Shock

Jays george
Msc Nursing

1. Kailash , 25- year old man , was not wearing his seat belt when he was the driver involved in a motor vehicle collision. The wind shield was broken and Kailash was found 15 feet from his car. His face was down , conscious , bleeding and moaning. All passengers were taken to the emergency department

2. Hypovolemic shock Presented to , Mrs. Priyadarshini john Assoc . Professor dypson PRESENTED BY, MISS. JAYS GEORGE 1 ST YEAR MSC(N) DYPSON

3. INTRODUCTION CIRCULATORY SHOCK , commonly known as shock , is a life threatening medical condition of low blood perfusion to tissues resulting in cellular injury and inadequate tissue function. It is a medical emergency and the most common cause of death for critically ill people.

4. DEFINITION Shock can be defined as condition in which systemic blood pressure is inadequate to deliver oxygen and nutrient supply to vital organs for cellular functions .

5. CLASSIFICATION LOW BLOOD FLOW Cardiogenic shock Hypovolemic shock Relative hypovolemia/distributive shock MALDISTRIBUTION OF BLOOD FLOW . Neurogenic shock Anaphylactic shock Septic shock

6. Hypovolemic shock This is the most common type of shock due to insufficient circulatory volume. In hypovolemic shock , there is decrease in circulatory volume to level that is inadequate to meet body’s need for tissue oxygenation.

7. Contd …… This occur when there is loss in the intravascular fluid up to 15% to 25%. This would represent a loss of 750 to 1300 ml of blood in a 70 kg person. E.g. : bleeding , burns, and blood loss from gastrointestinal or severe diarrhoea.

8. etiology 1. Sudden malfunction of heart Coronary artery occlusion with acute myocardial ischemia Trauma with structural damage to heart Toxaemia – viral or bacterial Effects of drugs

9. Contd … 2 . Deficient oxygenation of blood in lungs . Post operative atelectasis thoracic injuries particularly of chest, i.e. pneumothorax , crushing and laceration of lung. Disturbances of lung function following surgery and anaesthesia.

10. 3. R eduction in blood volume Haemorrhage (internal or external) Burns Peritonitis Intestinal obstruction Paralytic ileus Diarrhoea vomiting

11. 4. Miscellaneous Acute anaphylaxis Acute adrenal deficiency(Addison’s disease) Over dosage of drugs e.g. : analgesics like pethidine. Following therapy with beta blocking agents. Noxious stimuli such as pain

12. PATHOPHYSIOLOGY

13. Stages of shock

14. Clinical manifestations Cardiovascular Decreased capillary refill time. Chest pain Decreased ejection fraction Bradycardia

15. Pulmonary system Tachypnoea Cyanosis Crackles Rhonchi

16. Shortness of breath Wheezing Rhinitis Stridor

17. Renal system Bladder dysfunction Decreased urine output Decreased renal blood flow

18. Integumentary system Pallor Cool and clammy skin Decreased skin perfusion Flushing

19. Neurological system Decreased cerebral perfusion Anxiety Confusion Late coma

20. Gastrointestinal system Decreased bowel sounds Bowel dysfunction

21. Diagnostic evaluation

22. First aid in shock Reassure the casualty. Lay him down on his back comfortably with head low and turned to one side except in care of head injury. Loosen the clothing around the neck ,chest , and waist. Keep the casualty warm. Give him sips of water if he is thirsty , never give any alcoholic drinks.

23. Never use hot water bag or massage the limbs. Arrest haemorrhage by adequate measures. Check pulse , respiration and level of consciousness. Transport the casualty to the hospital immediately .

24. Management of shock Administration of intravenous fluids , blood products and medication. They are helpful in treating shock , these includes ; CRYSTALLOIDS : these are used for intravenous fluid replacement in early stages of shock .e.g. normal saline and ringer’s lactate solution are most commonly used.

25. blood It is given as packed RBCs, which should be cross-matched, but in an urgent situation, 1 to 2 units of type O Rh-negative blood are an acceptable alternative. When > 1 to 2 units are transfused (e.g., in major trauma), blood is warmed to 37° C.

26. ionotropic agents : like dopamine , dobutamine and epinephrine to improve myocardial contractility, adequate cardiac output and improve tissue perfusion

27. Vasodilators : Nitro-glycerine , sodium nitroprusside used to dilate the coronary arteries. DIURECTICS : These are used to treat oliguria and increase urine output. ANTIBIOTICS: used to treat septic shock because they are bactericidal. ANTIHISTAMINES: epinephrine used in anaphylactic shock.

28. steroids : Used to decrease fluid shift out of vasculature by stabilizing capillary walls. SODIUM BICARBONATE : It is used to treat metabolic acidosis that occurs as shock progress. BRONCHODILATORS : Like atropine , aminophylline , used to relieve Broncho constriction in case of anaphylactic shock.

29. Nursing diagnosis 1 . Ineffective tissue perfusion related to hypovolemia secondary to haemorrhage as evidenced by urinary output < 0.5 mg/kg/hr , increased BUN , decreased blood pressure , tachycardia, increased peripheral pulse , cool and clammy skin, decreased capillary refill , pallor or cyanosis.

30. 2 . Ineffective breathing pattern related to hypovolemia secondary to rapid respiration , decreased energy or fatigue as evidenced by increased rate and decreased depth of respirations associated with fear and anxiety , chest pain .

31. 3 . Fluid volume deficit related to bleeding and vomiting evidenced by Decreased urine output, increased urine concentration, sudden weight loss, decreased venous filling, increased body temperature, decreased pulse volume or pressure, elevated haematocrit, decreased skin or tongue turgor; dry skin/mucous membranes, thirst, decreased blood pressure.

32. 4 . Imbalanced nutritional pattern less than body requirement related to decreased oral intake as evidenced by reluctance to eat due to pain or injury, weakness , sudden weight loss .

33. 5. Anxiety related to severity of condition and unknown outcome as evidenced by verbalisation about condition and fear of death or withdrawal with no communication; restlessness ; sleeplessness ; increase in heart and respiratory rate.

34. Complications of shock Kidney damage Brain damage Gangrene of arms or legs, sometimes leading to amputation Heart attack Other organ damage Death

35. conclusion Hypovolemic shock is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working .

36. assignment Shock is commonly known as ______________? _____________is the first stage in shock ? Give an examples for crystalloids ____________? An early effect that shock has on the body is____________? Shock is best defined as_______________?