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MEDICAL SURGICAL
NURSING
SHOCK
PRESENTED BY
ABHISHEK K THOMAS
INTRODUCTION
• SHOCK IS A LIFE-THREATENING
CONDITION WITH A VARIETY OF
UNDERLYING CAUSES. IT IS
CHARACTERIZED BY INADEQUATE
TISSUE PERFUSION,IF UNTREATED
RESULTS CELL DEATH. THE NURSE
CARING FOR THE PATIENT WITH
SHOCK OR AT RISK FOR THE
SHOCK.
• RAPID ASSESSMENT AND RESPONSE
ARE ESSENTIAL FOR THE PATIENT
RECOVERY.
DEFINITION
ACCORDING TO MIKHAIL
1999
SHOCK CAN BE DEFINED AS A
CONDITION IN WHICH
SYSTEMIC BLOOD PRESSURE
IS INADEQUATE TO DELIVER
OXYGEN AND NUTRIENTS TO
SUPPORT THE VITAL ORGANS
AND CELLULAR FUNCTIONS.
INCIDENCE
• SHOCK IS COMMON IN BOTH
GENDERS
• CHILDREN AND OLD AGE PEOPLES
ARE MORE PRONE TO SHOCK
• 80% OF MORTALITY RATE CAUSE
BY SHOCK
• OF THESE CARDIOGENIC SHOCK
ACCOUNTS APPROX. 20%,
HYPOVOLEMIC ABOUT 20% AND
SEPTIC SHOCK ABOUT 60% OF
CASES.
ANATOMY & PHYSIOLOGY
CIRCULATORY SYSTEM:
THE CIRCULATORY SYSTEM
ALSO KNOWN AS
CARDIOVASCULAR SYSTEM
MAJOR WORK IS TO PUMP
BLOOD FROM HEART TO LUNGS
TO GET THE OXYGEN.
THE HEART SEND OXYGENATED
BLOOD THROUGH ARTERIES TO
THE REST OF THE BODY.
THE VEINS CARRY
DEOXYGENATED BLOOD BACK TO
THE HEART TO START THE
CIRCULATION PROCESS OVER
CONT…
WHAT IS CIRCULATORY SYSTEM?
•THE HEART AND VESSELS MAKEUP THE
CIRCULATORY SYSTEM THE MAIN FUNCTION
IS TO PROVIDE O2 , NUTRIENTS AND
HORMONE TO MUSCLE TISSUE AND ORGAN
THROUGHOUT YOUR BODY
•IT PROVIDE BLOOD SUPPLY TO ALL THE
BODY TISSUE SO IT CAN BE FUNCTION
PROPERLY.
CONT… • THIS ALSO HELPS OUR BODY TO
GET RID OF WASTE PRODUCTS
INCLUDES:
CO2 FROM RESPIRATION
(BREATHING) OTHER CHEMICAL
BY PRODUCT FROM OUR ORGANS
WASTE FROM THINGS WE EAT AND
DRINK
PARTS OF CIRCULATORY SYSTEM:
• HEART: IS A MUSCULAR ORGAN
THAT PUMPS BLOOD THROUGHOUT
OUR BODY
• BLOOD VESSELS: WHICH
INCLUDES ARTERIES VEINS AND
CAPILLARIES.
• BLOODS: MADEUP OF RBC, WBC,
PLASMA & PLATELETS
PATHOPHYSIOLOGY
CELL SWITCH TO FORM AEROBIC TO ANAEROBIC METABOLISM LACTIC & PRODUCTION
CELL FUNCTION CAUSES & SWELLS
MEMBRANE BECOME MORE PERMEABLE
ELECTROLYTES & FLUIDS SEEPIN & OUT OF CELLS
Na+,K+1 PUMP IMPAIRED
MITOCHONDRIA DAMAGES CELLS DEATHS
SHOCK
CLASSIFICATION
OF SHOCK
HYPOVOLEMIC SHOCK
CARDIOGENIC SHOCK
OBSTRUCTIVE SHOCK
DISTRIBUTIVE SHOCK
ANAPHYLATIC SHOCK
SEPTIC SHOCK
NEUROGENIC SHOCK
HYPOVOLEMIC SHOCK:
• HYPOVOLEMIC SHOCK IS A LIFE-
THREATENING CONDITION THAT
RESULTS WHEN YOU LOSE MORE THAN
20% OF YOUR BODY’S BLOOD OR FLUID
SUPPLY
• THE SEVERE FLUID LOSS MAKE IT
IMPOSSIBLE FOR THE HEART TO PUMP
A SUFFICIENT AMOUNT OF BLOOD TO
OUR BODY.
