logging in or signing up Chp. 15 Shock audio klarson Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1222 Category: Education License: All Rights Reserved Like it (5) Dislike it (0) Added: October 07, 2009 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... By: linkh (9 month(s) ago) nice presentation, thank you. Saving..... Post Reply Close Saving..... Edit Comment Close By: angelver (19 month(s) ago) hi misss karen,,i want to download ur presentation coz i need it urgently for my presentation this week..thanks ahead! Saving..... Post Reply Close Saving..... 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Edit Comment Close Premium member Presentation Transcript Chapter 15Shock : Chapter 15Shock Karen Larson, MBA, MSN, RN Shock : Shock Definition A condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function Classification of shock Low blood flow Cardiogenic Hypovolemic Maldistribution of blood flow Septic Anaphylactic Neurogenic 2 Low Blood Flow Cardiogenic Shock : Low Blood Flow Cardiogenic Shock Definition Systolic or diastolic dysfunction Compromised cardiac output (CO) Precipitating causes Myocardial infarction Cardiomyopathy Blunt cardiac injury Severe systemic or pulmonary hypertension Cardiac tamponade Myocardial depression from metabolic problems 3 Low Blood Flow Hypovolemic Shock : Low Blood Flow Hypovolemic Shock Definition Loss of intravascular fluid volume through internal or external fluid shifts Precipitating causes Hemorrhage Trauma/Surgery GI loss (e.g., vomiting, diarrhea) Fistula drainage Diabetes insipidus Burns Diuresis Chart 15-3 pg. 366 4 Maldistribution of Blood Flow Septic Shock : Maldistribution of Blood Flow Septic Shock Definition A widespread infection which activates the immune response and produces massive vasodilation allowing blood to pool peripherally. Mortality rate as high as 50%. Precipitating causes Gram negative, gram-positive bacteria Immunosuppression Extremes of age (<1yr. And >65yrs.) 20-30% of patients will never have an identifiable site of infection Chart 15-4 pg. 372 5 Maldistribution of Blood Flow Anaphylactic Shock : Maldistribution of Blood Flow Anaphylactic Shock Definition A severe allergic reaction when patients who have already produced antibodies to a foreign substance (antigen). The atigen-antibody reaction causes release of substances which cause widespread vasodilation and capillary permeability. Precipitating causes Penicillin sensitivity Bee sting allergy Latex sensitivity Certain foods or medications Blood transfusion reaction Manifestations Swelling of the lips and tongue, angioedema Wheezing, stridor Flushing, pruritus, urticaria Respiratory distress 6 Maldistribution of Blood Flow Neurogenic Shock : Maldistribution of Blood Flow Neurogenic Shock Hemodynamic phenomenon that can occur within 30 minutes of a spinal cord injury at the fifth thoracic (T5) vertebra or above and can last up to 6 weeks Can be in response to spinal anesthesia Results in massive vasodilation leading to pooling of blood in vessels 7 Maldistribution of Blood Flow Neurogenic Shock : Maldistribution of Blood Flow Neurogenic Shock Clinical manifestations Hypotension Bradycardia Temperature dysregulation (resulting in heat loss) Dry skin Poikilothermia (taking on the temperature of the environment) 8 Stages of Shock: : Stages of Shock: Compensatory Measures to increase cardiac output to restore tissue perfusion and oxygenation Progressive Compensatory mechanisms begin to fail Irreversible (or Refractory) Total body failure Compensatory Stage of Shock : Compensatory Stage of Shock SNS causes vasoconstriction, increased HR, and increased heart contractility. This maintains BP and CO. Body shunts blood from skin, kidneys, and GI tract, which results in cool, clammy skin, hypoactive bowel sounds, and decreased urine output. Perfusion of tissues is inadequate. Acidosis occurs as a result of anaerobic metabolism. Respiratory rate increases due to acidosis and may cause a compensatory respiratory alkalosis. Confusion may occur. Progressive Stage of Shock : Progressive Stage of Shock Mechanisms that regulate BP can no longer compensate, and BP and MAP decrease. All organs suffer from hypoperfusion. Vasoconstriction continues, further compromising cellular perfusion. Mental status further deteriorates as a result of decreased cerebral perfusion and hypoxia. Lungs begin to fail, decreased pulmonary blood flow causes further hypoxemia, and carbon dioxide levels increase; alveoli collapse and pulmonary edema occur. Inadequate perfusion of the heart leads to dysrhythmias and ischemia. As MAP falls below 70, GFR cannot be maintained. Acute renal failure may occur. Liver function, GI function, and hematologic function are all affected. DIC (disseminated intravascular coagulation) may occur as a cause or complication of shock. Irreversible Stage of Shock : Irreversible Stage of Shock At this point, organ damage is so severe that the patient does not respond to treatment and cannot survive. BP remains low. Renal and liver functions fail. Anaerobic metabolism worsens acidosis. Multiple organ dysfunction progresses to complete organ failure. The judgment that shock is irreversible is made only in