Care of patient with shock and managmend.pdf

DC SHOCK

1. Care of patient with
Shock
Prepared by: Jamal Naser Noori
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2. Objectives
▪Define shock
▪Explain pathophysiology of shock
▪Discuss the compensatory mechanism of shock
▪List types of shock
▪Discuss the signs and symptoms of shock
▪Explain the management of different types of
shock
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3. Question?
❖What do you mean by shock?
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4. Definition
▪Shock is a syndrome which results in impaired
oxygenation and tissue perfusion.
▪Shock is a life-threatening condition.
▪Shock results in inadequate supply of oxygen and
nutrients to the cells. If shock remains untreated:
cellular starvation occurs causes cell
death lead to organ failure patient death.
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5. Pathophysiology of shock
A mean arterial pressure (MAP) of 80 to 120
mmHg is needed for cells to receive the oxygen
and nutrients and metabolize energy in sufficient
amount to sustain life.
The body compensate and maintains this MAP
in response to changes in volume, pumping
ability of the heart and changes in the vascular
system.
When this compensatory mechanisms fail,
tissues are inadequately perfused and shock
occurs.
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6. Question?
What could be the signs and symptoms
of shock?
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7. General Signs and symptoms of shock
➢Neurological:
Fluctuatingmental status (GCS), sunken fontanel in
children
➢Skin and extremities:
Cool, pallor, mottling, cyanosis, poor cap refill, weak
pulses, poor muscle tone
➢Cardio-pulmonary:
tachypnea, tachycardia
➢Renal:
inadequate amount of urine, concentrated urine
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8. Question?
❖How many types of shock you know?
1.One
2.Two
3.Three
4.Four
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9. Classification of Shock
1. Hypovolumic Shock
a.Hemorrhage
b.Non hemorrhagic (serum/plasma loss)
2. Cardiogenic shock
a.Myocardial Infarction
b.Cardiac arrhythmias
c.Cardiomyopathies
3. Obstructive shock
a.Tension Pneumothorax
b.Cardiac Tamponade
c.Massive pulmonary embolism
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10. 4. Distributive shock
a.Anaphylactic shock
b.Septic shock
c.Neurogenic shock
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11. Brief description of classifications of Shock
❑Hypovolemic-results from severely diminished circulating blood
volume
❑Cardiogenic-as a result of cardiac dysfunction
❑Anaphylactic Shock-results from antigen-antibody reaction that
releases histamine into the blood stream.
❑Septic Shock(systemic inflammatory response syndrome) -caused
by widespread infection and invasion of microorganisms in the body
❑Obstructive Shock-results from obstruction to blood flow
❑Neurogenic shock-caused by damage or dysfunction of the
sympathetic nervous system (rare)
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12. Hypovolumic Shock
❑Definition:Impaired tissue perfusion resulting from
severely diminished circulating blood volume.
❑Causes:
1. loss of blood, plasma, body fluids as a result of
•surgery
•trauma
•burns
•severe dehydration (vomiting, diarrhea, DKA)
2. third-spacing in interstitial space, such as, ascites,
pancreatitis, hemothorax
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13. Signs & Symptoms of hypovolemic
shock
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14. Cont…
❑Signs & symptoms:
➢History of vomiting/diarrhea or trauma/blood loss.
➢Signs of dehydration: dry mucous membrane, loss of tears,
loss of skin turgor
➢Hypotension, tachycardia
❑Management:
➢Replace circulating blood volume rapidly with IV Fluids or
blood products.
➢Replace ongoing fluid/blood losses & treat the underlying
cause.
➢Vasopressors (Dopamine, Adrenaline, Vasopressin) can be
used as temporary method to restore blood pressure.
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16. Cardiogenic Shock
❑Definition:Impaired tissue perfusion as a result of cardiac
dysfunction (failure to pump adequate amount of blood
towards body).
❑Causes:
–MI (usually 40% of LV is damaged)
–Myocardial ischemia (left main artery disease, coronary
artery disease)
–Cardiomyopathy
–Arrhythmias
–Heart failure
–Cardiac tamponade
–Acute valvulardysfunction (acute mitral regurgitation, aortic
insufficiency)
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17. Signs & symptoms:
✓Hypotension
✓Tachycardia
✓Poor capillary refill
✓Pale skin
✓Weak pulses
✓Altered GCS
✓Cold and clammy skin
Management:
✓Give oxygen if needed and monitor ABGs.
✓Correct cardiac arrhythmias
✓Give vasopressors and inotropes to improve cardiac contractility.
✓Monitor ECG for any change in rhythm and cardiac enzymes to asses heart
muscle damage.
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18. Case study –Cardiogenic shock
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19. Anaphylactic Shock
❑Definition:Impaired tissue perfusion resulting from antigen-
antibody reaction that releases histamine into the blood
stream.
Capillary permeability increases and arteriolar dilatation
occurs.
❑Causes:
–Drug reactions
–Blood transfusion reactions
–Food allergies
–Insect bites
–Snake bites
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20. Signs and symptoms of Anaphylactic
Shock
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21. Symptoms and signs:
Skin: 90 %of episodes
⁻Generalized hives.
⁻Itching or flushing.
⁻Swollen lips-tongue-uvula.
⁻Per-orbital edema.
Respiratory: 70 % of
episodes
⁻Nasal discharge and congestion.
⁻Change in voice quality.
⁻Sensation of throat closure or
choking.
⁻Tridoror wheeze.
⁻Shortness of breath and cough.
Gastrointestinal: 45% of
episodes
⁻Nausea.
⁻Vomiting.
⁻Diarrhea.
⁻Crampyabdominal pain.
Cardiovascular: 45 % of
episodes
⁻Hypotonia(collapse).
⁻Syncope.
⁻Dizziness.
⁻Tachycardia.
⁻hypotension.

