I don't understand this multiple choice question.

[JuliusSeizure]

The topic is Shock and multisystem failure

Question: In early goal-directed therapy, the nurse knows that which of the following parameters are monitored in evaluating effectiveness of therapy?

A.) HR and BP

B.) SVO2 and O2 saturation

C.) Base deficit and hematocrit

D. SvO2 and CVP

I read through the chapter twice, but I don't think I understand the question. My gut is telling me A.) because it's the most simple answer, and it makes sense when it comes to shock.

[PyridiumP]

The

Well, CVP is central venous pressure. And it's used to help monitor the patient's response to fluid resuscitation (fluid resuscitation is the first line of treatment for shock then vasoactive meds). The value is normally 2 to 8 mm Hg, but we want higher than normal CVPs readings in shock, since ventricles tend to stiffen during shock. So assessment of SVO2 with a CVP line is helpful in evaluating the adequacy of intravascular volume.

And O2 saturation isn't going to help us for shock.

The question is asking about "goal directed therapy." Your goal in treating shock is to provide adequate tissue oxygenation. Therefore, what two measurements tell you about tissue oxygenation? CVP tells you about volume, an important concept in delivery capability. SVO2 tells you how much oxygen there is left in the blood after the arterial side has done its best to deliver it. O2 sat tells you how much oxygen was out there for the taking (remember to look at hematocrit for the complete picture there-- a 99% sat with a crit of 15 delivers only one third the amount of oxygen that a 99% sat of a crit of 45 delivers). Therefore in my opinion, O2 sat and SVO2 are the parameters that tell you the most about your goal, oxygen delivery and tissue uptake.

[ohthatswhatthatdoes]

It might also help to remember that your BP is one of the last things that will change. Your body will compensate a whole lot of bad things before your BP drops to the level of uh oh.