Shock is a condition where inadequate blood flow to tissues results in poor delivery of oxygen and nutrients. This can lead to cellular hypoxia and death, progressing to organ dysfunction and death without treatment. Adequate blood flow requires an effective cardiac pump, circulatory system, and sufficient blood volume. Septic shock is caused by infection leading to toxins that damage tissues and blood vessels, reducing blood flow. It most commonly affects those with weakened immune systems. Treatment focuses on rapid restoration of blood flow through fluids, antibiotics, and vasoactive drugs, as well as organ support like mechanical ventilation or dialysis.

2. What is shock ?
A condition in which widespread perfusion to the cells is
inadequate to deliver oxygen & nutrients to support vital
organs & cellular function.
Adequate blood flow to the tissues & cells requires an
adequate cardiac pump, effective vasculature or
circulatory system, & sufficient blood volume.
Without treatment, inadequate blood flow to the cells
results in poor delivery of O2 & nutrients, cellular hypoxia,
& cell death that progresses to organ dysfunction &
eventually death.

6. BLOOD
VOLUME
VENOUS
RETURN
STROKE
VOLUME
CARDIAC
OUTPUT
TISSUE

7. External : Fluid losses Internal : Fluid Shifts
o Trauma oHemmorhage
o Surgery oBurns
o Vomiting oAscites
o Diarrhea oPeritonitis
o Diuresis oDehydration
o Diabetes insipidus

8. • Medical management:

9. • Nursing Management:
• General Nursing Measure

12. PATHOPHYSIOLOGY

13. • Causes
 Septic shock occurs most often in the very old and the very young. It may
also occur in people with weakened immune systems.
 Any type of bacteria can cause septic shock.
 Fungi and (rarely) viruses may also cause the condition.
 Toxins released by the bacteria or fungi may cause tissue damage. This
may lead to low blood pressure and poor organ function.
 Some researchers think that blood clots in small arteries cause the lack of
blood flow and poor organ function.
 The body has a strong inflammatory response to the toxins that
may contribute to organ damage.
• Risk factors for septic shock include:
• Diabetes
• Diseases of the genitourinary system, biliary system, or
intestinal system
• Diseases that weaken the immune system, such as AIDS
• Indwelling catheters (those that remain in place for extended
periods, especially intravenous lines and urinary catheters and
plastic and metal stents used for drainage)
• Leukemia
• Long-term use of antibiotics

15. Little or no urine
agitation

16. Medical Management;
 Identification source of infection
 Culture;
 Specimens of Blood, sputum, urine, wound drainage, & tips of
invasive catheters.
 Using aseptic technique
 Rapid & effectiverestoration of tissue perfusion
 Evaluation & Tx of Pt.’s immune response & dysregulation of the
coagulation system.

Exams and Tests
 Blood tests may be done to check for:
 Infection around the body
 Low blood oxygen level
 Disturbances in the body's acid-base balance
 Poor organ function or organ failure

17.  A chest x-ray to look for pneumonia or fluid in the lungs
(pulmonary edema)
 A urine sample to look for infection
 Additional studies, such as blood cultures, may not become
positive for several days after the blood has been taken, or
for several days after the shock has developed.
 Treatment
 Septic shock is a medical emergency. In most cases, people are
admitted to the intensive care unit of the hospital.
 Treatment may include:
 Breathing machine (mechanical ventilation)
 Dialysis
 Drugs to treat low blood pressure, infection, or blood clotting
 Fluids given directly into a vein (intravenously)
 Oxygen
 Sedatives
 Surgery
 The pressure in the heart and lungs may be checked. This is
called hemodynamic monitoring. This can only be done with
special equipment and intensive care nursing.

18. Nursing Management;
 Aseptic technique
 Monitored for signs of infection
 (IV lines, arterial & veinous puncture sites, surgical
 incision ,traumatic,wounds,urinary catheter, & pressure ulcer.)
 Identify the pt.who are particular risk for sepsis & septic shock.
 Identify the site & source of sepsis & specific organisms involved.
 Obtains appropriate specimens culture & sensitivity.
 Closely monitors for fever, chills or shivering.
 Administers prescribed IV fluids & medications, including
(Antibiotic agents , & vasoactive medications).
 Monitor Blood levels ( antibiotic agents, BUN, creatinine, WBC,
HgB,Hct, platelet levels, coagulation studies). & reports changes
to physician.
 Monitors the pt. Hemodynamic status, fluid I&O,& nutritional
status.
 Daily wt. & close monitoring serum albumin& prealbumin levels.