detail description

1. SHOCK

3. DEFINITION
• Shock is defined as a state of
circulatory inadequacy with poor
tissue perfusion resulting in
generalized cellular hypoxia.

4. • The series of changes observed in
shock and their clinical
manifestations, are therefore
dependent on two sets of changes.
1. Circulatory inadequacy
at the filtration level.
2. circular changes or ultimately
death.

5. PATHOPHYSIOLOGY

7. CLASSIFICATION
A. Hypovolaemic Shock
1.Haemorrhagic Shock
2.Nonhaemorrhagic Shock
B. Neurogenic Shock
C. Cardiogenic Shock
D. Septic Shock
E. Anaphylatic Shock

8. 1. HYPOVOLAEMIC SHOCK
• Circulating blood volume is
inadequate from acute depletion. It
may be hemorrhagic shock and non
hemorrhagic shock.

9. PATHOPHYSIOLOGY
Decreased intravascular volume.
Decreased venous return.
Decreased stroke volume.
Decreased cardiac output.
Decreased tissue perfusion.

10. HEMORRHAGIC SHOCK
DEFINITION: It is a life threatening
condition that results when you lose
more than 20% of your body’s blood
or fluid supply. This sever fluid loss
makes it impossible for the heart to
pump a sufficient amount of blood to
your body.

11. CAUSES:
1. causes of bleeding in early
pregency.
2. Antepartum haemorrhage
3. post pertum haemorrhage.

12. PHASES OF
HAEMORRHAGIC SHOCK
1.PHASES OF COMPENSATION:
. Sympathetic stimulation: It is a initial
response to the blood loss leading to
peripheral vaso constriction to maintain
blood supply to the vital organ.
.clinical feature:
. Pallor
.Tachycardia
. Tachypnea

13. 2. PHASES OF DECOMPRESSION:
.Blood loss exceeds 1000 ml in normal
patients or less if other adverse factors
are operating .
.Clinical features:
. Pallor
. Tachycardia
. Tachypnea

14. 3.PHASES OF CIRCULAR DAMAGE AND
DANGER OF DEATH:
.Inadequate treated haemorrhagic
shock result in prolonged tissue hypoxia
and damage with the following effects:
1. Metabolic acidosis
2. Dilation
3. Cardiac failure
4. Death

15. NON HAEMARROGIC SHOCK
. Fluid loss shock associated
with excessive vomiting ,
diarrhoea , diueresis, or too
rapid removed of amniotic
fluid.

16. NEUROGENIC SHOCK
• Neurogenic shock is a type of medical shock
that resulted from a disruption in the
sympathatic outflow leading to unimpeded
vagal tone or the control of the anatomic
nervous system over vasoconstriction.
. Cause:
1. Spinal cord injury
2. Trauma to the brain

18. Sign and symptoms:
. Hypotension
. Bradycardia
. Hypothermia
. Difficulty in breathing
. Cold and clammy skin
.Pale skin appearance

19. . Nausea and vomiting
. Dizziness
. Weakness is experienced as a
result of insufficiency in blood supply

20. In severe state of neurogenic shock the
symptoms may also be accompanied with the
following symptoms;
.Anxiety
. Confusion or disorientation
. Unresponsive to stimuli
. Bluish discoloration of the lips ana finger
. Low urine output
. Excessive sweating
. Unconsciousness

21. CARDIOGENIC SHOCK
. Cardiogenic shock occurs when there is failure
of the pump action of the heart , resulting in
decrease in cardiac output causing reduced
end- organ perfusion.
. It can be defined as the present of
.sustained hypotension [systolic BP<80
mmhg for more than 30 minutes].
.Tissue hypoperfusion [cold peripheries
or oliguria <30 ml/hour]

22. .CAUSES:
1. Myocardial infraction
2. Myocardial confusion
3. Acute dysrhythmia
4. Acute mitral regurgitation
5. Ventricular septal rupture
6. Cardiac arrest

23. PATHOPHYSIOLOGY
Decreased cardiac contractility
Decreased stoke volume and
cardiac output
Pulmonary Decreased Decreased
Congestion systematic coronary artery
tissue perfusion perfusion

24. SYPMTOMS
1. Chest pain
2. Nausea and vomiting
3. Dyspnea
4. Perfuse sweating
5. Confusion/ disorientation
6. Palpitations
7. Faintness

25. SINGS
1. Pale, cold skin with slow capillary rafill
and poor peripheral pulses.
2. Hypotension
3. Tachycardia/ bradycardia
4. Quit heart sounds or presence of third
and fourth heart sounds.
5. Oliguria
6. Altered mental state.

26. SEPTIC SHOCK[Endotoxic shock]
Septic shock usually follows infection with
gram negative organisms and gram positive
organisms.
Causes:
1.Septic abortion
2.Prolonged rupture of membrane
3.Trauma
4. Diabetes
5. kidney disease

27. 6. Retained placental tissues.
CAUSATIVE ORGANISMS:
. Gram –ve organisms- E.coli, bacilli
,Pseudomonas .
.Gram +ve organisms:- Staphylococcus,
streptococcus.

