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Sunday, May 18, 2008

Medical Surgical Nursing Resource Slides: Identification of Shock

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Medical Surgical Nursing Resource Slides: Identification of Shock Slide Transcript
Slide 1: Identification of Shock States Caralee Brommé, RN, MSN, CCRN

Slide 2: Identification of Shock States „ Types of shock ƒ Hypovolemic ƒ Distributive/ Vasogenic ‚ Anaphylactic ‚ Neurogenic ‚ Septic ƒ Cardiogenic „ Clinical manifestations ƒ Compensated/Progressive ƒ Decompensated/ Nonprogressive ƒ Irreversible „ Diagnosis& treatment ƒ History ƒ Physical „ Case study Whaley and Wong (1999) 2

Slide 3: Identification of Shock States „ Shock, or circulatory failure is a complex clinical syndrome characterized by inadequate tissue perfusion to meet the metabolic demands of the body, which results in cellular dysfunction and eventual organ failure and death „ The causes are different, but the physiologic consequences are the same „ Hypotension,tissue hypoxia, and metabolic acidosis Whaley and Wong (1999) 3

Slide 4: Identification of Shock States „ Hypovolemic shock „ Characterized by a reduction in circulating volume or extra cellular loss ‚ Blood loss- trauma , GI bleeding, intracranial hemorrhage ‚ Plasma loss - increased capillary permeability associated with sepsis and acidosis, burns,peritonitis ‚ Extra cellular loss- vomiting diarrhea, glycosuric diuresis, and sunstroke Whaley and Wong (1999) 4

Slide 5: Assessment findings and classification with acute hemorrhage Assessment Class 1 Class 2 Class 3 Class 4 Blood loss <15% 15-30 30-40 >40 Blood loss <750ml 750- 1500- >2000 1500 2000 Pulse rate <100 >100 >120 >140 Blood Normal Normal Normal Normal Pressure Resp Rate 14-20 20-30 30-40 >35 Whaley and Wong (1999) 5

Slide 6: Identification of Shock States „ Distributive shock „ Characterized by systemic vasodilatation ƒ Vasogenic ‚ Anaphylaxis- allergen mediated ‚ Sepsis- overwhelming sepsis with circulating bacterial toxins ‚ Myocardial depression and peripheral dilation ƒ Neurogenic ‚ Spinal cord injury Whaley and Wong (1999) 6

Slide 7: Identification of Shock States „ Cardiogenic shock „ Results from impaired cardiac function resulting in reduced cardiac output ƒ Myocardial Infarction ƒ Primary pump failure- myocarditis, trauma, congestive heart failure ƒ Dysrhythmias- ‚ Paroxysmal atrial tachycardia, ‚ Ventricular dysrhythmias ƒ Obstructive Conditions ‚ Large Pulmonary emboli ‚ Tension Pneumothorax ‚ Pericardial Tamponade Whaley and Wong (1999) 7

Slide 8: Identification of Shock States „ Clinical manifestations ƒ Compensated/ progressive ‚ Increased heart rate/ tachycardia ‚ Vasoconstriction • Decreased perfusion of the hands and feet ‚ Irritability ‚ Thirsty ‚ Decrease urinary output - ‚ Normal BP with narrowing pulse pressure ƒ Example moderate dehydration Whaley and Wong (1999) 8

Slide 9: Identification of Shock States „ Decompensated shock ƒ Pronounced tachycardia ƒ Tachypnea ƒ Very lethargic, confused, apathetic ƒ Cool pale extremities with decreased capillary refill and skin turgor ‚ vasodilatation of the microcirculation ƒ BP might be maintained, but increasingly narrow in pulse pressure ƒ Moderate metabolic acidosis ‚ lactic acidosis from anaerobic metabolism „ Will progress to tissue hypoxia,metabolic acidosis and eventually organ dysfunction Whaley and Wong (1999) 9

Slide 10: Identification of Shock States „ Irreversible shock ƒ Pronounced vasoconstriction ƒ Severe tachycardia with progression to bradycardia- thready weak pulse ƒ Hypotension ƒ Coma ƒ Apnea ƒ Irreversibly organ damage ‚ Kidneys, brain, heart Whaley and Wong (1999) 10

Slide 11: Identification of Shock States „ Diagnosis ƒ History ‚ Type of illness- trauma vs. illness ‚ Length of illness-hours to days ‚ Find causative agent. ƒ ABG for acid/ base & oxygenation status ƒ Lactic acid level ƒ CBC, blood chemistry, full body fluid cultures ƒ EKG,CXR ƒ CVP, Arterial line Whaley and Wong (1999) 11

Slide 12: Identification of Shock States ƒ Physical exam ‚ Level of consciousness ‚ Heart rate/ Respiratory rate • O2sat (difficult d/t perfusion) ‚ Capillary refill (perfusion) ‚ BP (Art/ Doppler) ‚ Urinary output ‚ Cardiac monitoring ‚ Temperature monitoring Full hemodynamic monitoring in sever cases Whaley and Wong (1999) 12

Slide 13: Identification of Shock States „ Therapeutic Management ƒ Ventilation ‚ Establish airway- prep for intubation ‚ Administer O2 by mask ƒ Replace fluids ‚ Establish IV/ IO access ‚ Restore volume with fluid boluses • 20cc/kg isotonic solution ƒ Improve pump action ‚ Administer vasopressors • Epinephrine .01mg/ kg • Dopamine 2-20 mcg/kg/min Whaley and Wong (1999) 13

Slide 14: Identification of Shock States „ General support ƒ Keep pt flat with leg raised above level of heart ƒ Keep pt warm and dry „ Septic Shock ƒ Administer broad-spectrum antibiotics „ Anaphylaxis ƒ Remove allergen ‚ Tourniquet above injection site Whaley and Wong (1999) 14

Slide 15: Identification of Shock States in Infants and Children „ Children have an intense vasoconstrictor response: ƒ Systolic blood pressure will be maintained at the expense of peripheral perfusion ƒ Observe poor peripheral perfusion and narrow pulse pressure before hypotension is evident ƒ A decrease in heart rate below normal range will cause a significant fall in cardiac output Whaley and Wong (1999) 15

Slide 16: Identification of Shock 1. Type and degree of shock? 2. Initial intervention? 3. What signs of improvement will you see with treatment? Whaley and Wong (1999) 16

Slide 17: Identification of Shock States „ Summary ƒ The type and degree of shock must be diagnosed early and treatment started immediately. ƒ In infants and children, hypotension is a very late manifestation. ƒ Heart and respiratory rate, level of consciousness and capillary refill are essential parts of the physical exam. Whaley and Wong (1999) 17





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1 comments:

Anonymous said...

Great info, I am a nursing student and would really like to have a copy of this ppt to study for upcoming exam. email camerond127@yahoo.com
thx,Cathy


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