1. The document discusses haemorrhage, shock, blood coagulation, and the various types and stages of shock. It defines shock as a condition where tissues do not receive enough oxygen due to inadequate perfusion.
2. Shock is classified as hypovolemic, cardiogenic, or distributive including septic, neurogenic, and anaphylactic shock. Management involves treating the underlying cause, fluid resuscitation, and vasoactive medications.
3. Shock progresses through initial, compensatory, progressive, and irreversible stages as compensation mechanisms fail and organ damage occurs if perfusion is not restored.
This document discusses hemorrhage and shock. It covers:
1. The classification of hemorrhage based on the vessel involved, timing, volume lost, and type of intervention needed.
2. The signs and symptoms of hemorrhage and its pathophysiological effects like depletion of venous reservoirs and failure to maintain blood pressure.
3. The physiological response to hemorrhage including hemostasis, the three stages of clot formation, and new models of hemostasis involving an initiation, amplification, and propagation phase.
4. Methods for measuring blood loss are also mentioned. The document provides an overview of hemorrhage, its effects, and the body's response to stop bleeding.
The document discusses hemorrhage and shock. It defines hemorrhage as the copious discharge of blood from blood vessels. Hemorrhage is classified based on source (external vs internal), vessel type (arterial, venous, capillary), time (primary, reactionary, secondary), volume (mild, moderate, severe), and speed (acute, chronic). Common causes include trauma, medical conditions, and medications. Bleeding stops through vasoconstriction, platelet plug formation, and coagulation cascade. Treatment involves fluid replacement, hemostatic measures, and treating the underlying cause.
This document discusses the classification, pathophysiology, clinical features, and management of haemorrhage. It classifies haemorrhage based on source, time of onset, type, duration, and possible intervention. Management involves identifying and controlling the bleeding through resuscitation, investigating the bleeding site, achieving haemorrhage control through surgery or other techniques, and practicing damage control resuscitation to prevent physiological exhaustion. Local haemostatic agents, fluid resuscitation, blood transfusion, and sepsis control are also important in managing haemorrhage.
This document discusses hemorrhage, or abnormal blood loss. It describes external hemorrhage from soft tissue injuries and internal hemorrhage that can result from trauma or medical illnesses in body cavities like the chest, abdomen, pelvis or retroperitoneum. Signs of internal hemorrhage include blood from orifices or vomit. The body's response to hemorrhage is hemostasis to stop bleeding. Stages of hemorrhage are described based on percentage of circulating blood volume lost. Assessment of hemorrhage includes mental status, vital signs and interventions to control bleeding, provide oxygen and treat for shock.
Hemorrhage and shock can occur due to abnormal blood loss or inadequate tissue perfusion. Hemorrhage can be internal or external and is classified based on its source and severity. Shock progresses through four stages as blood loss worsens from vasoconstriction to organ failure. The body responds to hemorrhage initially through hemostasis to stop bleeding, but progresses to shock if blood loss is not replaced.
This document provides an overview of haemorrhage or bleeding. It defines haemorrhage, describes the normal anatomy of blood vessels and composition of blood. It discusses the different types of haemorrhage including capillary, venous, arterial, primary, reactionary, secondary, revealed, and concealed. It also covers the WHO grading of haemorrhage, classification, causes, signs and symptoms. The document outlines the emergency management of haemorrhage including controlling external and internal bleeding. It concludes with discussing nursing care plans and assessments for patients experiencing haemorrhage.
This document discusses shock and hemorrhage. It defines shock and classifies it into hypovolaemic, cardiogenic, obstructive, distributive, and endocrine shock. Cardiogenic shock is caused by cardiac pump failure, while hypovolaemic shock is caused by decreased intravascular volume from hemorrhage or fluid loss. Distributive shock results from diminished systemic vascular resistance and includes septic, anaphylactic, and neurogenic shock. The document further discusses the pathogenesis and treatment of septic shock, hemorrhage classification, and methods of determining acute blood loss.
This document discusses hemorrhage and shock. It covers:
1. The classification of hemorrhage based on the vessel involved, timing, volume lost, and type of intervention needed.
2. The signs and symptoms of hemorrhage and its pathophysiological effects like depletion of venous reservoirs and failure to maintain blood pressure.
3. The physiological response to hemorrhage including hemostasis, the three stages of clot formation, and new models of hemostasis involving an initiation, amplification, and propagation phase.
4. Methods for measuring blood loss are also mentioned. The document provides an overview of hemorrhage, its effects, and the body's response to stop bleeding.
The document discusses hemorrhage and shock. It defines hemorrhage as the copious discharge of blood from blood vessels. Hemorrhage is classified based on source (external vs internal), vessel type (arterial, venous, capillary), time (primary, reactionary, secondary), volume (mild, moderate, severe), and speed (acute, chronic). Common causes include trauma, medical conditions, and medications. Bleeding stops through vasoconstriction, platelet plug formation, and coagulation cascade. Treatment involves fluid replacement, hemostatic measures, and treating the underlying cause.
This document discusses the classification, pathophysiology, clinical features, and management of haemorrhage. It classifies haemorrhage based on source, time of onset, type, duration, and possible intervention. Management involves identifying and controlling the bleeding through resuscitation, investigating the bleeding site, achieving haemorrhage control through surgery or other techniques, and practicing damage control resuscitation to prevent physiological exhaustion. Local haemostatic agents, fluid resuscitation, blood transfusion, and sepsis control are also important in managing haemorrhage.
This document discusses hemorrhage, or abnormal blood loss. It describes external hemorrhage from soft tissue injuries and internal hemorrhage that can result from trauma or medical illnesses in body cavities like the chest, abdomen, pelvis or retroperitoneum. Signs of internal hemorrhage include blood from orifices or vomit. The body's response to hemorrhage is hemostasis to stop bleeding. Stages of hemorrhage are described based on percentage of circulating blood volume lost. Assessment of hemorrhage includes mental status, vital signs and interventions to control bleeding, provide oxygen and treat for shock.
Hemorrhage and shock can occur due to abnormal blood loss or inadequate tissue perfusion. Hemorrhage can be internal or external and is classified based on its source and severity. Shock progresses through four stages as blood loss worsens from vasoconstriction to organ failure. The body responds to hemorrhage initially through hemostasis to stop bleeding, but progresses to shock if blood loss is not replaced.
This document provides an overview of haemorrhage or bleeding. It defines haemorrhage, describes the normal anatomy of blood vessels and composition of blood. It discusses the different types of haemorrhage including capillary, venous, arterial, primary, reactionary, secondary, revealed, and concealed. It also covers the WHO grading of haemorrhage, classification, causes, signs and symptoms. The document outlines the emergency management of haemorrhage including controlling external and internal bleeding. It concludes with discussing nursing care plans and assessments for patients experiencing haemorrhage.
This document discusses shock and hemorrhage. It defines shock and classifies it into hypovolaemic, cardiogenic, obstructive, distributive, and endocrine shock. Cardiogenic shock is caused by cardiac pump failure, while hypovolaemic shock is caused by decreased intravascular volume from hemorrhage or fluid loss. Distributive shock results from diminished systemic vascular resistance and includes septic, anaphylactic, and neurogenic shock. The document further discusses the pathogenesis and treatment of septic shock, hemorrhage classification, and methods of determining acute blood loss.