retrospect. For All Types of Shock : For All Types of Shock Early identification and timely treatment of underlying cause The sequence of events for the different types of shock will vary. Therefore, the management and care of the patient will vary. Fluid replacement to restore intravascular volume Crystalloids: 0.9% saline, lactated Ringer’s, hypertonic solutions (3% saline); Colloids: albumin, dextran (dextran may interfere with platelet aggregation) Blood components for hypovolemic shock Complications of fluid replacement include fluid overload and pulmonary edema. Vasoactive medications to restore vasomotor tone and improve cardiac function Nutritional support to address metabolic requirements Support with parenteral or enteral nutrition. GI system should be used, if possible, to support its integrit Administration of H2 blockers or proton pump inhibitors Nursing Assessment : Nursing Assessment ABCs: Airway, breathing, and circulation Focused assessment of tissue perfusion Vital signs Peripheral pulses Level of consciousness Capillary refill Skin (e.g., temperature, color, moisture) Urine output 14 Nursing Management of Shock : Nursing Management of Shock Acute Interventions Evaluate the patient’s response to therapy Provide emotional support to the patient and family Collaborate with other members of the health team when warranted Neurologic status: Orientation and level of consciousness Cardiac status Continuous ECG VS, capillary refill Hemodynamic parameters: central venous pressure, PA pressures, CO, PAWP Heart sounds: Murmurs, S3, S4 15 Nursing Management of Shock : Nursing Management of Shock Respiratory status Respiratory rate and rhythm Breath sounds Continuous pulse oximetry Arterial blood gases Most patients will be intubated and mechanically ventilated Urine output Tympanic or pulmonary arterial temperature Skin: Temperature, pallor, flushing, cyanosis, diaphoresis, piloerection Bowel sounds, nasogastric drainage/stools for occult blood I&O, fluid and electrolyte balance Oral care/hygiene based on O2 requirements Passive/active range of motion 16 Nursing Implementation : Nursing Implementation Assess level of anxiety and fear Medication PRN Talk to patient Visit from clergy Family involvement Comfort measures Privacy Call light within reach Support of coping Patient and family education Communication End-of-life issues Grief processes 17 You do not have the permission to view this presentation. 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Chp. 15 Shock audio klarson Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1222 Category: Education License: All Rights Reserved Like it (5) Dislike it (0) Added: October 07, 2009 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... By: linkh (9 month(s) ago) nice presentation, thank you. Saving..... Post Reply Close Saving..... Edit Comment Close By: angelver (19 month(s) ago) hi misss karen,,i want to download ur presentation coz i need it urgently for my presentation this week..thanks ahead! Saving..... Post Reply Close Saving..... Edit Comment Close By: Iwat (20 month(s) ago) Nice presentation... very helpfull. thank you... Saving..... Post Reply Close Saving..... Edit Comment Close By: abeerulward (23 month(s) ago) Good effort...Thank you. Saving..... Post Reply Close Saving..... Edit Comment Close By: samoo (26 month(s) ago) hi miss klarson how r u , i need to downloud this audio presentation pls urgently please i need it today miss klarson Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Chapter 15Shock : Chapter 15Shock Karen Larson, MBA, MSN, RN Shock : Shock Definition A condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function Classification of shock Low blood flow Cardiogenic Hypovolemic Maldistribution of blood flow Septic Anaphylactic Neurogenic 2 Low Blood Flow Cardiogenic Shock : Low Blood Flow Cardiogenic Shock Definition Systolic or diastolic dysfunction Compromised cardiac output (CO) Precipitating causes Myocardial infarction Cardiomyopathy Blunt cardiac injury Severe systemic or pulmonary hypertension Cardiac tamponade Myocardial depression from metabolic problems 3 Low Blood Flow Hypovolemic Shock : Low Blood Flow Hypovolemic Shock Definition Loss of intravascular fluid volume through internal or external fluid shifts Precipitating causes Hemorrhage Trauma/Surgery GI loss (e.g., vomiting, diarrhea) Fistula drainage Diabetes insipidus Burns Diuresis Chart 15-3 pg. 366 4 Maldistribution of Blood Flow Septic Shock : Maldistribution of Blood Flow Septic Shock Definition A widespread infection which activates the immune response and produces massive vasodilation allowing blood to pool peripherally. Mortality rate as high as 50%. Precipitating causes Gram negative, gram-positive bacteria Immunosuppression Extremes of age (<1yr. And >65yrs.) 20-30% of patients will never have an identifiable site of infection Chart 15-4 pg. 372 5 Maldistribution of Blood Flow Anaphylactic Shock : Maldistribution of Blood Flow Anaphylactic Shock Definition A severe allergic reaction when patients who have already produced antibodies to a foreign substance (antigen). The atigen-antibody reaction causes release of substances which cause widespread vasodilation and