22. Laboratory tests:
❑Serum or plasma total tryptase
normal range 1 to 11.4ng/mL
❑Plasma histamine

23. Treatment:
Epinphrin
IM 0.3mg , 1:1000
IV 0.15mg , 1:10,000
Antihestsmin
Corticosteroid
Bronchodilator
Oxygen
Fluids and vasopressors, why?

24. Occurs rapidly and is life-threatening.
❑Management:
–Remove causative antigen
–Restore vascular tone –by giving vasopressors
–Anti-histamines drugs
–Bronchodilator (Aminophylline) if patient has bronchospasms
❑Nursing Responsibilities -Prevention!!, Recognition!! (sudden onset
flushing, warmth, anxiety, itching, nasal congestion, laryngeal edema,
bronchospasm, SOB, wheezing) Fast Action!!
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25. Septic Shock
❑Definition:Impaired tissue perfusion caused by widespread
infection and invasion of microorganisms in the body, causing
vasodilation.
❑Causes:
✓Invasion of infectious agent in the body
❑Management:
✓Fluid management
✓Send cultures as per doctors order
✓Antibiotics
✓Antipyretics
✓Check vital signs especially temperature every 2-4 hourly.
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26. Case study of Septic shock
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27. Obstructive Shock
Definition:Impaired tissue perfusion resulting form obstruction to
blood flow
–Pulmonary Embolism
–Aortic dissection
Management:
✓Give oxygen therapy
✓Treat the underlying cause
✓Provide adequate fluid therapy to maintain blood pressure
✓Use vasopressors to restore blood pressure if needed.
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28. Neurogenic Shock
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Definition:Impaired tissue perfusion caused by damage or
dysfunction of the sympathetic nervous system (rare).
Causes:
✓Trauma
✓Anesthesia
✓Spinal Shock

29. Irreversible Stage
Organ damage is so severe that the patient does not respond to
treatment and cannot survive.
❑BP remains low
❑Complete renal and liver failure
❑Anaerobic metabolism produces more lactic acidosis which
also contributes metabolic acidosis.
❑Patient develops multi-organ failure
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30. References
•www.highlands.edu/academics/divisions/.../nursing/Shock.ppt
•Medical Surgical nursing, Ninth edition (1)
•http://www.slideshare.net/aljonaieh/diagnosis-and-management-of-shock
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Thanks