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    Shock

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    vinnu kalyan
    1. Shock is a state in which oxygen and metabolic demands of the body are not met by cardiac output, resulting in organ ischemia and damage. If untreated, shock can lead to multi-organ dysfunction and ultimately death. 2. There are several types of shock including cardiogenic, hypovolemic, anaphylactic, neurological, and septic shock. 3. Shock progresses through initial, compensatory, progressive, and irreversible stages as the body attempts to compensate for low perfusion and tissue oxygen levels but eventually organs become damaged without treatment.

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    Shock

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    vinnu kalyan
    77 views30 pages
    1. Shock is a state in which oxygen and metabolic demands of the body are not met by cardiac output, resulting in organ ischemia and damage. If untreated, shock can lead to multi-organ dysfunction and ultimately death. 2. There are several types of shock including cardiogenic, hypovolemic, anaphylactic, neurological, and septic shock. 3. Shock progresses through initial, compensatory, progressive, and irreversible stages as the body attempts to compensate for low perfusion and tissue oxygen levels but eventually organs become damaged without treatment.

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    1. Shock is a state in which oxygen and metabolic demands of the body are not met by cardiac output, resulting in organ ischemia and damage. If untreated, shock can lead to multi-organ dysfunction and ultimately death. 2. There are several types of shock including cardiogenic, hypovolemic, anaphylactic, neurological, and septic shock. 3. Shock progresses through initial, compensatory, progressive, and irreversible stages as the body attempts to compensate for low perfusion and tissue oxygen levels but eventually organs become damaged without treatment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    77 views30 pages

    Shock

    Uploaded by

    vinnu kalyan
    1. Shock is a state in which oxygen and metabolic demands of the body are not met by cardiac output, resulting in organ ischemia and damage. If untreated, shock can lead to multi-organ dysfunction and ultimately death. 2. There are several types of shock including cardiogenic, hypovolemic, anaphylactic, neurological, and septic shock. 3. Shock progresses through initial, compensatory, progressive, and irreversible stages as the body attempts to compensate for low perfusion and tissue oxygen levels but eventually organs become damaged without treatment.

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    © All Rights Reserved
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    of 30

    SHOCK

    INTRODUCTION

    Shock is a state in which the oxygen and metabolic demands of


    the body are not met by cardiac output. When this process
    occur in a single organ, rather than throughout the body,organ
    ischemia and infraction ensure.when shock occur more globel
    level multiorgan disfunction and failture are the consequences,if
    not corrected ultimately leading to death .shock is most often
    accompanied by hypotension,termed decompensated shock
    .However shock may also occur with normal or elevated blood
    pressure.
    DEFINITION OF SHOCK
    -

    • “ Shock is characterised by an adequate tissue perfusion


    in which there is insufficient delivery of oxygen and
    nutrients to the body’s tissue and inadequate removal of
    waste products from the tissues,if untreated,results in cell
    death “ -Javed Ansari

    • Shock can be best defind as a clinical syndrom that


    results from inadequate tissue perfusion creating
    an imbalance between the delivery of oxygen and
    nutrients needed to support cellular function
    - (maier 2015)
    ETIOLOGY

     Severe bleeding :- Shock is often caused by due to


    loss of blood .Blood loss could be be external or
    internal With in a particular organ or system. Greater
    the loss of blood ,greater the risk of developing
    shock.
     Heart attack :-obstructed blood supply to the
    heart and failture of function of the heart can
    produce shock
     Severe burns:-Extensive areas of the burned skin
    surface can produce shock.
     Loss of fluids:-Excessive loss of body
    fluids;Diarrhoea ,vomiting etc. Can produce shock.
    ETIOLOGY (conti..)