capillary permeability. Precipitating causes Penicillin sensitivity Bee sting allergy Latex sensitivity Certain foods or medications Blood transfusion reaction Manifestations Swelling of the lips and tongue, angioedema Wheezing, stridor Flushing, pruritus, urticaria Respiratory distress 6 Maldistribution of Blood Flow Neurogenic Shock : Maldistribution of Blood Flow Neurogenic Shock Hemodynamic phenomenon that can occur within 30 minutes of a spinal cord injury at the fifth thoracic (T5) vertebra or above and can last up to 6 weeks Can be in response to spinal anesthesia Results in massive vasodilation leading to pooling of blood in vessels 7 Maldistribution of Blood Flow Neurogenic Shock : Maldistribution of Blood Flow Neurogenic Shock Clinical manifestations Hypotension Bradycardia Temperature dysregulation (resulting in heat loss) Dry skin Poikilothermia (taking on the temperature of the environment) 8 Stages of Shock: : Stages of Shock: Compensatory Measures to increase cardiac output to restore tissue perfusion and oxygenation Progressive Compensatory mechanisms begin to fail Irreversible (or Refractory) Total body failure Compensatory Stage of Shock : Compensatory Stage of Shock SNS causes vasoconstriction, increased HR, and increased heart contractility. This maintains BP and CO. Body shunts blood from skin, kidneys, and GI tract, which results in cool, clammy skin, hypoactive bowel sounds, and decreased urine output. Perfusion of tissues is inadequate. Acidosis occurs as a result of anaerobic metabolism. Respiratory rate increases due to acidosis and may cause a compensatory respiratory alkalosis. Confusion may occur. Progressive Stage of Shock : Progressive Stage of Shock Mechanisms that regulate BP can no longer compensate, and BP and MAP decrease. All organs suffer from hypoperfusion. Vasoconstriction continues, further compromising cellular perfusion. Mental status further deteriorates as a result of decreased cerebral perfusion and hypoxia. Lungs begin to fail, decreased pulmonary blood flow causes further hypoxemia, and carbon dioxide levels increase; alveoli collapse and pulmonary edema occur. Inadequate perfusion of the heart leads to dysrhythmias and ischemia. As MAP falls below 70, GFR cannot be maintained. Acute renal failure may occur. Liver function, GI function, and hematologic function are all affected. DIC (disseminated intravascular coagulation) may occur as a cause or complication of shock. Irreversible Stage of Shock : Irreversible Stage of Shock At this point, organ damage is so severe that the patient does not respond to treatment and cannot survive. BP remains low. Renal and liver functions fail. Anaerobic metabolism worsens acidosis. Multiple organ dysfunction progresses to complete organ failure. The judgment that shock is irreversible is made only in retrospect. For All Types of Shock : For All Types of Shock Early identification and timely treatment of underlying cause The sequence of events for the different types of shock will vary. Therefore, the management and care of the patient will vary. Fluid replacement to restore intravascular volume Crystalloids: 0.9% saline, lactated Ringer’s, hypertonic solutions (3% saline); Colloids: albumin, dextran (dextran may interfere with platelet aggregation) Blood components for hypovolemic shock Complications of fluid replacement include fluid overload and pulmonary edema. Vasoactive medications to restore vasomotor tone and improve cardiac function Nutritional support to address metabolic requirements Support with parenteral or enteral nutrition. GI system should be used, if possible, to support its integrit Administration of H2 blockers or proton pump inhibitors Nursing Assessment : Nursing Assessment ABCs: Airway, breathing, and circulation Focused assessment of tissue perfusion Vital signs Peripheral pulses Level of consciousness Capillary refill Skin (e.g., temperature, color, moisture) Urine output 14 Nursing Management of Shock : Nursing Management of Shock Acute Interventions Evaluate the patient’s response to therapy Provide emotional support to the patient and family Collaborate with other members of the health team when warranted Neurologic status: Orientation and level of consciousness Cardiac status Continuous ECG VS, capillary refill Hemodynamic parameters: central venous pressure, PA pressures, CO, PAWP Heart sounds: Murmurs, S3, S4 15 Nursing Management of Shock : Nursing Management of Shock Respiratory status Respiratory rate and rhythm Breath sounds Continuous pulse oximetry Arterial blood gases Most patients will be intubated and mechanically ventilated Urine output Tympanic or pulmonary arterial temperature Skin: Temperature, pallor, flushing, cyanosis, diaphoresis, piloerection Bowel sounds, nasogastric drainage/stools for occult blood I&O, fluid and electrolyte balance Oral care/hygiene based on O2 requirements Passive/active range of motion 16 Nursing Implementation : Nursing Implementation Assess level of anxiety and fear Medication PRN Talk to patient Visit from clergy Family involvement Comfort measures Privacy Call light within reach Support of coping Patient and family education Communication End-of-life issues Grief processes 17