Hemorrhage is the escape of blood from vessels either internally or externally. It must be aggressively managed to reduce shock, organ failure, and death by arresting bleeding rather than fluid resuscitation alone. Untreated hemorrhage can lead to a dangerous cycle of coagulopathy, acidosis, hypothermia, and further bleeding termed "physiological exhaustion." Medical therapy for hemorrhagic shock risks worsening hypothermia, acidosis, and coagulopathy if bleeding is not controlled. Hemorrhage is classified based on degree and location, and treatment depends on shock severity and response to fluids.
Hemorrhage is the loss of blood from blood vessels. It can lead to shock if severe. The document discusses the definition, types, causes, signs and symptoms, diagnostic tests, and treatment of hemorrhage. Treatment involves arresting the hemorrhage through direct pressure, elevation, and other measures. Medical management includes fluid replacement, supplemental therapy, and measures for oxygenation and cardiac function. Nursing care focuses on thorough assessment and monitoring of the patient.
Hemorrhage is the loss of blood from blood vessels. When tissue is damaged, the body's natural clotting process is initiated to stop bleeding. There are several factors that can affect clotting, including calcium, fibrinogen, and prothrombin. Hemorrhage can be classified according to the vessel involved (arteries, veins, or capillaries), clinical presentation (revealed or concealed), or time of wound (primary, reactionary, secondary). Signs of hemorrhage range from mild symptoms like restlessness to life-threatening signs like diminished urine output and coma. Shock results from inadequate blood flow and oxygen delivery to tissues, and can progress through initial, compensatory,
Hypervolemia is an excess of body fluid caused by increased fluid intake or decreased excretion. This increases the workload on the heart and blood pressure. Symptoms include weight gain, edema, shortness of breath, and cognitive issues. Causes include heart failure, liver cirrhosis, medications, and intravenous fluids. Investigations include physical exams, labs, and imaging tests. Management involves limiting fluid/salt intake and using diuretics like thiazides, loop diuretics, and potassium-sparing diuretics to increase urinary sodium and fluid excretion. Resistance to diuretics can be overcome through intravenous administration or combining diuretic classes.
This document provides an overview of disseminated intravascular coagulation (DIC) including its definition, pathophysiology, classification, etiology, tests, clinical manifestations, complications, treatment, and nursing process. DIC is an acquired syndrome characterized by widespread activation of coagulation and loss of localization arising from different causes that can damage microvasculature and cause organ dysfunction. It is secondary to serious illnesses like infection, cancer, obstetric complications, and tissue injury. Treatment focuses on treating the underlying cause, supportive care, and replacing depleted blood components to stop abnormal coagulation and control bleeding.
1) Shock is a life-threatening condition where tissue perfusion is inadequate, preventing delivery of oxygen and nutrients to vital organs and cells.
2) Shock progresses through initial, compensatory, progressive, and irreversible stages and can be caused by hypovolemia, heart problems, neurologic issues, sepsis, or allergic reactions.
3) Nursing management of shock involves rapid assessment of circulation, breathing, level of consciousness and skin signs; providing immediate care like oxygen, IV fluids, medications; and identifying and treating the underlying cause.
This document provides information about shock and its nursing management. It begins with an introduction to shock, defining it as a life-threatening condition caused by inadequate blood flow to tissues. It then outlines the stages of shock as initial, compensatory, progressive, and irreversible. The main types of shock discussed are hypovolemic, cardiogenic, neurogenic, septic, and anaphylactic. For each type, causes, signs and symptoms, and nursing care are described. The document concludes with test questions to assess learning.
This document discusses different types of shock, including definitions, causes, signs and symptoms, and treatment. It covers hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic shock. Hypovolemic shock is defined as decreased intravascular volume and can be caused by external or internal fluid loss. Signs include rapid pulse, tachypnea, cool skin, and cyanosis. Treatment focuses on fluid resuscitation. Cardiogenic shock results from impaired heart function and common causes are heart attacks or cardiomyopathy. Septic shock is a severe infection that causes vasodilation and maldistribution of blood flow. Anaphylactic shock is a severe allergic reaction that also causes vasod
The document discusses shock, its causes, signs and symptoms, and treatment. It defines shock as inadequate tissue perfusion and lists the main types as hypovolemic, cardiogenic, obstructive, and distributive. It outlines steps to treat hemorrhagic shock, the most common cause, including stopping bleeding, elevating wounds, applying direct pressure, and using tourniquets if needed before giving fluids and assessing the patient's response.
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
Hypovolemia is a deficiency of body fluid that results in a decrease in total fluid volume. It can be caused by fluid or sodium losses from the body through vomiting, diarrhea, burns, or hemorrhage. Symptoms include decreased blood pressure, increased heart rate, dry skin, nausea, and decreased urine output. Treatment involves oral or IV fluid replacement depending on the severity, with close monitoring to prevent fluid overload. Monitoring includes fluid balance charts, weight, and plasma biochemistry.
Fluid and electrolyte imbalances can occur when fluid intake and output are not equal. Hypovolemia is a decreased fluid volume, while hypervolemia is an increased fluid volume. Symptoms of hypovolemia include thirst, low blood pressure, and decreased skin turgor. Treatment involves oral or IV fluid replacement depending on severity. Hypernatremia is a high serum sodium level over 145 mEq/L usually due to too much sodium or too little water. It can cause neurological symptoms and death. Treatment focuses on lowering the sodium level through infusion of hypotonic fluids and use of diuretics.
The post operative period begins after surgery and focuses on enabling successful recovery. It aims to reduce mortality, length of stay, and costs through quality care. Patients are monitored in the PACU or SICU by nurses. They assess vitals, consciousness, bleeding, pain/anxiety and more to detect complications and ensure stability for discharge. The goal is safe transfer from intensive recovery phases to continued recovery in step-down units or at home with instructions.
Perioperative nursing involves caring for patients before, during, and after surgery by assessing their needs, developing a care plan, and evaluating outcomes; this includes obtaining consent, preparing patients both physically and psychologically for surgery, monitoring patients' vital signs and comfort during procedures, and facilitating recovery afterwards while addressing any postoperative needs. Perioperative nurses work as part of a surgical team with specific roles in the preoperative, intraoperative, and postoperative phases to help ensure patient safety and successful surgical outcomes.
This document discusses body fluids and electrolyte balance. It begins by outlining learning objectives related to body fluids, electrolytes, and fluid and electrolyte imbalances. It then provides details on the composition and functions of body fluids, the fluid compartments of the body, key electrolytes like sodium, potassium and calcium, factors that influence fluid balance, common fluid and electrolyte imbalances, and nursing interventions.
The seminar covered haemorrhage, or bleeding, including its definition, types, causes, signs and symptoms, investigations, management, prevention and nursing care. Haemorrhage results from ruptured blood vessels and a reduction in circulating blood volume. It can be arterial, venous, or capillary based on the vessel involved. Common causes include head trauma, high blood pressure, aneurysms and blood disorders. Signs range from restlessness to pallor and loss of consciousness. Investigations may include CT scans, MRI and angiography. Management involves supportive care, surgery, and rehabilitation. Nurses monitor for changes and complications while educating patients on prevention, medications and follow-up.
