Stages Of Shock

Front 1

Initial stage of shock

Back 1

This stage is present when the clients baseling MAP is decrease by less that 10 mm Hg. During this stage, compensatroy mechanisms are so effective at returning MAP to normal levels that oxygenated blood flow to all vital organs is maintained.
Increased sympathetic stimulation(Mild vasoconstriction, and increase in heart rate)

Front 2

Nonprogressive Stage of shock

Back 2

This stage occurs when MAP decreses 10-15 mm Hg below baseline.
A.Continued sympathetic stimulation(moderate vasocontriction, Increased heartrated, decreased pulse pressure)
B. Chemical compensation(Renin, aldosteron and antidiuretic hormone scretion AEB increased vasocontriction, decreased urine output, stimulation of the thirst reflex)
C. Some anaerobic metabolism in nonvital organs(mild acidosis, mild hyperkalemia)

Front 3

Progressive Stage of shock

Back 3

Decrease in MAP of >20 mm Hg from baseline
A. Anoxia of nonvital organs
B. Hypoxia of vital organs
C. Overall metabolism is anaerobic(moderate acidois, moderate hyperkalemia, tissue ischemia)

Front 4

Refractory Stage of shock

Back 4

A. Sever tissue hypoxia with ischemia and necrosis
b. Release of myocardial depressant factor from the pancreas
c. buildup of toxic metabolites
d. Multiple organ dysfunction syndrome
e. Death

Front 5

Description of Septic Shock

Back 5

Septic shock occurs when large amounts of toxins and endotoxins produced by bacteria are released into the blood, causing a whold body inflammotory reaction

Front 6

Causes

Back 6

any pathogenic organism
gram negative bacteria

Front 7

Complications

Back 7

Disseminted intravascular coagulation
Renal failure
heart failure
GI ulcers
abnormal liver function
Death

Front 8

Assessment(History)

Back 8

A. Assess age, ask about recent illness, trauma, invasive procedures, or chronic conditions, that may lead to sepsis
B. Assess for drug use in the past week, some drugs may cause changes that result in septic shock such drugs as: aspirin and aspirin containing drugs antibotics, and cancer therapy drugs

Front 9

Physical Assessment

Back 9

Manifestations of the first phase are unique to septic shock and are often opposite from those seen with all other types of shock

Front 10

Cardiovascular Changes

Back 10

cardiac output increases during the first phase called hyperdynamic
also tachycardia, increased stroke volume, and normal to elevated systolic BP, and a normal CVP

Front 11

Respiratory Changes

Back 11

HYPERDYNAMIC STAGE: respiratory rate and depth are increased, leading to respiratory alkalosis
hYPODYNAMIC STAGE:
Acute respiratory distress may occur

Front 12

Psychosocial assessment

Back 12

indicator that clients may be in the beginning of septic shock os a change in affect of behavior. Compare with how they acted earlier in the day, if possible.

Front 13

Skin Changes

Back 13

HYPERDYNAMIC STAGE:
No change
hYPODYNAMIC STAGE:
skinis cool, clammy, and pallor or cyanosis is present

Front 14

Laboratory assessment

Back 14

Presence of bacteria in the blood
Obtain specimens of urine, blodd, sputum and any drainage for culture per DR. order
Abnormal findings with septic shock is changes in WBS count the differential leuckocyte count may show a left shift
Changes in H&H levels are usually not present until late in SS at that point fibrinogen levels and platelet count are low also.
Activated protein C is reduced

Front 15

Expected outcomes

Back 15

ABG's within normal range
Maintenance of urine output of at lease 20mL/hr
Maintenance of MAP within 10mm hg of baseline
absence of multiple organ dysfunction syndrome
states measures to reduce risk for sepsis

Front 16

Interventions

Back 16

-Ensure patent airway
-Start or KVO IV
-Administer Oxygen
-Obtain specimens of blood, urine, wound drainage, and sputum for culture
-Increase IV fluid rate
-Use aseptic technique
-Handle client gently
-Examine client for overt bleeding
-Elevate clients feet, keeping head flat or at 30 degree angle
-Take VS every 5 minutes until stable
-Administer medications as prescribed ( heparin during phase 1, clotting factor platelets and plasma during phase 2)
-DO NOT LEAVE CLIENT

Front 17

Drug therapy

Back 17

A.Vasoconstrictors 1.Dopamine hydrochloride(Intropin, Revimine) 2. Epinephrine (Adrenalin) 3.Norepinephrine (Levophed) 4.Phenylephrine (Neo-synephrine)
B. Antibotics

Drug therapy in the first phase is aimed at preventing coagulation, and second phase is aimed increasing the blood's ability to clot

Doing experimental therapy by Giving clients antibodies

Front 18

Description of Cardiogenic Shock

Back 18

A condition of diminished cardiac output that severly impairs tissue perfusion, the most lethal form of shock, sometimes called pump failure.

Front 19

Causes

Back 19

Direct Pump Failure

Front 20

specific cause or risk factors

Back 20

MI
cardiac arrest
ventricular dysrhythmias(fibrillation, tachycardia)
cardiac amyloidosis
cardiomyopathies(viral, toxic)
Myocardial degeneration

Front 21

Assessment Hx

Back 21

Assess for disorders such as MI or cardiomyopathy that severely decreases left ventricular function, anginal pain

Front 22

Physical findings

Back 22

urine output less than 20 mL/hr
pale, cold clammy skin
rapid shallow breathes
rapid thready pulse
MAP of less than 60mm Hg in adults
Juggular vein distention
severe anxiety
decreased LOC
pulmonary crackles

Front 23

Treatment

Back 23

Intra aortic balloon pumo
Possible tube feedings or parental nutrition
bed rest

Front 24

Medications

Back 24

Vasopressors
Inotropics
Vasoconstrictors
analgesics;sedatives
osmotic diuretics
vasodilators
oxygen

Front 25

Surgery

Back 25

Possible heart transplant
possible ventricular device