     Spinal anesthesia
     Severe bacterial infection :-Discharge of toxins
    produced by the bacteria into the blood
    stream can produce shock
     Pooling of blood or fluid
     Insects bits,vaccines,Environmental agent
    ,larvas,blood products
    TYPES OF SHOCK

    1.Cardiogeni 2.Hypovole
    c shock mic shock

    5.Septic 3.Anaphylac
    shock
    Shock tic shock

    4.Neurological
    shock
    1.CADIOGENIC SHOCK

     Cardiogenic shock is a result of


    failture of the heart to pumb
    blood effectively
     A major effect is the back up flow of
    blood in to lungs
     Cardiogenic shock is the inability of the
    heart to maintain cardiac output
    necessary to meet body needs .Extra
    strain on heart causes decreased tissue
    perfusion.
    Causes
     Systolic dysfunction
     Diastolic dysfunction
     Arrhythmias
    Structural problems
    Causes

    CLINICAL MANIFESTATIONS
     Chest pain
     Decreased cardiac output
     Clammy skin
     Decreased blood pressure
     Dyspnea
     Tachycardia
     Oliguria
     Anxiety or delirium
     Pulmonary embolism
    2.HYPOVOLEMIC SHOCK

     Hypovolemic shock is an emergency conditions in which


    severe blood and fluid loss makes the heart unable to pumb
    enough blood to the body
     It occur due to decrease in the circulatory blood volume
    resulting from dehydration with loss of fluid volume.
     Inadequate vascular volume leads to decreased venous
    return and cardiac output .
    Causes
     External loss of blood (eg: Hemorrhage from trauma)
     Internal bleeding
     Massive vasodilation (sepsis)
     Pooling of blood or fluid.
    CLINICAL MANIFESTATIONS

     Decreased cardiac output


     Hypotension
     Ineffective tissue perfusion
     Cool and clammy skin
     Cyanosis
    3.ANAPHYLACTIC SHOCK

     This type of distraction or disterbance is the result of an immediate


    hypersensitivity reactions.
     It is a life threatening condition that requires present interventions.
    Causes
     Food allergies (egg,fish,peanutes), Insect strings
     Diagnostic agent
     Biological agent: Blood,Blood products,vaccines
     Drug
    Clinical manifestations
     Weak and rapid pulse
     Breathlessness and coughing
     Localized edema
     Skin eruptions
    4. NEUROLOGICAL SHOCK

     Neurological shock occurs when dysfunction or injury to the


    nervous system can causes extensive dilation of peripheral blood
    vessels
    Causes
     Spinal anesthesia drug
     Emotional stress
     Spinal injury,pain and dyscomfort of nervous system.
    Clinical manifestations
     Hypotension
     Warm and dry skin
     Decreased heart rate
     Loss of reflex activity
    5.SEPTIC SHOCK

    Septic shock a form of distributers shock, occurs when micoorganisms


    invade the body. The primary mechanism of this type of shock is the
    maldistribution of blood flow to the tissue
    Toxic shock syndrome is an example of gram +ve
    shock caused by staphylococcus aureus
    Clinical manifestations
    • Pyrexia(fever) • Weakness

    • Reduced contractility
    • Warm and sweaty skin due to vasodilation
    • Systemic vasodilation resulting in hypotension
    (low blood pressure)
    PATHOPHYSIOLOGY
    STAGES OF SHOCK

    There are mainly four stages, they are :- 1 . Initial stage


    2 . Comensatory stage
    3 . Progressive stage

    1. Initial stage 4. Irreversible stage

     This is the first stage of shock. During this stage lack of oxygen lead to hypoxia,And this
    leading to mitochondria being unable to produce adenosine triphosphate(ATP)
     The cell membrane become damaged ,they became leaky to Extracellular fluid,and cell
    Perform anaerobic respiration.
     This causes a build of lactic acid and pyruvic acid,which results in systemic Metabolic
    acidosis
    2.Compensatory stage

     In this stage blood pressure remains with in the normal limits


     When aterial pressure and tissue perfusion are reduced,Compensatory mechanisms are
    activated to maintain tissue perfusion.
     Vasoconstriction,Increased heart rate and increased contractility of heart contribute to
    maintaining adequate cardiac output.
     Result from stimulation of sympathetic nervous system and subsequent nervous system and
    release of catecholamines(eg:epinephrine,norepinephrine)
     Patient display “Fight and flight response “.
     Reduced blood flow to the kidney activates the rennin-angiotensin aldosteron system
    ,causing vasoconstriction and sodium and water retention,leading to increased blood
    volume and venous return.
     Result of compensatory mechanism cardiac output and tissue perfusion are maintained.
    3.Progressive stage