This document discusses haemorrhages and methods for arresting them. It defines haemorrhage as the loss of blood from the body due to external or internal injuries. There are three main types of haemorrhages: capillary, venous, and arterial. Arterial haemorrhages are the most life-threatening. The document outlines symptoms of haemorrhages and discusses using direct or indirect pressure to arrest bleeding by applying pressure to wounds or pressure points until bleeding stops. The goal is to be able to correctly identify haemorrhage types and apply proper first aid methods to control bleeding.
1. Hemorrhage is defined as blood escaping from the circulatory system. It can be classified by the type of vessel (arterial, venous, capillary), timing (primary, reactionary, secondary), duration (acute, chronic), and nature (external, internal).
2. Hemorrhagic shock occurs when blood loss exceeds 30-40% of total blood volume, leading to falling blood pressure and tissue hypoperfusion. It is classified into four stages based on symptoms.
3. Homeopathic medicines like Carbo veg, Aconite, Ferrum, Bovista, Crot. H, and Secale cor are used to manage hemorrhage based on
Hypervolemia, also known as fluid overload, is a condition where there is too much fluid in the blood. It is usually the result of an underlying health problem such as heart failure, cirrhosis, kidney failure, or medications. Common symptoms include edema, tiredness, high blood pressure, and shortness of breath. Treatment involves diuretics and addressing the underlying cause. Nursing care focuses on monitoring the patient's response to diuretics through weight, intake and output measurements, and educating them on diet.
This document provides an overview of shock, including its definition, pathophysiology, classification, signs and symptoms, initial management, and specific types such as hypovolemic, septic, cardiogenic, and obstructive shock. It defines shock as inadequate tissue perfusion and oxygen delivery, discusses the body's compensatory mechanisms and their failure in severe shock. It classifies shock into hypovolemic, cardiogenic, distributive, and obstructive types and provides details on managing each type, including damage control resuscitation for hemorrhagic shock and use of vasopressors for neurogenic shock. Key goals in shock management are outlined as well as factors like lactate and base deficit that can guide res
Hemorrhage is the escape of blood from vessels either internally or externally. It must be aggressively managed to reduce shock, organ failure, and death by arresting bleeding rather than fluid resuscitation alone. Untreated hemorrhage can lead to a dangerous cycle of coagulopathy, acidosis, hypothermia, and further bleeding termed "physiological exhaustion." Medical therapy for hemorrhagic shock risks worsening hypothermia, acidosis, and coagulopathy if bleeding is not controlled. Hemorrhage is classified based on degree and location, and treatment depends on shock severity and response to fluids.
Hemorrhage is the loss of blood from blood vessels. It can lead to shock if severe. The document discusses the definition, types, causes, signs and symptoms, diagnostic tests, and treatment of hemorrhage. Treatment involves arresting the hemorrhage through direct pressure, elevation, and other measures. Medical management includes fluid replacement, supplemental therapy, and measures for oxygenation and cardiac function. Nursing care focuses on thorough assessment and monitoring of the patient.
Hemorrhage is the loss of blood from blood vessels. When tissue is damaged, the body's natural clotting process is initiated to stop bleeding. There are several factors that can affect clotting, including calcium, fibrinogen, and prothrombin. Hemorrhage can be classified according to the vessel involved (arteries, veins, or capillaries), clinical presentation (revealed or concealed), or time of wound (primary, reactionary, secondary). Signs of hemorrhage range from mild symptoms like restlessness to life-threatening signs like diminished urine output and coma. Shock results from inadequate blood flow and oxygen delivery to tissues, and can progress through initial, compensatory,
Hypervolemia is an excess of body fluid caused by increased fluid intake or decreased excretion. This increases the workload on the heart and blood pressure. Symptoms include weight gain, edema, shortness of breath, and cognitive issues. Causes include heart failure, liver cirrhosis, medications, and intravenous fluids. Investigations include physical exams, labs, and imaging tests. Management involves limiting fluid/salt intake and using diuretics like thiazides, loop diuretics, and potassium-sparing diuretics to increase urinary sodium and fluid excretion. Resistance to diuretics can be overcome through intravenous administration or combining diuretic classes.
This document provides an overview of disseminated intravascular coagulation (DIC) including its definition, pathophysiology, classification, etiology, tests, clinical manifestations, complications, treatment, and nursing process. DIC is an acquired syndrome characterized by widespread activation of coagulation and loss of localization arising from different causes that can damage microvasculature and cause organ dysfunction. It is secondary to serious illnesses like infection, cancer, obstetric complications, and tissue injury. Treatment focuses on treating the underlying cause, supportive care, and replacing depleted blood components to stop abnormal coagulation and control bleeding.
1) Shock is a life-threatening condition where tissue perfusion is inadequate, preventing delivery of oxygen and nutrients to vital organs and cells.
2) Shock progresses through initial, compensatory, progressive, and irreversible stages and can be caused by hypovolemia, heart problems, neurologic issues, sepsis, or allergic reactions.
3) Nursing management of shock involves rapid assessment of circulation, breathing, level of consciousness and skin signs; providing immediate care like oxygen, IV fluids, medications; and identifying and treating the underlying cause.
This document provides information about shock and its nursing management. It begins with an introduction to shock, defining it as a life-threatening condition caused by inadequate blood flow to tissues. It then outlines the stages of shock as initial, compensatory, progressive, and irreversible. The main types of shock discussed are hypovolemic, cardiogenic, neurogenic, septic, and anaphylactic. For each type, causes, signs and symptoms, and nursing care are described. The document concludes with test questions to assess learning.
This document discusses different types of shock, including definitions, causes, signs and symptoms, and treatment. It covers hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic shock. Hypovolemic shock is defined as decreased intravascular volume and can be caused by external or internal fluid loss. Signs include rapid pulse, tachypnea, cool skin, and cyanosis. Treatment focuses on fluid resuscitation. Cardiogenic shock results from impaired heart function and common causes are heart attacks or cardiomyopathy. Septic shock is a severe infection that causes vasodilation and maldistribution of blood flow. Anaphylactic shock is a severe allergic reaction that also causes vasod
The document discusses shock, its causes, signs and symptoms, and treatment. It defines shock as inadequate tissue perfusion and lists the main types as hypovolemic, cardiogenic, obstructive, and distributive. It outlines steps to treat hemorrhagic shock, the most common cause, including stopping bleeding, elevating wounds, applying direct pressure, and using tourniquets if needed before giving fluids and assessing the patient's response.
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
Hypovolemia is a deficiency of body fluid that results in a decrease in total fluid volume. It can be caused by fluid or sodium losses from the body through vomiting, diarrhea, burns, or hemorrhage. Symptoms include decreased blood pressure, increased heart rate, dry skin, nausea, and decreased urine output. Treatment involves oral or IV fluid replacement depending on the severity, with close monitoring to prevent fluid overload. Monitoring includes fluid balance charts, weight, and plasma biochemistry.
