Presentation on theme: "Care of Patients with Shock"— Presentation transcript:
1 Care of Patients with Shock Chapter 39Care of Patients with Shock
2 ShockWidespread abnormal cellular metabolism that occurs when the human need for oxygenation and tissue perfusion is not met to the level needed to maintain cell function.“Whole-body” response.Shock is a “syndrome.”Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and lead to a life-threatening emergency.
3 Classification of Shock by Functional Impairment Hypovolemic shockCardiogenic shockDistributive shockObstructive shock
4 Classification of Shock by Origin of the Problem HypovolemicCardiogenicBasogenicSeptic
6 Review of Oxygenation and Tissue Perfusion Total blood volumeCardiac outputSize of the vascular bed
7 Hypovolemic ShockOccurs when low circulating blood volume causes a mean arterial pressure decrease; the body’s oxygen need is not metCommonly caused by hemorrhage (external or internal) and dehydrationS&P
8 Cardiogenic ShockActual heart muscle is unhealthy, and pumping is directly impaired.Myocardial infarction is the most common cause of direct pump failure.
9 Distributive ShockBlood volume is not lost but is distributed to the interstitial tissues where it cannot circulate and deliver oxygenCaused by loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds, capillary leakNeural-induced distributive shockChemical-induced distributive shock
11 Obstructive ShockCaused by problems that impair the ability of the normal heart muscle to pump effectivelyHeart is normal, but conditions outside the heart prevent either adequate filling of the heart or adequate contraction of the healthy heart musclePericarditisCardiac tamponade
13 Initial Stage of Shock Baseline MAP decreased by less than 10 mm Hg Heart and respiratory rate increased from the baseline or a slight increase in diastolic blood pressureAdaptive responses of vascular constriction and increased heart rate
14 Nonprogressive Stage MAP decreases by 10 to 15 mm Hg. Kidney and hormonal adaptive mechanisms activated.Tissue hypoxia in nonvital organs.Acidosis and hyperkalemia.Stopping conditions that started shock and supportive interventions can prevent shock from progressing.
15 Progressive Stage of Shock Sustained decrease in MAP of more than 20 mm Hg from baseline.Vital organs develop hypoxia.Life-threatening emergency.Immediate interventions are needed.Conditions causing shock need to be corrected within 1 hour of the onset of the progressive stage.
16 Refractory Stage of Shock Too much cell death and tissue damage result from too little oxygen reaching the tissues.Body can no longer respond effectively to interventions, and shock continues.
17 Multiple Organ Dysfunction Syndrome Sequence of cell damage caused by the massive release of toxic metabolites and enzymes.Metabolites released from dead cells.Microthrombi form.MODS occurs first in the liver, heart, brain, and kidney.Myocardial depressant factor from the ischemic pancreas.
18 Health Promotion and Maintenance Primary prevention of hypovolemic shockSecondary prevention of hypovolemic shock
19 Physical Assessment/Clinical Manifestations Cardiovascular changesPulseBlood pressureOxygen saturationSkin changesRespiratory changesRenal and urinary changesCentral nervous system changesMusculoskeletal changes
21 Nonsurgical Management Goals of shock management are to maintain tissue oxygenation, increase vascular volume to normal range, and support compensatory mechanismsOxygen therapyIV therapyDrug therapy
22 Drug TherapiesVasoconstrictors, such as dopamine, epinephrine, norepinephrine, phenylephrineAgents that enhance contractilityAgents that enhance myocardial perfusion
23 Sepsis and Septic Shock Complex type of distributive shock—usually begins as a bacterial or fungal infection and progresses to a dangerous condition over a period of daysSepsis—widespread infection coupled with a more general inflammatory response, known as systemic inflammatory response syndrome (SIRS), that is triggered when an infection escapes local control
24 Severe SepsisProgression of sepsis with an amplified inflammatory response
25 Septic ShockStage of sepsis and SIRS when multiple organ failure is evident and uncontrolled bleeding occurs.Even with appropriate intervention, the death rate among patients in this stage of sepsis exceeds 60%.
26 Septic Shock (Cont’d) Etiology and genetic risk Incidence/prevalence Health promotion and maintenance