our secure Web site at http://www.nursingcenter.com/ce/ajn .

• To use the form provided in this issue, record your answers in the test answer section of the CE enrollment form below. Each question has only one correct answer. You may make copies of the form.

• Complete the registration information and course evaluation. Mail the completed enrollment form and registration fee to: Lippincott Professional Development, CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. You will receive your certificate in four to six weeks. For faster service, include a fax number and we will fax your certificate within two business days of receiving your enrollment form. You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade.

• Registration deadline is October 31, 2019.

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DISCOUNTS AND CUSTOMER SERVICE

• Send in together two or more tests from any nursing journal published by Lippincott Professional Development (LPD), and deduct $0.95 from the price of each test.

• We also offer CE accounts for hospitals and other health care facilities online at www.nursingcenter.com. Call 1-800-787-8985 for details.

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PROVIDER ACCREDITATION

LPD will award the number of contact hours indicated for each continuing nursing education activity. LPD is accredited as a provider of continuing nursing education by the Commission on Accreditation of the American Nurses Credentialing Center.

These activities are also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for the number of contact hours indicated. LPD is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida #50-1223.

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Assessing Patients During Septic Shock Resuscitation

GENERAL PURPOSE:

To provide information about the practice and interpretation of 2 components of the Surviving Sepsis Campaign 6-hour bundle in adults: capillary refill time and skin mottling score.

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LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing nursing education activity, you should be able to

• outline research findings about the use of capillary refill time and the skin mottling score.

• delineate various aspects of the implementation and interpretation of these noninvasive assessments.

1. About how many million people worldwide develop severe sepsis each year?

a. 5

b. 15

c. 19

2. An analysis of 2 large inpatient cohorts found that sepsis was a factor in what percentage of all U.S. hospital deaths?

a. one-quarter to one-half

b. one-third to one-half

c. one-half to two-thirds

3. One method the Surviving Sepsis Campaign 6-hour bundle recommends for documenting reassessment of volume status and tissue perfusion after initial fluid resuscitation is dynamic assessment of fluid responsiveness through

a. passive leg raising.

b. blood pressure monitoring.

c. pitting edema measurement.

4. Which statement about capillary refill time (CRT) practice and interpretation is accurate?

a. CRT is an indication of peripheral perfusion.

b. A shorter CRT indicates reduced capillary perfusion.

c. The Society of Critical Care Medicine has standardized the guidelines for the practice and interpretation of CRT measurement.

5. Anderson and colleagues found that CRT increased with age at a rate of what percentage per decade?

a. 1.5%

b. 3.3%

c. 5.2%

6. In studies of CRT, researchers have used only 2 sites, one of which is the

a. fingertip.

b. earlobe.

c. toe.

7. Which of the following compression durations for assessing CRT falls within the usual range?

a. 3 seconds

b. 10 seconds

c. 18 seconds

8. In patients with septic shock, Hernandez and colleagues found that, over the 6-hour resuscitation period,

a. both CRT and lactate levels decreased.

b. both CRT and lactate levels increased.

c. CRT increased and lactate levels decreased.

9. In a study by Ait-Oufella and colleagues of patients with septic shock, at the end of the initial 6-hour resuscitation, how did the CRT of patients who were alive at day 14 compare with that of nonsurvivors?

a. It was significantly shorter.

b. It was about the same.

c. It was significantly longer.

10. Skin mottling, in the absence of microvascular clotting, is an indicator of

a. hypoperfusion.

b. hyperthermia.

c. phospholipid syndrome.

11. A common site for observing skin mottling is the

a. face.

b. lower back.

c. anterior leg.

12. The skin mottling score (SMS) incorporates a 6-point scale, ranging from 0, no mottling, to 5, severe mottling that extends to the

a. thigh.

b. groin.

c. chest.

13. A CRT of less than 2 seconds at hour 6 is associated with successful resuscitation at

a. 12 hours.

b. 18 hours.

c. 24 hours.

14. In their study, van Genderen and colleagues used 4 perfusion indicators

a. as targets.

b. to signal when to continue measuring only tissue oxygenation.

c. to indicate when fluid resuscitation is no longer effective.

15. The perfusion indicators for the patient in the case study

a. suggest a need for continued resuscitation.

b. indicate that fluid resuscitation is no longer effective.

c. are inconclusive.

16. According to the article,

a. CRT and SMS can be considered end points of resuscitation.

b. CRT and SMS should be used in conjunction with other indicators of peripheral perfusion.

c. there is no relationship between changes in CRT, SMS, and lactate levels during resuscitation.

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