Fluid and electrolyte imbalances can occur when fluid intake and output are not equal. Hypovolemia is a decreased fluid volume, while hypervolemia is an increased fluid volume. Symptoms of hypovolemia include thirst, low blood pressure, and decreased skin turgor. Treatment involves oral or IV fluid replacement depending on severity. Hypernatremia is a high serum sodium level over 145 mEq/L usually due to too much sodium or too little water. It can cause neurological symptoms and death. Treatment focuses on lowering the sodium level through infusion of hypotonic fluids and use of diuretics.
The post operative period begins after surgery and focuses on enabling successful recovery. It aims to reduce mortality, length of stay, and costs through quality care. Patients are monitored in the PACU or SICU by nurses. They assess vitals, consciousness, bleeding, pain/anxiety and more to detect complications and ensure stability for discharge. The goal is safe transfer from intensive recovery phases to continued recovery in step-down units or at home with instructions.
Perioperative nursing involves caring for patients before, during, and after surgery by assessing their needs, developing a care plan, and evaluating outcomes; this includes obtaining consent, preparing patients both physically and psychologically for surgery, monitoring patients' vital signs and comfort during procedures, and facilitating recovery afterwards while addressing any postoperative needs. Perioperative nurses work as part of a surgical team with specific roles in the preoperative, intraoperative, and postoperative phases to help ensure patient safety and successful surgical outcomes.
This document discusses body fluids and electrolyte balance. It begins by outlining learning objectives related to body fluids, electrolytes, and fluid and electrolyte imbalances. It then provides details on the composition and functions of body fluids, the fluid compartments of the body, key electrolytes like sodium, potassium and calcium, factors that influence fluid balance, common fluid and electrolyte imbalances, and nursing interventions.
The seminar covered haemorrhage, or bleeding, including its definition, types, causes, signs and symptoms, investigations, management, prevention and nursing care. Haemorrhage results from ruptured blood vessels and a reduction in circulating blood volume. It can be arterial, venous, or capillary based on the vessel involved. Common causes include head trauma, high blood pressure, aneurysms and blood disorders. Signs range from restlessness to pallor and loss of consciousness. Investigations may include CT scans, MRI and angiography. Management involves supportive care, surgery, and rehabilitation. Nurses monitor for changes and complications while educating patients on prevention, medications and follow-up.
This document discusses haemorrhages and methods for arresting them. It defines haemorrhage as the loss of blood from the body due to external or internal injuries. There are three main types of haemorrhages: capillary, venous, and arterial. Arterial haemorrhages are the most life-threatening. The document outlines symptoms of haemorrhages and discusses using direct or indirect pressure to arrest bleeding by applying pressure to wounds or pressure points until bleeding stops. The goal is to be able to correctly identify haemorrhage types and apply proper first aid methods to control bleeding.
1. Hemorrhage is defined as blood escaping from the circulatory system. It can be classified by the type of vessel (arterial, venous, capillary), timing (primary, reactionary, secondary), duration (acute, chronic), and nature (external, internal).
2. Hemorrhagic shock occurs when blood loss exceeds 30-40% of total blood volume, leading to falling blood pressure and tissue hypoperfusion. It is classified into four stages based on symptoms.
3. Homeopathic medicines like Carbo veg, Aconite, Ferrum, Bovista, Crot. H, and Secale cor are used to manage hemorrhage based on
Hypervolemia, also known as fluid overload, is a condition where there is too much fluid in the blood. It is usually the result of an underlying health problem such as heart failure, cirrhosis, kidney failure, or medications. Common symptoms include edema, tiredness, high blood pressure, and shortness of breath. Treatment involves diuretics and addressing the underlying cause. Nursing care focuses on monitoring the patient's response to diuretics through weight, intake and output measurements, and educating them on diet.
This document provides an overview of shock, including its definition, pathophysiology, classification, signs and symptoms, initial management, and specific types such as hypovolemic, septic, cardiogenic, and obstructive shock. It defines shock as inadequate tissue perfusion and oxygen delivery, discusses the body's compensatory mechanisms and their failure in severe shock. It classifies shock into hypovolemic, cardiogenic, distributive, and obstructive types and provides details on managing each type, including damage control resuscitation for hemorrhagic shock and use of vasopressors for neurogenic shock. Key goals in shock management are outlined as well as factors like lactate and base deficit that can guide res
This seminar covers different types of shock including definitions, pathophysiology, clinical features, investigations, and treatment. The main types discussed are hypovolaemic shock, traumatic shock, cardiogenic shock, neurogenic shock, septic shock, and crush syndrome. Hypovolaemic shock is the most common and results from sudden loss of blood or fluid volume. Treatment focuses on fluid resuscitation and controlling bleeding. Septic shock has a high mortality and is usually caused by gram-negative bacteria. Crush syndrome occurs after body portions are compressed by heavy weights.
This document provides information on shock, including its definition, types, pathophysiology, clinical features, and management. It defines shock as a state of inadequate tissue perfusion and oxygenation that can lead to organ dysfunction and death. The main types of shock discussed are hypovolemic, septic, and cardiogenic shock. For each type, the document outlines their pathophysiology, signs and symptoms, and general management approach. Overall, it serves as an overview of shock for medical students, covering the essential details of definitions, types, effects on organ systems, and clinical distinctions between compensated and decompensated states of shock.
This document provides information on shock, including its definition, physiology, pathophysiology, types, symptoms, signs, management, and treatment. It defines shock as inadequate perfusion leading to inadequate oxygen delivery to tissues. The stages of shock are described as initial, compensatory, progressive, and irreversible. Types of shock include cardiogenic, hypovolemic, neurogenic, septic, anaphylactic, and obstructive shock. Signs and symptoms result from cellular hypoperfusion and include restlessness, tachycardia, decreased consciousness, nausea, and decreased urine output. Management involves treating the underlying cause, giving oxygen, intravenous fluids, and vasopressors if needed. The goal of treatment is
This document discusses different types of shock including hypovolemic, septic, cardiogenic, neurogenic, and anaphylactic shock. It provides details on the definition, pathophysiology, clinical presentation, risk factors, and management of each type. For hypovolemic shock, it further discusses classification, fluid resuscitation, indicators of successful resuscitation, and choice of crystalloid versus colloid fluids. Septic shock is emphasized as an important type that can lead to multiple organ failure.
Shock is a clinical condition caused by inadequate tissue perfusion leading to cellular ischemia. The main causes of death in surgical patients are from shock. Shock can be classified as cardiogenic, hypovolemic, distributive, or obstructive. The key features of shock are hypotension, tachycardia, altered mental status, and signs of poor peripheral perfusion. Treatment involves rapid fluid resuscitation to restore perfusion, with blood products as needed. Ongoing fluid needs and use of vasopressors depends on the type and severity of shock. Monitoring includes vital signs, urine output, lactate, and base deficit to guide resuscitation efforts until tissues are fully resuscitated.
1. Cardiogenic shock is defined as a cardiac output less than 2.2 L/minute/m2 due to pathology in the heart itself. It can be caused by myocardial infarction, trauma, myocarditis, cardiomyopathy or sepsis.
2. Diagnosis is based on hypotension, reduced cardiac index, elevated pulmonary capillary wedge pressure, and signs of low cardiac output like tachycardia, hypotension, elevated jugular venous pressure, and oliguria.