     This stage begins as compensatory mechanism fail to maintain cardiac


    output.
     Due to decreased perfusion of cell,sodium ions build up with in ,while
    potassium ions leak out
     Tissue become hypoxic because of poor perfusion and lactic acid build
    up with in the cells by anaerobic metabolism and this leads to metabolic
    acidosis. This acidosis state depress mycardial function.
     Venous pooling and increased capillary permeability
     As the fluid is lost ,blood concentration and viscosity increased.
    4.Irreversible stage

     At this stage vital organ damage occur


     As shock progresses organ damage occur as compensatory
    mechanism can no longer maintain cardiac output.
     Reduced perfusion damages cell membrane,lysosomal enzymes are
    released and energy stores are depleted,possibly leading to death.
     Perfusion to coronary arteries reduced,causing myocardial
    depression
     Reduction in cardiac output
     Eventually circulatory and respiratory failure,brain damage will occur
    CLINICAL MANIFESTATIONS OF SHOCK
     Chest pain
     Low blood pressure (Hypotension)
     Feeling anxious ,confused
     Cyanosis
     Profuse sweating

     Cold and clammy skin


     Dizziness or fainting
     Rapid and shallow breathing (Tachypnea)
     Rapid and weak pulse (Trachycardia)
    DIAGNOSTIC EVALUATION

     Historytaking
     Physical examination
     Blood,urine and sputum cultures
    May identity Organism
    responsible for septic shock
     Electrocardiography : heart rate
     CT scan
    DIAGNOSTIC EVALUATION

     Hemodinamic monitoring may reveal characteristic


    pattern of intra cardiac pressure and cardiac
    output .which are used to guide fluid and drug
    management
     Coagulation studies

     Erythrocytic sedimentation
     Echocardiography

     Urine specific gravity


     Chest x-ray
    MANAGEMENT

     Early goal directed therapy


     Identify source of infection
     Administer IM epinephrine quickly for patients with septic
    shock
     Cardiac monitoring and pulse oximetry
     management of airway,breathing and circulation
     Fluid replacement to restore intravascular volumes
    MANAGEMENT (cont..)

     Vasoactive medications:-
    - Vasoconstrictors
    - Vasodilators
     Nutritional support
     Heart transplantation
     Individualized observations
    NURSING MANAGEMENT OF SHOCK

    NURSING DIAGNOSIS
     Fluid volume deficit related to vomiting,diarrhoea,high fever.
     Decreased cardiac output
     Ineffective breathing pattern
    NURSING GOALS
     Patient will maintain adequate fluid volume
     Patient will achieve adequate cardiac output.
     Patient will maintain effective breathing pattern
    NURSING INTERVENTIONS FOR SHOCK

     Restore fluids by the administration of fluids


     Making input and out put chart
     Administration of fluid and medications as prescribed by the physician
     Assess skin and peripheral pulse ,monitoring vital signs ,and frequent
    monitoring of blood pressure,monitor dysrrhythmias
     If the ingested drug or food are the cause avoid it
     Monitor blood gas and changes
     Assess presence of angioedema
     Administrator oxygen prescribed,giving proper ventilation,Administrator
    epinephrine by inhalar
    COMPLICATIONS

    Pathological process cause effect on other organs by life threatening


    complications. They are:-
     Acute respiratory syndrome
     Acute renal failure
     Diessiminated intravascular coagulation
     Loss of consciousness
     Gastrointestinal complications
     Multiorgan disfunction
     Coma
     Death
    PREVENTION

     Primary prevention of shock is an essential focus on nursing


    intervention;hypovolemic shock can be prevented In some instance by
    closely monitoring patiens who is at risk for Fluid deficit and assisting in
    fluid replacement before intravascular volume is depleted
     General nursing measures include safe administration of prescribed fluid
    and medications and proper documentation
     Monitoring sign of complications and side effects
     Early reporting

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