• IT OCCURS USUALLY IN CHILDREN'S
AND OLD AGE GROUP PEOPLES.
• THIS CONDITION REQUIRES
IMMEDIATE EMERGENCY MEDICAL
ATTENTION.
CARDIOGENIC SHOCK
• CARDIOGENIC SHOCK IS A STATE OF
SYSTEMIC HYPOTENSION PERSISTING
<30 MINUTES WITH REDUCED END
ORGAN PERFUSION DUE TO LOW
CARDIAC OUTPUT DESPITE
ADEQUATE FILLING PRESSURE.
• CARDIOGENIC SHOCK OCCUR WHEN
THE HEART HAS BEEN DAMAGED SO
MUCH, THAT IT IS UNABLE TO SUPPLY
ENOUGH BLOOD TO THE VITAL
ORGANS OF THE BODY. AS A RESULT
OF THE FAILURE OF THE HEART TO
PUMP ENOUGH NUTRIENTS IN THE
BODY.
OBSTRUCTIVE
SHOCK
• OBSTRUCTION TO THE OUTFLOW
DUE TO IMPAIRED CARDIAC
FILING AND EXCESSIVE AFTER
LOAD.
• OBSTRUCTIVE SHOCK CAN BE
CAUSED BY A NUMBER OF
DIFFERENT ETIOLOGIES THAT
RESULTS IN MECHANISM.
OBSTRUCTION OF VENOUS
RETURN TO THE HEART IN
TRAUMA PATIENT THIS IS MOST
COMMONLY DUE TO THE
PRESENCE OF TENSION
DISTRIBUTIVE SHOCK
ABNORMAL DISTRIBUTION OF BLOOD
FLOW IN THE SMALL BLOOD VESSELS
RESULT INADEQUATE SUPPLY OF
BLOOD TO THE BODY’S TISSUES AND
ORGANS.
MOST COMMON FORMS OF
DISTRIBUTIVE SHOCK ARE:
• ANAPHYLACTIC SHOCK:
ANAPHYLACTIC SHOCK IS CAUSED BY
A SEVERE ALLERGIC REACTION WHEN
A PATIENT WHO HAS ALREADY
PRODUCED ANTIBODIES TO THE
FOREIGN SUBSTANCE (ANTIGEN)
DEVELOP A SYSTEMIC ANTIGEN-
ANTIBODIES REACTION.
• SEPTIC SHOCK:
REFERS TO SEVERE SEPSIS WHICH IS
NOT RESPONSIVE TO INTRAVENOUS
FLUID INFUSION FOR
RESUSCITATION AND REQUIRES
INOTROPIC OR VASOPRESSOR AGENT
TO MAINTAIN SYSTOLIC BLOOD
PRESSURE.
IT IS CONSIDERED AS PART OF A
SPECTRUM AND A PROGRESSION OF
SIRS (SYSTEMIC INFLAMMATORY
RESPONSE SYNDROME).
• NEUROGENIC SHOCK:
NEUROGENIC SHOCK IS A LIFE-
THREATENING CONDITION CAUSED
BY IRREGULAR BLOOD CIRCULATION
IN THE BODY. TRAUMA OR INJURY TO
THE SPINE CAN CAUSE THIS
DISRUPTION. IT CAN OCCUR AFTER
DAMAGE TO THE CENTRAL NERVOUS
SYSTEM SUCH AS SPINAL CORD
INJURY.
