Pathophysiology,definition,stages and complications of shock

Take shock short notes

1. Aksum University College of Health Sciences and Comprehensive Specialized Hospital School of Nursing Department of Adult Health Nursing Adult health Nursing practicum -I (GAHNS 5062) Presentation on Hypovolemic shock Prepared By: Mengstu Negash ID No: AKU 1603733   6/7/2024 1 MN

2. Outlines Definition of shock Classifications of shock Stages of shock General management of shock Nursing management of shock Complications of shock Summary Reference 6/7/2024 2 MN

3. Definition Shock is a life-threatening condition that results from inadequate tissue perfusion Adequate blood flow to the tissues and cells requires an effective cardiac pump, adequate vasculature or circulatory system, and sufficient blood volume. If one of these components is impaired, perfusion to the tissues is threatened or compromised. 6/7/2024 3 MN

4. Classification of shock Cardiogenic Shock Distributive Shock Septic Shock. Neurogenic Anaphylactic Shock Hypovolemic Shock 6/7/2024 4 MN

5. Cardiogenic Shock shock resulting from impairment or failure of the myocardium. 6/7/2024 5 MN

6. Pathophysiology of cardiologic shock C ardiac output, a function of both stroke volume and heart rate, is compromised. BP falls and tissue perfusion is reduced. Blood supply for tissues and organs is inadequate , resulting in impaired tissue perfusion. This weakens the heart and impairs its ability to pump, the ventricle does not fully eject its volume of blood during systole. As a result, fluid accumulates in the lungs . 6/7/2024 6 MN

7. Medical Management of cardiologic shock Oxygenation - if the patient’s oxygen saturation is less than 90%, at a rate of 2 to 6 L/min noninvasive and invasive Pain Control If a patient experiences chest pain, IV morphine may be given for pain relief. Medications commonly combined to treat cardiogenic shock include dobutamine, nitroglycerin, and dopamine 6/7/2024 7 MN

8. Distributive Shock Occurs when intravascular volume pools in peripheral blood vessels. This abnormal displacement of intravascular volume causes a relative hypovolemia because not enough blood returns to the heart, which leads to inadequate tissue perfusion. The ability of the blood vessels to constrict helps return the blood to the heart 6/7/2024 8 MN

9. Causes of Distributive Shock D istributive shock can be caused by either a loss of sympathetic tone or a release of biochemical mediators from cells that causes vasodilatation . 6/7/2024 9 MN

10. Patho physiology of Distributive Shock In all types of distributive shock, massive arterial and venous dilation promotes peripheral pooling of blood. Arterial dilation reduces systemic vascular resistance. Initially , cardiac output can be high, both from the reduction in after load (systemic vascular resistance) and from the heart muscle’s increased effort to maintain perfusion despite the incompetent vasculature. 6/7/2024 10 MN

11. Pathophysiology of Distributive shock Pooling of blood in the periphery results in decreased venous return. Decreased venous return results in decreased stroke volume and decreased cardiac output. Decreased cardiac output, in turn, causes decreased BP and ultimately decreased tissue perfusion . Septic shock , the most common type of distributive shock, is caused by widespread infection or sepsis 6/7/2024 11 MN

12. Management of Distributive Shock Fluid replacement – at least 30 ml/kg of crystalloids over 30 minutes If fluid therapy alone does not effectively improve tissue perfusion, vasopressin agents, specifically nor epinephrine or dopamine If the infecting organism is unknown, broad-spectrum antibiotic agents are started until If fluid 6/7/2024 12 MN

13. Distributive Shock… Neurogenic Shock - vasodilatation occurs as a result of imbalance between parasympathetic and sympathetic stimulation . predominant parasympathetic stimulation causes vasodilatation leading to a relative h ypovolemic state Neurogenic shock can be caused by spinal cord injury, spinal anesthesia, or other nervous system damage. It may also result from the depressant action of medications or from lack of glucose 6/7/2024 13 MN

14. Distributive Shock… Anaphylactic shock is caused by a severe allergic reaction when foreign substance develop a systemic antigen–antibody reaction; specifically, an immunoglobulin E (IgE)- mediated response. Makes mast cells to release potent vasoactive substances, such as histamine or bradykinin, and cytokines , causing vasodilation. The most common triggers are foods medications , and insect stings and bites. 6/7/2024 14 MN

