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NurseReview.Org - Identification of Shock

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http://NurseReview.Org

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  • hello, i find this very helpful to my work place. will you please send this to me? i wanted to share it to my colleague.. here is my email adress. angel_delfin21@yahoo.com thank you so much.
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  • i like this link.,great info very helpful and organize..
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  • actually, I want to download this slide. I want to learn more about that..
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  • Found a helpful website that I thought may help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools that already are helping me. Hope they help :-)
    www.RNpedia.com
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  • Great info, will you please email me this ppt? My email address is camerond127@yahoo.com

    Cathy
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  • Transcript

    • 1. Identification of Shock States Caralee Brommé, RN, MSN, CCRN
    • 2. Identification of Shock States
      • Types of shock
        • Hypovolemic
        • Distributive/ Vasogenic
          • Anaphylactic
          • Neurogenic
          • Septic
        • Cardiogenic
      • Clinical manifestations
        • Compensated/Progressive
        • Decompensated/ Nonprogressive
        • Irreversible
      • Diagnosis& treatment
        • History
        • Physical
      • Case study
    • 3. Identification of Shock States
      • Shock, or circulatory failure is a complex clinical syndrome characterized by inadequate tissue perfusion to meet the metabolic demands of the body , which results in cellular dysfunction and eventual organ failure and death
      • The causes are different, but the physiologic consequences are the same
      • Hypotension,tissue hypoxia, and metabolic acidosis
    • 4. Identification of Shock States
      • Hypovolemic shock
      • Characterized by a reduction in circulating volume or extra cellular loss
          • Blood loss - trauma , GI bleeding, intracranial hemorrhage
          • Plasma loss - increased capillary permeability associated with sepsis and acidosis, burns,peritonitis
          • Extra cellular loss - vomiting diarrhea, glycosuric diuresis, and sunstroke
    • 5. Assessment findings and classification with acute hemorrhage >35 30-40 20-30 14-20 Resp Rate Normal Normal Normal Normal Blood Pressure >140 >120 >100 <100 Pulse rate >2000 1500-2000 750-1500 <750ml Blood loss >40 30-40 15-30 <15% Blood loss Class 4 Class 3 Class 2 Class 1 Assessment
    • 6. Identification of Shock States
      • Distributive shock
      • Characterized by systemic vasodilatation
        • Vasogenic
          • Anaphylaxis - allergen mediated
          • Sepsis - overwhelming sepsis with circulating bacterial toxins
          • Myocardial depression and peripheral dilation
        • Neurogenic
          • Spinal cord injury
    • 7. Identification of Shock States
      • Cardiogenic shock
      • Results from impaired cardiac function resulting in reduced cardiac output
        • Myocardial Infarction
        • Primary pump failure- myocarditis, trauma, congestive heart failure
        • Dysrhythmias-
          • Paroxysmal atrial tachycardia,
          • Ventricular dysrhythmias
        • Obstructive Conditions
          • Large Pulmonary emboli
          • Tension Pneumothorax
          • Pericardial Tamponade
    • 8. Identification of Shock States
      • Clinical manifestations
        • Compensated/ progressive
          • Increased heart rate/ tachycardia
          • Vasoconstriction
            • Decreased perfusion of the hands and feet
          • Irritability
          • Thirsty
          • Decrease urinary output -
          • Normal BP with narrowing pulse pressure
        • Example moderate dehydration
    • 9. Identification of Shock States
      • Decompensated shock
        • Pronounced tachycardia
        • Tachypnea
        • Very lethargic, confused, apathetic
        • Cool pale extremities with decreased capillary refill and skin turgor
          • vasodilatation of the microcirculation
        • BP might be maintained, but increasingly narrow in pulse pressure
        • Moderate metabolic acidosis
          • lactic acidosis from anaerobic metabolism
      • Will progress to tissue hypoxia,metabolic acidosis and eventually organ dysfunction
    • 10. Identification of Shock States
      • Irreversible shock
        • Pronounced vasoconstriction
        • Severe tachycardia with progression to bradycardia- thready weak pulse
        • Hypotension
        • Coma
        • Apnea
        • Irreversibly organ damage
          • Kidneys, brain, heart
    • 11. Identification of Shock States
      • Diagnosis
        • History
          • Type of illness- trauma vs. illness
          • Length of illness-hours to days
          • Find causative agent.
        • ABG for acid/ base & oxygenation status
        • Lactic acid level
        • CBC, blood chemistry, full body fluid cultures
        • EKG,CXR
        • CVP, Arterial line
    • 12. Identification of Shock States
        • Physical exam
          • Level of consciousness
          • Heart rate/ Respiratory rate
            • O2sat (difficult d/t perfusion)
          • Capillary refill (perfusion)
          • BP (Art/ Doppler)
          • Urinary output
          • Cardiac monitoring
          • Temperature monitoring
          • Full hemodynamic monitoring in sever cases
    • 13. Identification of Shock States
      • Therapeutic Management
        • Ventilation
          • Establish airway- prep for intubation
          • Administer O2 by mask
        • Replace fluids
          • Establish IV/ IO access
          • Restore volume with fluid boluses
            • 20cc/kg isotonic solution
        • Improve pump action
          • Administer vasopressors
            • Epinephrine .01mg/ kg
            • Dopamine 2-20 mcg/kg/min
    • 14. Identification of Shock States
      • General support
        • Keep pt flat with leg raised above level of heart
        • Keep pt warm and dry
      • Septic Shock
        • Administer broad-spectrum antibiotics
      • Anaphylaxis
        • Remove allergen
          • Tourniquet above injection site
    • 15. Identification of Shock States in Infants and Children
      • Children have an intense vasoconstrictor response:
        • Systolic blood pressure will be maintained at the expense of peripheral perfusion
        • Observe poor peripheral perfusion and narrow pulse pressure before hypotension is evident
        • A decrease in heart rate below normal range will cause a significant fall in cardiac output
    • 16. Identification of Shock
      • Type and degree of shock?
      • Initial intervention?
      • What signs of improvement will you see with treatment?
    • 17. Identification of Shock States
      • Summary
        • The type and degree of shock must be diagnosed early and treatment started immediately.
        • In infants and children, hypotension is a very late manifestation.
        • Heart and respiratory rate, level of consciousness and capillary refill are essential parts of the physical exam.

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