ETIOLOGY
• SEVER ALLERGIC
REACTIONS
• SIGNIFICANT BLOOD
LOSS
• HEART FAILURE
• BLOOD INFECTION
• DEHYDRATION
• POISONING
• BURN
CLINICAL
MANIFESTATION
DIAGNOSTIC EVALUATION
• HISTORY COLLECTION
• PHYSICAL
EXAMINATION
• BLOOD CULTURE &
SENSITIVE TEST
• CBC TEST
• ECG
• ECHOCARDIOGRAM
• IMAGINE TEST LIKE X-
RAY AND CT- SCAN
• CARDIAC MONITORING
MEDICAL
MANAGEMENT
NON-
PHARMACOLOGICAL
MANAGEMENT
MODIFY TRENDELENBURG
POSITION
ASSESSMENT OF VITAL
SIGNS
OXYGEN
ADMINISTRATION
PARENTERAL
NUTRITIONAL SUPPORT.
PHARMACOGICAL
MANAGEMENT
CRYSTALLOID: RINGER SOLUTION AND
NORMAL SALINE SOLUTION.
INOTROPIC AGENTS: LIKE DOPAMINE,
DOBUTAMINE AND EPINEPHRINE.
VASODILATORS: NITROGLYCERIN
DIURETICS: FRUSEMIDE, LASIX
ANTIBIOTICS: EPINEPHRINE USED IN
ANAPHYLACTIC SHOCK
CORTICOSTEROIDS: DEXAMETHASONE
SODIUM BICARBONATE: TO TREAT
METABOLIC ACIDOSIS
BRONCHODILATORS: ATROPINE
SURGICAL
MANAGEMENT
• WOUND DEBRIDEMENT: IN THE
CASE OF CHRONIC INFECTED
WOUND, BURNS WOUND
DEBRIDEMENT DONE FOR THE
FAST HEALING
• ANGIOPLASTY: IN THE CASE OF
MYOCARDIAL INFARCTION
ANGIOPLASTY CAN BE
PERFORMED.
COMPLICATIONS
PREVENTION OF
SHOCK
PRE-OPERATIVE
• Patients blood should be in adequate
quantity and volume
• Patient’s tissue should be adequately
hydrated
• Patients should be kept warm on his
journey from ward to theatre.
POST OPERATIVE
• Fluid and electrolyte replacement
saline, dextrose 5%,plasma
• Gently handling the nursing staff
will help in prevention of shock
• Administer diuretic like mannitol.
NURSING RESPONSIBILITY
• Check the vital signs
continuously of the patient
• Maintain the input and
output chart of the patient
• To administer oxygen to the
patient if having breathing
problem
• Check for response give
rescues of breaths and CPR
as needed
• To change the position of
the patient if patient in
every 2 hour
• To administer adequate fluid
THANK YOU

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SHOCK (Medical SURGICAL BASED EDITION)).pptx

  • 2. INTRODUCTION • SHOCK IS A LIFE-THREATENING CONDITION WITH A VARIETY OF UNDERLYING CAUSES. IT IS CHARACTERIZED BY INADEQUATE TISSUE PERFUSION,IF UNTREATED RESULTS CELL DEATH. THE NURSE CARING FOR THE PATIENT WITH SHOCK OR AT RISK FOR THE SHOCK. • RAPID ASSESSMENT AND RESPONSE ARE ESSENTIAL FOR THE PATIENT RECOVERY.
  • 3. DEFINITION ACCORDING TO MIKHAIL 1999 SHOCK CAN BE DEFINED AS A CONDITION IN WHICH SYSTEMIC BLOOD PRESSURE IS INADEQUATE TO DELIVER OXYGEN AND NUTRIENTS TO SUPPORT THE VITAL ORGANS AND CELLULAR FUNCTIONS.
  • 4. INCIDENCE • SHOCK IS COMMON IN BOTH GENDERS • CHILDREN AND OLD AGE PEOPLES ARE MORE PRONE TO SHOCK • 80% OF MORTALITY RATE CAUSE BY SHOCK • OF THESE CARDIOGENIC SHOCK ACCOUNTS APPROX. 20%, HYPOVOLEMIC ABOUT 20% AND SEPTIC SHOCK ABOUT 60% OF CASES.
  • 5. ANATOMY & PHYSIOLOGY CIRCULATORY SYSTEM: THE CIRCULATORY SYSTEM ALSO KNOWN AS CARDIOVASCULAR SYSTEM MAJOR WORK IS TO PUMP BLOOD FROM HEART TO LUNGS TO GET THE OXYGEN. THE HEART SEND OXYGENATED BLOOD THROUGH ARTERIES TO THE REST OF THE BODY. THE VEINS CARRY DEOXYGENATED BLOOD BACK TO THE HEART TO START THE CIRCULATION PROCESS OVER
  • 6.
