Shock

Shock, definition, types, causes, pathophysiology, clinical manifestation, diagnostic evaluation, management

1. Subject- Medical Surgical Nursing Topic- Shock - MR. Migron rubin

2. Introduction Cells need two things to function: oxygen and glucose. This allows the cells to generate energy and do their specific jobs. When cells don’t receive either of them or both, they stop functioning.

3. DEFINITION Shock is defined as a condition where the tissues in the body don't receive enough oxygen and nutrients to allow the cells to function.

4. Classification 1. Cardiogenic shock- I t occurs due to systolic or diastolic dysfunction. 2. Hypovolemic shock- I t occurs due to intravascular fluid volume. 3. Obstructive shock- I t occurs when there is physical obstruction in blood flow.

5. 4 . Distributive shock- (neurogenic, anaphylactic & septic) Neurogenic shock- It occurs from trauma that leads to spinal cord injuries . Anaphylactic shock- It is acute life threatening hypersensitivity reaction to a sensitizing substance like drug, chemical, vaccine, food etc . Septic shock- Also known as blood poisoning, is a condition caused by infections that lead to bacteria entering blood.

6. etiology Severe allergic reaction Significant blood loss Heart failure Blood infections Dehydration Poisoning Burns

7. Pathophysiology Cardiogenic shock Structural defects in heart, dysrhythmias etc. Systolic & diastolic dysfunction Decreased cardiac output & increased pulmonary pressure Pulmonary edema Decreased cellular oxygen supply Decreased tissue perfusion

8. Hypovolemic shock Decreased blood volume due to accident, burn etc. Decreased venous return Decreased cardiac output Decreased tissue perfusion Decreased cellular metabolism

9. Neurogenic shock Disruption of sympathetic nervous system Vasodilation Decreased bp Decreased cardiac output Decreased cellular oxygen supply Decreased tissue perfusion Impaired cellular metabolism

10. Anaphylactic shock allergen , drug etc. antigen antibody reaction Vasodilation Capillary permeability Severe broncho constrIction Decreased oxygen supply and utilization Inadequate tissue perfusion

11. Septic shock infection release of toxin Peripheral vascular effects Myocardial PROBLEMS Endothelial destruction decreased contractility Microvascular insufficiency Inadequate blood flow to tissue Inadequate blood flow to the tissue Tissue hypoxia CELL Death

12. OBSTRUCTIVE shock Physical obstruction in blood flow Decreased venous return Decreased cardiac output Decreased cellular oxygen supply Decreased tissue perfusion Impaired cellular metabolism

13. Clinical manifestations Extremely low blood pressure Weakness Chest pain Weak pulse Profuse sweating Dizziness

14. Moist, clammy skin Unconsciousness Rapid, shallow breathing Feeling anxious, agitated or confused Cyanosis

15. Diagnostic evaluation History collection Physical examination Blood culture & sensitivity test CBC- increased WBC & ESR level Arterial blood gas analysis- respiratory alkalosis

16. ECG- dysarrthmias Echocardiogram-to rule out aortic stenosis and pulmonary embolism . X-ray & CT scan Cardiac monitoring-Spo2,pulse,temp,BP are monitored continuously . Central venous pressure -fluid loss.

17. COMPLICATIONS Loss of consciousness Respiratory failure Coagulation disorder Multi organ damage Coma Death

18. management I. Medical management pharmacological management Crystalloids: ringer’s solution and normal saline Inotropic agents: like dopamine , dobutamine and epinephrine Vasodilators : nitroglycerine Diuretics : lasilactone , furosemide Antibiotics : ciprofloxacin, amoxicillin and clavulanic acid Antihistamines : epinephrine used in anaphylactic shock. Corticosteroids : dexamethasone Sodium bicarbonate :used to treat metabolic acidosis Broncodilators : like atropine , aminophylline etc.

19. b. non- pharmacological management  Modified trendelenberg position Assessment of vital signs Oxygen administration Parenteral nutrition support

20. II. SURGICAL MANAGEMENT Wound debridement- in case of chronic infected wound, burns wound debridement to be done for fast healing Angioplasty-in case of myocardial infarction angioplasty can be performed Tracheostomy

21. Iii. Nursing management ASSESSMENT Continuous monitoring of vital signs should be done. Assess Airway, breathing & circulation of the patient. Monitor for ABG value Check for urine output of the client.  

22. NURSING DIAGNOSIS Impaired tissue perfusion related to decrease cardiac output, decreased venous return  In effective breathing pattern related to hypoxia, bronchospasm Fluid volume deficit related to vomiting hemorrhage Acute pain related to myocardial infarction  Imbalanced nutrition less then body requirement related to vomiting, low intake of food