SHOCK

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Author:
astof
ID:
8869
Filename:
SHOCK
Updated:
2010-03-02 19:08:47
Tags:
MED SURG IV
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Description:
NURSING
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  1. DEFINE
    • Is a syndrome characterized by:
    • decreased tissue perfusion and impaired cellular metabolism which =>
    • imbalance b/w the supply of and demand for O2 and nutrients => hypoperfusion
  2. CLASSES OF SHOCK
    LOW BLOOD FLOW (cardiogenic and hypovolemic)

    MALDISTRIBUTION OF BLOOD FLOW (septic, anaphylactic, and neurogenic shock)
  3. CARIOGENIC SHOCK
    • systolic dysfunction inability of the heart to pump blood forward
    • ie. MI, cardiomyopathy
    • diastolic dysfunction inability of the heart to fil during diastole
    • ie. pericardial tamponade
    • dysrhythmias (bradydysrhythmias, tachydysrhythmias)
    • structural factors valvular abnormality (stenosis or regurgitation), ventricular septal rupture, tension pneumothorax
  4. HYPOVOLEMIC SHOCK
    • absolute hypovolemia
    • external loss of whole blood (hemorrhage from trauma, surgery, gi bleeding

    loss of other body fluids (vomiting , diarrhea, excessive diuresis, diabetes isnipidus, DM)

    • Relative hypovolemia
    • pooling of blood or fluids (bowel obstruction)
    • fluid shifts (burn injuries, ascities)
    • internal bleeding (fx of long bones, ruptured spleen, hemothorax, severe pancreatitis)
    • massive vasodilation (sepsis)
  5. MALDISTRIBUTION OF BLOOD FLOW
    NEUROGENIC SHOCK
    • hemodynamic consequence of injury and/or disease to the spinal cord at or above T5
    • spinal anesthesia
    • vasomotor center depression (severe pain, drugs, hypoglycemia, injury)
  6. maldistribution
    anaphylactic shock
    contrast media, blood/blood products, drugs, insect bites, anesthetic agents, food/food additives, vaccines, environmental agents, latex
  7. maldistribution of blood flow
    shock
    septic shock
    infection (urinary tract, respiratory tract, invasive procedure, indwelling lines and catheters)

    • At risk:
    • older adults, pts w chronic diseases (/dm, chronic kidney disease, HF) immunosuppressive therapy or who are malnourished or debilitated

    Gram-negative bacteria most common; gram positive bacteria, viruses, fungi, and patasites
  8. Shock
    =>
    SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS)
    =>
    Multiple Organ dyfunction Syndrome (MODS)
    Mediator excess: cytokines (tumor necrosis factor, interleukins), oxygen free radicalss

    widespread endothelial injury and dysfunction

    vasodilation and increased capillary permeability

    tissue edema

    neutrophil entrampment in microcirculation
  9. MODS - multiple organ dysfunction syndrome
    • Target organs
    • cardiovascular dysfunction
    • lung dysfunction
    • GI dysfunction
    • liver dysfunction
    • CNS dysfunction
    • Renal dysfunction
    • Skin dysfunction

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