“SHOCK”

Hypovolemic shock &

Septic shock

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.

“HYPOVOLEMIC SHOCK”

HYPOVOLEMIC SHOCK

• Is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

• The most common type of shock is characterized by decreased intravascular volume.

CausesLosing about a fifth or more of the normal amount of blood in your body causes hypovolemic shock.Blood loss can be due to:Bleeding from cutsBleeding from other injuriesInternal bleeding, such as in the gastrointestinal tract

• The amount of circulating blood in your body may drop when you lose too many other body fluids. This can be due to:

• Burns• Diarrhea• Excessive perspiration• Vomiting

Signs Pallor Cool, moist skin rapid breathing cyanosis of the lips, gums, & tongue rapid weak, thread pulse, narrowing pulse pressure low blood pressure concentrated urine  The greater and more rapid the blood loss, the more severe the

symptoms of shock 

PATHOPHYSIOLOGY

BLOOD VOLUME

BLOOD VOLUME

VENOUS RETURN

VENOUS RETURN

STROKE VOLUME

STROKE VOLUME

CARDIAC OUTPUT

CARDIAC OUTPUT

TISSUE PERFUSION TISSUE PERFUSION

External : Fluid losses Internal : Fluid Shifts

o Trauma oHemmorhage

o Surgery oBurns

o Vomiting oAscites

o Diarrhea oPeritonitis

o Diuresis oDehydration

o Diabetes insipidus

Risk factors for Hypovolemic shock

Primary Interventions Volume replacement, with an infusion of lactated

ringer’s solution. 0.9% NaCl, colloids or blood component therapy.

O2 administered by nasal cannula, face mask, or mechanical ventilation.

Medication : Cardiac Vasodilators Corticosteroid

• Medical management: Major goals in the Treatment of

hypovolemic shock are; To restore intravascular volume To reverse the sequence of events

leading to inadequate tissue perfusion To redistribute fluid volume To correct the underlying cause. 

• Nursing Management:

• Primary prevention of shock Closely monitoring pt. Who are at risk for

fluid deficits Assisting with fluids replacement before

intravascular volume is depleted.

• General Nursing Measure

Ensuring safe administration of prescribed fluids & medications & documenting their administration & effects monitoring for complications & side effects of treatment & reporting them promptly.

SEPTIC SHOCK

Septic shock Septic shock is a serious condition that occurs when a

body-wide infection leads to dangerously low blood pressure.

Surgery is a procedure that affects your body in many ways besides the actual reason for the operation. Any type of surgery from an appendectomy (Sepsis and Appendicitis) to a face lift to a Cesarean section (Sepsis and Pregnancy) exposes your body to infection and a fair number of complications, many of which could develop into sepsis.

Sometimes called blood poisoning, sepsis is the body's often deadly response to infection or injury. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival.

Once sepsis sets in, if left untreated, it can progress to septic shock and death. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with organ dysfunction and/or amputations.

PATHOPHYSIOLOGY

• 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

• Lymphoma• Recent infection• Recent surgery or medical procedure• Recent use of steroid medications• Solid organ or bone marrow transplantation• Immunosuppression• Malnourishment• Chronic illness• Invasive Procedures

Signs of infection

• Increasing redness around the incision• Pus or other fluid coming from the incision• Warmer than usual skin around the incision• Increased pain around the incision• Fever• Fatigue

Symptoms

Septic shock can affect any part of the body, including the heart, brain, kidneys, liver, and intestines. Symptoms may include:

Cool, pale arms and legs High or very low temperature, chills Light-headedness Little or no urine Low blood pressure Palpitations Rapid heart rate Restlessness, agitation, lethargy, or confusion Shortness of breath Skin rash or discoloration

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

Other tests may include:

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.

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.

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