3. Initial management involves treating the underlying cause, optimizing preload and afterload, and using inotropic support and vasopressors if needed.
Shock is defined as a state of reduced effective tissue perfusion leading to cellular injury. The document discusses the classification, pathophysiology, clinical features, and treatment of various types of shock including hypovolaemic, traumatic, and cardiogenic shock. Compensatory mechanisms initially attempt to maintain blood pressure and tissue perfusion through vasoconstriction, increased heart rate, and fluid shifts. However, without treatment, shock progresses to cellular dysfunction, organ failure and death. Treatment focuses on fluid resuscitation, controlling bleeding, and treating the underlying cause.
Shock is defined as a state of reduced effective tissue perfusion leading to cellular injury. The document discusses the classification, pathophysiology, clinical features, and treatment of various types of shock including hypovolaemic, traumatic, cardiogenic, and septic shock. Compensatory mechanisms initially work to maintain blood pressure but progressive shock leads to organ failure and death if not treated promptly with fluid resuscitation, controlling bleeding, and vasoactive drugs.
Shock is the state of not enough blood flow to the tissues of the body as a result of problems with the circulatory system.Initial symptoms may include weakness, fast heart rate, fast breathing, sweating, anxiety, and increased thirst. This may be followed by confusion, unconsciousness, or cardiac arrest as complications worsen.
Shock is divided into four main types based on the underlying cause: low volume, cardiogenic, obstructive, and distributive shock. Low volume shock may be from bleeding, diarrhea, vomiting, or pancreatitis. Cardiogenic shock may be due to a heart attack or cardiac contusion. Obstructive shock may be due to cardiac tamponade or a tension pneumothorax. Distributed shock may be due to sepsis, spinal cord injury, or certain overdoses.
The diagnosis is generally based on a combination of symptoms, physical examination, and laboratory tests. A decreased pulse pressure (systolic blood pressure minus diastolic blood pressure) or a fast heart rate raises concerns. The heart rate divided by systolic blood pressure, known as the shock index (SI), of greater than 0.8 supports the diagnosis more than low blood pressure or a fast heart rate in isolation.
Treatment of shock is based on the likely underlying cause.[2] An open airway and sufficient breathing should be established.[2] Any ongoing bleeding should be stopped, which may require surgery or embolization.[2] Intravenous fluid, such as Ringer's lactate or packed red blood cells, is often given.[2] Efforts to maintain a normal body temperature are also important.[2] Vasopressors may be useful in certain cases.[2] Shock is both common and has a high risk of death.[3] In the United States about 1.2 million people present to the emergency room each year with shock and their risk of death is between 20 and 50%
Shock is a state of low tissue perfusion that can lead to cell death if not treated promptly. There are several types of shock including hypovolemic, cardiogenic, obstructive, distributive, and endocrine. The management of shock involves identifying the underlying cause, restoring adequate perfusion and oxygen delivery, and providing supportive care. Initial treatment consists of oxygen, IV fluids, and medications to support blood pressure and organ function while the root cause is addressed. Prompt recognition and treatment of shock is crucial to prevent organ damage and death.
Hemorrhagic shock occurs due to heavy blood loss, which reduces tissue perfusion and oxygen delivery. It is defined as inadequate oxygen delivery to tissues due to reduced circulating blood volume and oxygen-carrying capacity. Common causes are trauma, gastrointestinal bleeding, and obstetrical bleeding. Signs and symptoms include low blood pressure, rapid heart rate, confusion, and loss of consciousness as organs are deprived of oxygen. Diagnostic evaluation includes physical examination, imaging studies, and laboratory tests. Management focuses on restoring circulating volume through fluid replacement, blood transfusion, and vasopressor medications to maintain adequate blood pressure and oxygen delivery to tissues in order to prevent multiple organ failure and death.
1. Shock is defined as inadequate tissue perfusion resulting in cellular dysfunction. The document outlines the pathophysiology, classification, signs, and management of shock.
2. Shock is classified based on its underlying etiology as hypovolemic, cardiogenic, obstructive, distributive, or endocrine shock. Septic shock is a type of distributive shock caused by infection.
3. Management of shock involves initial resuscitation with oxygen, airway control, and fluid resuscitation. Ongoing resuscitation may require vasopressors and inotropes depending on the type of shock, along with monitoring of cardiovascular and perfusion parameters.
Seminar1 homeostatic mechanism and hemodynamic monitoringtheerthapk
Homeostasis refers to the body's ability to regulate its internal environment and maintain a stable condition. It involves negative feedback loops consisting of receptors, control centers, and effectors. Examples include regulation of blood pressure, CO2 levels, temperature, water balance, and glucose levels. The pulmonary artery catheter can directly measure central venous pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac output, and mixed venous oxygen saturation to assess hemodynamics. However, it carries risks such as infection, arrhythmias, and embolism.
This document discusses the classification, recognition and management of shock. It defines shock as acute circulatory failure resulting in inadequate organ perfusion and cellular hypoxia. Shock is classified into four types: hypovolemic, cardiogenic, distributive, and obstructive. Key aspects of each type are discussed in detail, including causes, pathophysiology, diagnosis, and treatment approaches. General management principles for shock include initial resuscitation with fluids, blood products, and vasopressors as needed. Goals of resuscitation are also outlined.
This document provides an overview of shock in pediatrics, including epidemiology, classification, pathogenesis, clinical manifestations, and principles of management. It begins with an introduction defining shock and its causes. It then discusses the main types of shock - hypovolemic, cardiogenic, distributive, and septic shock. The document reviews the epidemiology of shock in developing countries and the United States. It also provides details on the pathophysiology, clinical features, diagnosis, and management approaches for different shock types. The goals of treatment are outlined as restoring circulatory volume and blood flow while monitoring the patient.
This document discusses shock and its pathophysiology. It begins by defining shock as inadequate perfusion leading to inadequate oxygen delivery to tissues. It then covers the stages of shock from the initial insult through compensatory mechanisms failing, leading to end organ damage and potential death. It discusses the different types of shock including cardiogenic, hypovolemic, neurogenic, and septic shock. The document provides details on cardiovascular physiology and the body's compensatory responses to maintain perfusion. It also discusses signs and symptoms of shock along with criteria for diagnosis and treatment approaches.
Research Variables types and identificationaneez103
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This document discusses several theories of learning including constructivism, behaviorism, Piaget's theory of cognitive development, brain-based learning, learning styles theory, multiple intelligences theory, and observational learning. For each theory, the key principles are outlined and the impacts on curriculum, instruction, and assessment are described. Theories of teaching are also briefly introduced including formal, descriptive, and normative theories. Overall, the document provides an overview of major psychological and educational theories of the learning process.
Dialysis is a technique where substances move across a semipermeable membrane from the blood into a dialysate solution. It has evolved historically from early Roman baths for removing urea to the modern use of hemodialysis machines and peritoneal dialysis. Dialysis works through diffusion, osmosis, and ultrafiltration to remove waste and excess fluid for patients with renal failure or other indications. Complications can include infections, hypotension, and various electrolyte abnormalities for both hemodialysis which uses an external machine, and peritoneal dialysis which uses the peritoneal membrane.