15. Distributive Shock… Anaphylaxis has three defining characteristics: Acute onset of symptoms Presence of two or more symptoms that include respiratory compromise, reduced BP, GI distress, and skin or mucosal tissue irritation Cardiovascular compromise from minutes to hours after exposure to the antigen Signs and symptoms of anaphylaxis may present within 2 to 30 minutes of exposure to the antigen 6/7/2024 15 MN

16. Distributive Shock… Treatment of anaphylactic shock requires removing the causative antigen ( e.g.discontinue abx) Fluid management is critical, as massive fluid shifts can occur within minutes due to increased vascular permeability (Intramuscular epinephrine is given for its vasoconstrictive action. Diphenhydramine is given intravenously to reverse the effects of histamine, thereby reducing capillary permeability. 6/7/2024 16 MN

17. Hypovolemic shock Hypovolemic shock, the most common type of shock, is characterized by decreased intravascular volume. Hypovolemic shock occurs when there is a reduction in intravascular volume by 15% to 30%, which represents an approximate loss of 750 to 1500 mL of blood in a 70-kg person 6/7/2024 17 MN

18. Causes of hypovolemic shock Hemorrhagic External(trauma, hematoma) Internal(Gi bleeding, hemothorax, hemoperitoneum) Non hemorrhagic Vomiting Diarrhea Burns 6/7/2024 18 MN

19. Patho physiology of hypovolemic shock Decreased Blood Volume decrease Venous return decrease Stroke volume decrease Co->decrease Tissue Perfusion 6/7/2024 19 MN

20. Clinical Features Of Hypovolemic Shock Cool, clammy skin Confusion Decreased or no urine out put Generalized weakness Pale skin colour Sweating, moist skin Tachycardia, tachypnea ,hypotension 6/7/2024 20 MN

21. Hypovolemic shock stages Class I Class II Class III Class IV Blood Loss(ml) Up to 750 750-1500 1500-2000 >2000 Blood Loss (%) Up to15% 15%-30% 30%-40% >40% Pulse rate <100 >100 >120 >140 BP Normal Normal Decreased Decreased RR 14-20 20-30 30-40 >35 UOP >30 20-30 5-15 Negligible CNS Slightly anxious Mildly anxious Anxious ,confused Confused /lethargic 6/7/2024 21 MN

22. stages shock 1.Initial stage -The CO is insufficient to supply the normal needs of tissues but not low enough to cause serious symptoms. 2.Compensatory stage -The cardiac out put is reduced further but due to compensatory vasoconstriction, the Bp tends to remain with in the normal range. Blood flow to the skin and kidney decrease while blood flow to the CNS and myocardium is maintained. 6/7/2024 22 MN

23. stages shock 3.Progressive stage –Change become more and more apparent falling Bp, increased vasoconstriction, increased heart rate and oliguria. If compensatory mechanism are unable to cope with the reduce output. 4.Irreversible – in this type of shock no type of therapy can save the patients life. 6/7/2024 23 MN

24. General Management of shock Establish patent airway Ensure adequate ventilation and oxygenation Control any external bleeding Secure iv line and resuscitate Prevent hypothermia Treating underline cause Blood transfusion – if there is blood loss 6/7/2024 24 MN

25. Nursing Management Safe administration of prescribed fluids and medications Stop bleeding Monitor vls closely Monitor input and out put Air way management 6/7/2024 25 MN

26. Complications of shock Kidney failure Arrhythmias Hepatic dysfunction DIC Ischemic bowel disease Metabolic acidosis 6/7/2024 26 MN

27. summary Hypovolemic shock is a life threatening condition caused by a significant loss of blood or flood ,leading to insufficient blood volume to maintain adequate circulation and oxygen delivery to tissues. Common causes include bleeding,dehydration,burns and excessive vomiting or diarrhea Signs and symptoms include rapid HR,low Bp, cold clammy skin etc. 6/7/2024 27 MN

28. summary In general to day we have discussed about the introduction , definition, causes ,Pathophysiology, clinical features ,stages ,emergency management and complications of shock. 6/7/2024 28 MN

29. References 1.Brunner and Suddarth , Text book of Medical Surgical Nursing 15 th edition 2.kumar,Abbas and Aster ,Robins basic pathology 10 TH edition 6/7/2024 29 MN

30. THE END!! 6/7/2024 30 MN