  • 7. CONT… WHAT IS CIRCULATORY SYSTEM? •THE HEART AND VESSELS MAKEUP THE CIRCULATORY SYSTEM THE MAIN FUNCTION IS TO PROVIDE O2 , NUTRIENTS AND HORMONE TO MUSCLE TISSUE AND ORGAN THROUGHOUT YOUR BODY •IT PROVIDE BLOOD SUPPLY TO ALL THE BODY TISSUE SO IT CAN BE FUNCTION PROPERLY.
  • 8. CONT… • THIS ALSO HELPS OUR BODY TO GET RID OF WASTE PRODUCTS INCLUDES: CO2 FROM RESPIRATION (BREATHING) OTHER CHEMICAL BY PRODUCT FROM OUR ORGANS WASTE FROM THINGS WE EAT AND DRINK PARTS OF CIRCULATORY SYSTEM: • HEART: IS A MUSCULAR ORGAN THAT PUMPS BLOOD THROUGHOUT OUR BODY • BLOOD VESSELS: WHICH INCLUDES ARTERIES VEINS AND CAPILLARIES. • BLOODS: MADEUP OF RBC, WBC, PLASMA & PLATELETS
  • 9. PATHOPHYSIOLOGY CELL SWITCH TO FORM AEROBIC TO ANAEROBIC METABOLISM LACTIC & PRODUCTION CELL FUNCTION CAUSES & SWELLS MEMBRANE BECOME MORE PERMEABLE ELECTROLYTES & FLUIDS SEEPIN & OUT OF CELLS Na+,K+1 PUMP IMPAIRED MITOCHONDRIA DAMAGES CELLS DEATHS SHOCK
  • 10. CLASSIFICATION OF SHOCK HYPOVOLEMIC SHOCK CARDIOGENIC SHOCK OBSTRUCTIVE SHOCK DISTRIBUTIVE SHOCK ANAPHYLATIC SHOCK SEPTIC SHOCK NEUROGENIC SHOCK
  • 11. HYPOVOLEMIC SHOCK: • HYPOVOLEMIC SHOCK IS A LIFE- THREATENING CONDITION THAT RESULTS WHEN YOU LOSE MORE THAN 20% OF YOUR BODY’S BLOOD OR FLUID SUPPLY • THE SEVERE FLUID LOSS MAKE IT IMPOSSIBLE FOR THE HEART TO PUMP A SUFFICIENT AMOUNT OF BLOOD TO OUR BODY. • IT OCCURS USUALLY IN CHILDREN'S AND OLD AGE GROUP PEOPLES. • THIS CONDITION REQUIRES IMMEDIATE EMERGENCY MEDICAL ATTENTION.
  • 12. CARDIOGENIC SHOCK • CARDIOGENIC SHOCK IS A STATE OF SYSTEMIC HYPOTENSION PERSISTING <30 MINUTES WITH REDUCED END ORGAN PERFUSION DUE TO LOW CARDIAC OUTPUT DESPITE ADEQUATE FILLING PRESSURE. • CARDIOGENIC SHOCK OCCUR WHEN THE HEART HAS BEEN DAMAGED SO MUCH, THAT IT IS UNABLE TO SUPPLY ENOUGH BLOOD TO THE VITAL ORGANS OF THE BODY. AS A RESULT OF THE FAILURE OF THE HEART TO PUMP ENOUGH NUTRIENTS IN THE BODY.