- The concept of the therapeutic community was first developed by Maxwell in 1953 in his book "Social Psychiatry", which was later published in the United States as "Therapeutic Community".
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The document discusses the history and development of nursing research from its origins in the 1850s led by Florence Nightingale to current priorities and trends. Some key events include the establishment of the first nursing research organization Sigma Theta Tau in 1936, increased government funding of nursing research beginning in the 1940s-1950s, and the establishment of the National Institute of Nursing Research in 1993 which significantly advanced the field. The document outlines priority areas for nursing research according to different specialties such as clinical nursing, nursing administration, and nursing education.
This document discusses different forms of realism as it relates to education. It defines realism as the view that there is a real world that exists independently of our perceptions. The main forms discussed are humanistic realism, social realism, sense realism, and neorealism. Humanistic realism focuses on education bringing human welfare and success. Social realism aims to promote working efficiency. Sense realism believes knowledge comes from the senses. Neorealism is more inclined toward science. The educational implications are that education should prepare students for real life, use objective teaching methods like observation, and encourage self-discipline.
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This document discusses concepts related to health, disease, and their determinants from various perspectives. It defines health positively as a state of complete physical, mental, and social well-being, and not just the absence of disease. Health is influenced by biological, behavioral, environmental, and socioeconomic factors. Disease results from the interaction between an external agent, the host, and the environment. A holistic view recognizes the multidimensional nature of health and its dependence on psychological, social, cultural, economic, and political influences. Maintaining health requires efforts at the individual, community, national, and international levels.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
2. BLOOD COAGULATION
When a tissue is damaged
Prothrombin is converted into its active form
thrombin
(In the presence of calcium)
Fibrinogen then transformed by thrombin to
fibrin
Mesh is formed by platelets and other blood
cells to form clot
3. CLOTTING FACTORS
3
I. FIBRINOGEN
II. PROTHROMBIN
III. TISSUE FACTOR( THROMBOPLASTIN)
IV. CALCIUM( CA2+)
V. LABILE FACTOR, PROACCELERIN, AC-
GLOBULIN
VI. STABLE FACTOR
4. CONTD…
VII. ANTIHAEMOPHILIC GLOBULIN( AHG),
ANTIHAEMOPHILIC FACTOR A
VIII. CHRISTMAS FACTOR, PLASMA
THROMBOPLASTIN COMPONENT(PTA),
ANTIHAEMOPHILIC FACTOR B
IX. STUART POWER FACTOR
X. PLASMA THROMBOPLASTIN
ANTECEDENT( PTA), ANTIHAEMOPHILIC
FACTOR C
XI. HAGEMAN FACTOR
XII. FIBRIN STABILISING FACTOR 4
5. CLASSIFICATION
BY ATLS Based on blood volume
1. Class I Haemorrhage
2. Class II Haemorrhage
3. Class III Haemorrhage
4. Class IV Haemorrhage
5
6. CONTD…
World Health Organization
Grade 0 - no bleeding
Grade 1 - Petechial bleeding;
Grade 2 - mild blood loss (clinically
significant);
Grade 3 - gross blood loss, requires
transfusion (severe);
Grade 4 - debilitating blood loss, retinal or
cerebral associated with fatality
6
7. According to Origin:
Mouth
Hematemesis, Haemoptysis
Anus
Hematochezia
Urinary tract
Hematuria
Upper head
Intracranial haemorrhage
Cerebral haemorrhage
Intracerebral haemorrhage
Subarachnoid haemorrhage (SAH) 7
13. SIGNS & SYMPTOMS OF
HAEMORRHAGE
Blood coming from an open wound.
Bruising
Shock, which may cause any of the
following symptoms:
• Confusion or decreasing alertness
• Clammy skin
• Dizziness or light-headedness after an
injury
• Low blood pressure
• Paleness (pallor) 13
14. Contd…
• Rapid pulse, increased heart rate
• Shortness of breath
• Weakness
Symptoms of internal bleeding may also
include:
• Abdominal pain and swelling
• Chest pain
14
15. • External bleeding through a natural opening
– Blood in the stool(appears black, maroon,
or bright red)
– Blood in the urine (appears red, pink, or
tea-colored)
– Blood in the vomit (looks bright red, or
brown like coffee-grounds)
– Vaginal bleeding (heavier than usual or
after menopause)
• Skin colour changes that occur several days
after an injury (skin may black, blue, purple,
yellowish green) 15
17. Apply direct pressure:
• with gloved hand,
• sterile dressing(s).
Bleeding stopped? YesNo
Elevate extremity:
• above victim’s heart,
continue direct pressure
Locate pressure point,
apply pressure:
• maintain direct pressure
over wound
Treat for shock:
• care for wound,
• seek definitive care
Bleeding stopped?
Bleeding stopped?
No
Bleeding from
extremity?
No
Apply tourniquet
(last resort)
Yes
No
Definitive therapy
17
18. Apply pressure directly to
wound site:
–Gloved hand, dressing
–If dressing soaks
through, add more
gauze on top and press
harder
18
Direct pressure
19. If possible, raise wound site
above level of victim’s heart
19
Elevate wound site
20. Find proximal “pressure
point” and press on it
(radial, ulnar, brachial,
axillary, femoral arteries—
not carotid)
Apply direct pressure to site
20
Pressure points
Yes
Yes
21. Tourniquet
Apply band above injury site, tighten to stop
bleeding:
–Last resort—risky
–Note time of application
–Reassess frequently
21
22. 22
FIRST AID IN EXTERNAL
BLEEDING
Bring the sides of wound together and press
firmly.
Press on the pressure point for 10-15 min.
Place the causality in comfortable position
and raise the injured Part and reassure him.
Apply a clean pad larger than the wound and
press it firmly with the palm until bleeding
becomes less.
If bleeding continues do not take off original
dressing but add more pads.
Bandage, it but not too tightly.
23. CONTROL OF INTERNAL
HAEMORRHAGE
The organ is emptied of blood clots
if possible.
The vessels are encouraged to
contract.
Packing
Surgical ligature
Internal pressure.
23
24. FIRAT AID IN INTERNAL
BLEEDING
Lay the causality down with head low; raise
his legs by Use of pillow.
Keep him calm and relaxed. Reassure him.
Do not allow him to move.
Keep up the body heat with thin blankets or
coat.
24
25. CONTD…
Do not give anything to eat or drink
aspiration may occur.
Do not apply ice bags or hot water
bottles to chest or abdomen.
Take him to the hospital as early as
possible.
Transport gently
25
27. NURSING MANAGEMENT
Risk for bleeding related to
pregnancy related complications,
postpartum complication, treatment
related side effects, circumcision,
DIC, inherent coagulopathies, GI
disorders, aneurysm, impaired liver
function, trauma or history of falls.
27
29. DEFINITION
1. Shock can be best be defined as a condition
in which tissue perfusion is inadequate to
deliver oxygen and nutrients to support vital
organs and cellular function.
2. Shock is a syndrome characterized by
decreased tissue perfusion and impaired
cellular metabolism. This results in an
imbalance between the supply of and
demand for oxygen and nutrients.
29
30. Contd….
3. Shock is a condition where the
tissues in the body do not receive
enough oxygen and to allow cells to
function.
