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Shock
The document provides a comprehensive overview of shock in medical surgical nursing, defining it as a condition where tissues do not receive enough oxygen and nutrients. It classifies shock into five types: cardiogenic, hypovolemic, obstructive, and distributive (including neurogenic, anaphylactic, and septic), and outlines their causes, pathophysiology, clinical manifestations, diagnostics, and management strategies. Management includes both medical and surgical approaches, along with detailed nursing assessments and interventions.
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Shock
- 1. SUBJECT- MEDICAL SURGICALNURSING TOPIC- SHOCK -MR. MIGRON RUBIN
- 2. INTRODUCTION Cells need twothings 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 definedas 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-It occurs due to systolic or diastolic dysfunction. 2. Hypovolemic shock- It occurs due to intravascular fluid volume. 3. Obstructive shock- It 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 allergicreaction • Significant blood loss • Heart failure • Blood infections • Dehydration • Poisoning • Burns
- 7. PATHOPHYSIOLOGY CARDIOGENIC SHOCK STRUCTURAL DEFECTSIN 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 BLOODVOLUME DUE TO ACCIDENT, BURN ETC. DECREASED VENOUS RETURN DECREASED CARDIAC OUTPUT DECREASED TISSUE PERFUSION DECREASED CELLULAR METABOLISM
- 9. NEUROGENIC SHOCK DISRUPTION OFSYMPATHETIC 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 OFTOXIN 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 OBSTRUCTIONIN BLOOD FLOW DECREASED VENOUS RETURN DECREASED CARDIAC OUTPUT DECREASED CELLULAR OXYGEN SUPPLY DECREASED TISSUE PERFUSION IMPAIRED CELLULAR METABOLISM
- 13. CLINICAL MANIFESTATIONS • Extremelylow blood pressure • Weakness • Chest pain • Weak pulse • Profuse sweating • Dizziness
- 14. • Moist, clammyskin • Unconsciousness • Rapid, shallow breathing • Feeling anxious, agitated or confused • Cyanosis
- 15. DIAGNOSTIC EVALUATION • Historycollection • Physical examination • Blood culture & sensitivity test • CBC- increased WBC & ESR level • Arterial blood gas analysis- respiratory alkalosis
- 16. • ECG-dysarrthmias • Echocardiogram-torule 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 ofconsciousness • Respiratory failure • Coagulation disorder • Multi organ damage • Coma • Death
- 18. MANAGEMENT I. MEDICAL MANAGEMENT A.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