29. GENERAL CHANGES IN SEPTIC SHOCK:-
There are four phases of changes . The first, two
phases are reversible ,the third one probably
correctable and fourth one irreversible.
CLINICAL FEATURES:-
1. Reversible phase:- It has 2 phases
.Early (warm) phase:
-Hypotension
-Tachycardia

30. - Pyrexia
- Rigors
- Flushed skin
.Late (cold) phase:-
- cold and calmy
- cyanosis
- Purpura
- Jaundice
- Coma

31. 2. Irreversible stage:-
prolonged cellular hypoxia leads to
- Acute renal failure
- Metabolic acidosis
- cardiac failure
- Pulmonarry edema

32. ANAPHYLACTIC SHOCK
Anaphylaxis is a serious , potentially
life threatening allergic response that’s
is marked by swelling, low blood
pressure, and dilated blood vessels in
sever a person will go in to shock is
called anaphylactic shock.

33. Symptom:-
1. Sever itching of eye and face.
2. Swealling
3. Breathing difficulty
4. Abdominal pain
5. Cramps.
6. Vomiting
7. Diarrhea

34. MANAGEMENT
1. Haemorrhagic shock:-
. Basic mangment of
haemorrhagic shock is to stop
the bleeding and replace the
volume which has lost.

35. . Restore circulatory volume:-
Blood should be transfuses specially in
haemorrhagic shock as soon as it is available.
Normal saline has to be infused imitially for
immediate volume replacement.
. Administration of oxygen to avoid metabolic
acidosis:-
In the initial phases, administration of
oxygen by nasal cannula at a rate of 6-8 liters
per mintue is enough but in the later phases,
ventilation by endotracheal intubation may be
nceassary.

36. . Pharmacological agents:-
1.Analgesies:- 10 -15 mg morphire , IV, if ther is
pain
2. Corticosteroids:- Hydrocortirone 1 gm.
3. Vasopressors:- To increase the blood pressure
so maintain renal perfusion.
Dopamine – 2.5 mg/kg/ minute.
4. Monitoring:-
. Central venous pressurs
. Pulse rate
. Blood pressure
. Urine out put ( normal 60 ml/ hour)

37. 2. SEPTIC SHOCK:-
.PRINCIPLES OF MANGMENT:-
Aralional approach to the mangment of
andotoxic shock can be formulated only
on the basis of the pathological changes
produced by endotoxemic.
.ANTIBIOTICS:-
.Ampicillin ( every 6 hour)
. Gentamicin ( 2 mg/kg IV)
. Metromidazole ( 400mg IV every 8
hours)

38. . INTRAVENOUS FLUIDES AND ELECTROLYTES
. CORRECTION OF ACIDOSIS
. MAINTENCE OF BLOOD PRESSURE
. VASODILATOR THERAPY
. DIURATIC THERAPY
. CORTICOSTEROIDES
. INTENSSIVE INSULINE THERAPY

39. 3. CARDIOGENIC SHOCK:-
. The aim of mangmant is to make the
diagnosis prevent further ischaemia and treat
the underlying cause-
. ASSESS AIRWAY AND BREATHING:-
1. In tubation and mechanical ventilation
may be needed.
2.Provide oxygen as adaquate.

40. . CARCULATION:-
1. Gain venous access.
. MONITORING:-
1. Cardiac monitoring
2. Blood pressure monitoring
3. Venous pressure monitoring
4. Uninary catherter
. PHARMACOLOGICAL:-
1. Dopamine
2. Dobutamine

41. 4. NEUROGENIC SHOCK:-
.Assessing the general condition of the
patient is the intial step in managing
neurogenic shock.
.The goal of treatment is to stabilize the
patient and prevent any irrevervible tissue
damage including revival of patient.
. The patient must be carefully assessed of
their general condition giving importance to
airway pattern and breathing including the
circulation

42. . Spinal immobilization is necessary to
prevent further spinal cord damage.
. Sever bradycardia can be manged with
IV infusion of atropine give 0.5 mg – 1
mg every 5 mg every 5 minutes.
. Immediates transfer to the nearest
hospital is necessary once the patient
has been stabilized for further
treatment

43. ROLE OF NURSES
1. Assess the ABCs ( Airway , breathing, and
circulation).
2. Assess the vital sings, peripheral pulses, level
of consciousness, capilary refile, urine
output.
3. Monitor the patients ongoing physical and
emotional states to defect the changes in the
patients condition

44. 4. Evaluate the patients response therapy.
5. Provide emotional support to the patient and
family.
6. To maintain appropriate parental therapy.
7. Maintain appropriate parental support.
8. Mensure intake and output per hour.
9. Connect the catheter to gravity drainage
system closed and reported physician if urine
output less than 30 ml/hour.
10. Give the medicine according to the physician
order.

45. 11. Keep clients warm and dry.
12. Maintain the best position to improve the
optimum ventilation by elevating the head of
bed 30 – 60 degress.
13. Monitor full bed rest.
14. Monitor ECG continusly.
15. Monitor vital sings every hour.
16. Provide oxygen according to the patients
requirement.
17. Perform suction when indicated
18. Assist and teach clinents effective coughing
and deep breathing.