4. Shock is defined as failure of the
circulatory system to maintain
adequate perfusion to vital organs.
30
31. 31
Shock
Homeostasis
–cellular state of balance
–perfusion of cells with oxygen and
glucose is one of its cornerstones
–Transfer of waste materials from the
cell to blood for elimination
33. 33
AEROBIC METABOLISM
6 O2
GLUCOSE
METABOLISM
6 CO2
6 H2O
36 ATP
HEAT (417 kcal)
Glycolysis: Inefficient source of energy production; 2
ATP for every glucose; produces pyruvic acid
Oxidative phosphorylation: Each pyruvic acid is
converted into 34 ATP
34. 34
ANAEROBIC METABOLISM
GLUCOSE METABOLISM
2 LACTIC ACID
2 ATP
HEAT (32 kcal)
Glycolysis: Inefficient source of energy production; 2
ATP for every glucose; produces pyruvic acid
35. 35
Anaerobic Metabolism
Occurs without oxygen
– oxydative phosphorylation can’t occur
without oxygen
– glycolysis can occur without oxygen
– cellular death leads to tissue and organ
death
– can occur even after return of perfusion
∀⇒ organ or organism death
36. VASCULAR RESPONSES
Oxygen attaches to the haemoglobin
molecule in red blood cells, and the blood
carries it to body cells.
Central regulatory mechanisms
Local regulatory mechanisms
36
37. B.P REGULATION
Three major components of the circulatory
system blood volume, the cardiac pump, and
the vasculature must respond effectively to
complex neural, chemical, and hormonal
feedback systems to maintain an adequate
blood pressure and ultimately perfuse body
tissues.
Mean arterial blood pressure = cardiac output
× peripheral resistance
37
38. CONTD…
Cardiac output is determined by stroke
volume (the amount of blood ejected at
systole) and heart rate.
Blood pressure is regulated by the
baroreceptors (pressure receptors) located in
the carotid sinus and aortic arch.
Chemoreceptor’s, also located in the aortic
arch and carotid arteries, regulate blood
pressure and respiratory rate using much the
same mechanism in response to changes in
oxygen and carbon dioxide concentrations in
the blood. 38
39. CONTD…
The kidneys also play an important role in
blood pressure regulation.
Adequate blood volume, an effective cardiac
pump, and an effective vasculature are
necessary to maintain blood pressure and
tissue perfusion.
39
41. INITIAL STAGE
Initially, the body compensates
with the onset of shock.
No changes are noted clinically.
Changes are beginning to occur
on the cellular level.
42. COMPENSATORY STAGE
Activation of SNS - activation of epinephrine
and nor epinephrine.
Vasoconstriction, increased heart rate, and
increased contractility of the heart contribute
to maintaining adequate cardiac output.
Kidneys release renin into blood
formation of angiotensin & release of
aldosterone, ADH
43. Decreased CO
SNS stimulation
Epinephrine &
nor epinephrine
released
Vasoconstriction
Increased SVR
Renin secreted by
kidney
Angiotension
Aldosterone
ADH
Increase blood volume
hydrostatic pressure
fluid pulled into
capillary
Blood Pressure Maintained
46. PROGRESSIVE STAGE
Vicious circle of compensation
eventually leads to decompensation.
Mean arterial pressure starts to fall -
SBP below 90.
47. CLINICAL FEATURES
RESPIRATORY:
o rapid & shallow
o Crackles
o Decreased arterial oxygen
o Increased CO2
o Pulmonary edema
o Interstitial inflammation & fibrosis
o ARDS 47
48. CARDIOVASCULAR:
o Dysrhythmias
o Ischemia
o Rapid HR- > 150 bpm
o Chest pain
o Rised cardiac enzyme levels
NEUROLOGIC
o Mental status changes-Confusion
o Lethargy
o Dilated pupils, sluggish reaction to light
48
49. RENAL EFFECTS
o Acute renal failure
HEPATIC EFFECTS
o susceptible to Infection
o Elevated liver enzymes& bilirubin
levels
49
50. GI EFFECTS
o Stress ulcer
o Bloody diarrhea
o Bacterial toxin translocation
HEMATOLOGIC EFFECTS
o DIC
50
51. MEDICAL MANAGEMENT
IV FLUIDS& MEDICATIONS
Early enteral support
Antacids, histamine-2 blockers, or
anti-peptic agents.
51
53. IRREVERSIBLE STAGE
Severe organ damage
Low B.P
Complete renal and liver failure
Multiple organ dysfunction
progressing to complete organ
failure has occurred, and death is
imminent.
53
54. MANAGEMENT
MEDICAL
Same as progressive stage
Antibiotic agents & immunomodulation
therapy
NURSING
Offering brief explanations to the patient
Provide opportunities for the family to
see, touch, and talk to the patient.
54
57. Most common type of shock
–Decreased intravascular volume
• Primary cause = loss of blood or body
fluids from an internal or external
source
57
HYPOVOLEMIC SHOCK
Scalp laceration 3rd
degree/full thickness burn
58. CONTD…
• INTERNAL: Hemorrhage, severe
burns, severe dehydration
• EXTERNAL: Trauma, Surgery,
Vomiting, Diarrhoea, Diuresis,
Diabetes insipidus
58
59. CLINICAL FEATURES
A rapid, weak, thready pulse
Cool, clammy skin
Rapid and shallow breathing
Hypothermia
Thirst and dry mouth
Cold and mottled skin (Livedo
reticularis)
59
60. MANAGEMENT
MEDICAL
Treatment of the underlying cause
- Fluid & blood replacement
- Redistribution of fluid by positioning
Pharmacologic therapy
NURSING
o Administering blood & fluids safely
o oxygen
60
62. MANAGEMENT
MEDICAL
Correction of underlying causes
Initiation of first-line treatment
• Supplying supplemental oxygen
• Controlling chest pain
• Providing selected fluid support
62
63. CONTD…
• Administering vasoactive
medications
• Controlling heart rate with
medication or by implementation of
a transthoracic or intravenous
pacemaker
• Implementing mechanical cardiac
support 63
65. Circulatory or distributive shock –
abnormal displacement of blood
volume in the vasculature.
65
DISTRIBUTIVE SHOCK
Urticaria/anaphylaxis Meningococcic sepsis
69. MANAGEMENT
MEDICAL
• identifying and eliminating the
cause of infection.
• Fluid replacement.
PHARMACOLOGIC THERAPY
• Antibiotic sensitivity.
• 3rd
generation cephalosporin +
amino glycoside 69
70. NUTRITIONAL THERAPY
• Nutritional supplementation - within
the first 24 hours .
• Enteral feedings
NURSING MANAGEMENT
• Follow aseptic technique.
• Monitor for signs of infection.
• Monitor hemodynamic status, fluid
intake& output& nutritional status.
• Daily weight & close monitoring of
serum albumin.
70
71. NEUROGENIC SHOCK
vasodilation occurs as a result of a
loss of sympathetic tone.
may have a prolonged course
(spinal cord injury) or a short one
(syncope or fainting)
Dry, warm skin & bradycardia.
71
72. MANAGEMENT
MEDICAL
1. Restoring sympathetic tone through
stabilization of a spinal cord injury
or, in the instance of spinal
anaesthesia, by positioning the
patient properly.