  • 13. OBSTRUCTIVE SHOCK • OBSTRUCTION TO THE OUTFLOW DUE TO IMPAIRED CARDIAC FILING AND EXCESSIVE AFTER LOAD. • OBSTRUCTIVE SHOCK CAN BE CAUSED BY A NUMBER OF DIFFERENT ETIOLOGIES THAT RESULTS IN MECHANISM. OBSTRUCTION OF VENOUS RETURN TO THE HEART IN TRAUMA PATIENT THIS IS MOST COMMONLY DUE TO THE PRESENCE OF TENSION
  • 14. DISTRIBUTIVE SHOCK ABNORMAL DISTRIBUTION OF BLOOD FLOW IN THE SMALL BLOOD VESSELS RESULT INADEQUATE SUPPLY OF BLOOD TO THE BODY’S TISSUES AND ORGANS. MOST COMMON FORMS OF DISTRIBUTIVE SHOCK ARE: • ANAPHYLACTIC SHOCK: ANAPHYLACTIC SHOCK IS CAUSED BY A SEVERE ALLERGIC REACTION WHEN A PATIENT WHO HAS ALREADY PRODUCED ANTIBODIES TO THE FOREIGN SUBSTANCE (ANTIGEN) DEVELOP A SYSTEMIC ANTIGEN- ANTIBODIES REACTION.
  • 15. • SEPTIC SHOCK: REFERS TO SEVERE SEPSIS WHICH IS NOT RESPONSIVE TO INTRAVENOUS FLUID INFUSION FOR RESUSCITATION AND REQUIRES INOTROPIC OR VASOPRESSOR AGENT TO MAINTAIN SYSTOLIC BLOOD PRESSURE. IT IS CONSIDERED AS PART OF A SPECTRUM AND A PROGRESSION OF SIRS (SYSTEMIC INFLAMMATORY RESPONSE SYNDROME). • NEUROGENIC SHOCK: NEUROGENIC SHOCK IS A LIFE- THREATENING CONDITION CAUSED BY IRREGULAR BLOOD CIRCULATION IN THE BODY. TRAUMA OR INJURY TO THE SPINE CAN CAUSE THIS DISRUPTION. IT CAN OCCUR AFTER DAMAGE TO THE CENTRAL NERVOUS SYSTEM SUCH AS SPINAL CORD INJURY.
  • 16. ETIOLOGY • SEVER ALLERGIC REACTIONS • SIGNIFICANT BLOOD LOSS • HEART FAILURE • BLOOD INFECTION • DEHYDRATION • POISONING • BURN
  • 18. DIAGNOSTIC EVALUATION • HISTORY COLLECTION • PHYSICAL EXAMINATION • BLOOD CULTURE & SENSITIVE TEST • CBC TEST • ECG • ECHOCARDIOGRAM • IMAGINE TEST LIKE X- RAY AND CT- SCAN • CARDIAC MONITORING
  • 20. NON- PHARMACOLOGICAL MANAGEMENT MODIFY TRENDELENBURG POSITION ASSESSMENT OF VITAL SIGNS OXYGEN ADMINISTRATION PARENTERAL NUTRITIONAL SUPPORT.
  • 21. PHARMACOGICAL MANAGEMENT CRYSTALLOID: RINGER SOLUTION AND NORMAL SALINE SOLUTION. INOTROPIC AGENTS: LIKE DOPAMINE, DOBUTAMINE AND EPINEPHRINE. VASODILATORS: NITROGLYCERIN DIURETICS: FRUSEMIDE, LASIX ANTIBIOTICS: EPINEPHRINE USED IN ANAPHYLACTIC SHOCK CORTICOSTEROIDS: DEXAMETHASONE SODIUM BICARBONATE: TO TREAT METABOLIC ACIDOSIS BRONCHODILATORS: ATROPINE
  • 22. SURGICAL MANAGEMENT • WOUND DEBRIDEMENT: IN THE CASE OF CHRONIC INFECTED WOUND, BURNS WOUND DEBRIDEMENT DONE FOR THE FAST HEALING • ANGIOPLASTY: IN THE CASE OF MYOCARDIAL INFARCTION ANGIOPLASTY CAN BE PERFORMED.
  • 24. PREVENTION OF SHOCK PRE-OPERATIVE • Patients blood should be in adequate quantity and volume • Patient’s tissue should be adequately hydrated • Patients should be kept warm on his journey from ward to theatre. POST OPERATIVE • Fluid and electrolyte replacement saline, dextrose 5%,plasma • Gently handling the nursing staff will help in prevention of shock • Administer diuretic like mannitol.
  • 25. NURSING RESPONSIBILITY • Check the vital signs continuously of the patient • Maintain the input and output chart of the patient • To administer oxygen to the patient if having breathing problem • Check for response give rescues of breaths and CPR as needed • To change the position of the patient if patient in every 2 hour • To administer adequate fluid