2. Specific treatment depends on its
cause. If hypoglycemia (insulin
shock) is the cause, glucose is
rapidly administered. 72
73. NURSING
• Elevate and maintain the head of
the bed at least 30 degrees.
• . In suspected spinal cord injury,
neurogenic shock may be
prevented by carefully immobilizing
the patient.
• Applying elastic compression
stockings and elevating the foot of
the bed
73
74. • Check the patient daily for any
redness, tenderness, warmth of the
calves, and positive Homans sign
(calf pain on dorsiflexion of the
foot).
• Administering heparin or low-
molecular-weight heparin
(Lovenox) as prescribed, applying
elastic compression stockings, or
initiating pneumatic compression of
the legs may prevent thrombus
formation. 74
75. • Performing passive range of motion
of the immobile extremities.
• In the immediate post injury period,
the nurse must monitor the patient
closely for signs of internal bleeding
that could lead to hypovolemic
shock.
75
76. ANAPHYLACTIC SHOCK
Caused by severe allergic reaction
when a patient who has already
produced antibodies to a foreign
substance (antigen) develops a
systemic antigen–antibody
reaction.
76
77. Due to antibody responses
Release of histamine Vasodilatation
Increased capillary Permeability
Severe bronchoconstriction
Decreased oxygen supply and
utilization
Inadequate tissue Perfusion
77
78. MANAGEMENT
MEDICAL
Removing the causative antigen
(e.g., discontinuing an antibiotic
agent), administering medications
that restore vascular tone, and
providing emergency support of
basic life functions.
78
79. Epinephrine
Diphenhydramine
Nebulized medications ( albuterol)
cardiopulmonary resuscitation
ET Intubation or tracheotomy
NURSING
Assessing all patients for allergies
or previous reactions to antigens
and communicating the existence
of these allergies or reactions to
others. 79
80. Assess the patient’s understanding
of previous reactions and steps
taken by the patient and family to
prevent further exposure to
antigens.
Advise the patient to wear or carry
identification that names the
Specific allergen or antigen.
When administering any new
medication, the nurse observes the
patient for an allergic reaction. 80
81. Identify patients at risk for
anaphylactic reactions to contrast
agents (radiopaque, dye-like
substances that may contain
iodine) used for diagnostic tests.
Take immediate action if signs and
symptoms occur, and must be
prepared to begin cardiopulmonary
resuscitation if cardio respiratory
arrest occurs.
81
82. In addition to monitoring the
patient’s response to treatment, the
nurse assists with intubation if
needed, monitors the
hemodynamic status, ensures
intravenous access for
administration of medications, and
administers prescribed medications
and fluids, and documents
treatments and their effects.
82
83. Community health and home care
nurses whose role includes
administering medications,
including antibiotic agents, in the
patient’s home or other settings
must be prepared to administer
epinephrine subcutaneously or
intramuscularly in the event of an
anaphylactic reaction.
83
84. PREVENTION OF SHOCK
Preoperatively:
His blood should be adequate in
quantity and volume.
His tissues should be adequately
hydrated.
He should be mobile.
Patient should be kept warm on his
journey from ward to theatre.
84
85. Post operatively:
Fluid and electrolyte replacement
normal saline, dextrose 5%, plasma
and rest and relief from the pain
continues.
Gentle handling by nursing staff
will help in prevention of shock.
Diuretics like mannitol .
If oliguria persists furosemide can
be given.
Dopamine
87. BIBLIOGRAPHY
1. Joyce B M. Medical- Surgical
Nursing. 8th
Edition. U.P. Elsevier
Publications; 2009.
Page No: 2154-2182
2.Chintamani. Moroney’s Surgery
For Nurses. 17th
Edition. New Delhi:
Elsevier Publications; 2008.
Page No: 67-81
87
88. 3. Ignatavicius. Workman. Medical
Surgical Nursing-Patient Centred
Collaborative Care. USA: Elsevier
Publications; 2010. Page
No:827-830
4. Lewis. Medical Surgical Nursing:
Assessment And Management Of
Clinical Problems. 8th
Edition. USA:
Elsevier Publications; 2011.
Page No: 1722-1744
88
89. 5. Soni S. Textbook Of Advance
Nursing Practice.1st
Edition. Jaypee
Brothers Medical Publishers; 2003.
Page No: 450-464
6. Basheer S P. A Concise Textbook
Of Advanced Nursing Practice.
Bangalore: Emmess Medical
Publishers; Page No: 9-20
89
90. 7. Smeltzer S C. Brunner And
Suddarth’s Textbook Of Medical
Surgical Nursing.11th
Edition. New
Delhi: Wolters Kluwer Pvt. Ltd;
2008.Page No: 356-378
8. En. Wikipedia.Org/ Wiki/
Emergency Bleeding Control
9. Http:// Nursing Care plans
BlogSpot. In/ 2012
90
With onset of shock, changes begin to occur with decreases in CO. There is a reduction in the oxygenation to the cells. Aerobic metabolism is decreased; anerobic metabolism is increased - lactic acid begins to accumulate.
The fluid shift from interstitial to intravascular space occurs due to the hydrostatic pressure in the capillaries - (decreased push) This causes an increased pull causing what is referred to as an “auto-transfusion” of fluid.
Activation of the SNS causes release of epinephrine and norepinephrine. This causes vasoconstriction of the vessles which increases SVR. This maintains blood flow to the heart and brain; blood flow to the GI, kidney, lungs, skin is decreased. Epinephrine causes Beta activation which increases rate and force of heart contraction which leads to increased cardiac output.
Decreased blood flow to the kidney stimulates the release of renin which forms angiotension. Angiotension is a strong vasoconstrictor. Also, this stimulates the adrenal cortex to release aldosterone. Aldosterone saves salt which draws water. ADH is released in response to increased osmolarity, which results in a retention of water by the kidney.
Clinical manifestations during this stage may be subtle. Initial early clues are changes in LOC; or looking for irritability. These changes are associated with decreased oxygen to the brain (hypoxia)
Blood pressure may or may not change - may be in normal range - so this is not a reliable indicator.
Pulse and respirations will be elevated.
Urine output will begin to decrease.
Vasoconstriction may produce cool, pale looking skin - (septic shock warm)
Patient may complain of thirst
During progessive stage of shock, compensation mechanisms begin to become ineffective. Clinical manifestations of shock become apparent. Prompt management of this patient is necessary during this stage to reverse this.
A massive sympathetic nervous system response occurs. Profound vasoconstriction of most vascular beds occurs - some become occluded. Renal blood flow is minimal causing more renin - angiotension - and more vasoconstriction.
The heart is unable to pump against the significant SVR for long, and CO falls. Decreased CO and vasoconstriciton lead to tissue hypoxia followed by anerobic metabolism and accumulation of lactic acid. Lactic acid then causes the microcirculation to dialate causing decreased venous return. Also, lactic acidosis causes increased capillary permeability allowing fluid to move back from the vascular to interstitial space. Blood then pools in the microcirculation.
Increased vascular capacity, decreaed blood volume and decreaed MAP makes cycle worse and worse. With prolonged decrease in capillary blood flow, tissue becomes progressively hypoxic.