NURS 4183Adult Health II - Shock, Sepsis & MODS. / Adult Health II - Shock, Sepsis and MODS.

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Shock— - Syndrome characterized by ↓ tissue perfusion and impaired cellular metabolism resulting in an imbalance b/w the supply of and demand for O2 and nutrients (exchange is essential for life)... . When cells experience hypo tissue perfusion, the demand for O2 and nutrients exceeds the supply at the microcirculatory level. - Types of Shock o Distributive shock o Hypovolemic shock o Cardiogenic shock o Obstructive shock Cardiogenic shock - Occurs when systolic or diastolic dysfunction of the heart’s pumping action results in reduced CO o Most common cause is acute MI o Early clinical presentation can be  Tachycardia  Hypotension  Tachypnea with crackles & cyanosis - Manifestations to include o Decreased cap refill o Increased Na+ and water retention o Decreased urine output o Decreased bowels, N/V o Increased blood glucose o Increased BUN Hypovolemic Shock - Occurs after a loss of intravascular fluid volume o Absolute – loss through hemorrhage, GI loss, body drainage, diabetes insipidus or diuresis  Loss of blood, loss of other body fluids through vomiting, diarrhea, GI bleeding, excessive diuresis o Relative – when fluid volume moves out of the vascular space into the extravascular space  fluid shift, internal bleeding, massive vasodilation and pooling of blood or other body fluids - Manifestations to include o Tachypnea leading to the late sign of bradypnea o Decreased urine output o Pallor, cool clammy skin o Anxiety, confusion, agitation o Absent bowels o Decreased HCT & HGB o Increased lactate Neurogenic Shock - Can occur within 30 minutes of a spinal cord injury an can last up to 6 weeks - Most important clinical manifestations are o Hypotension o Bradycardia - Manifestations to include o Skin will initially be warm from massive vasodilation, then risk for hypothermia once heat disperses o Flaccid paralysis o Bladder dysfunction Anaphylactic Shock - An acute, life threatening hypersensitivity allergic reaction. - Reactions causes massive vasodilation, release of vasoactive mediators (can constrict or dilate) and increased capillary permeability leading to fluid leaks from the vascular space into the interstitial space - Can lead to respiratory distress - Sudden onset of symptoms include o Dizziness o Chest pain o Incontinence o Swelling of lips and tongue o Wheezing and stridor o Flushing skin o Pruritus and urticaria o Confusion o Metallic taste Septic Shock - Sepsis is defined as a set of symptoms or syndrome in response to an infection - Shock is a subset of sepsis with an increased mortality. It is characterized by persistent hypotension and inadequate tissue perfusion - Manifestations to include o Hyperventilation o Crackles o Respiratory alkalosis leading to acidosis o Pulmonary HTN o Respiratory failure o Warm & flushed skin leading to the late sign of cool & mottled o Confusion & agitation, can lead to coma (late) o Increase glucose o Increased lactate o Decreased platelets Sepsis/Shock Continuum » SIRS = initial insult (inflammatory response) » Sepsis = SIRS + suspicion or confirmed infection » Severe Sepsis = SIRS + infection + hypoperfusion or organ dysfunction » Septic Shock = SIRS + infection +organ dysfunction + refractory hypotension o Invasion of microorganism with an amplified response to the infection  Bacteria (most common)  Fungus, virus or parasites o Septic shock is the end result Obstructive Shock - Develops when a physical obstruction to blood flow occurs with a decreased CO - Manifestations to include o JVD o Pulsus Paradoxus o Hypotension o Tachypnea leading to late bradypnea o SOB o Decreased urine output o Pallor cool and clammy skin o Decreased or absent bowels o Decreased cerebral perfusion Stages of Shock » Initial stage o Metabolism changes from aerobic to anaerobic causing lactic acid buildup  Lactic acid is usually removed by the liver, however this process requires O2, which is unavailable due to the decrease in tissue perfusion » Compensatory stage o The body activate compensatory mechanisms in attempt to overcome the increasing consequences and maintain homeostasis o The pt clinical presentation begins to reflect the body’s response to imbalanced O2 supply and demand o Classic sign of shock is drop in BP (hypotension) o The SNS is activated which stimulates vasoconstriction and release of Epi and NorEPi  Blood flow to the most vital organs (heart and brain) is maintained & blood flow to nonvital organs such as kidneys, GI tract, skin, lung is diverted or shunted • This effect, is reason for clinical manifestations » Progressive stage o This stage begins as compensatory mechanisms fail o In this stage, aggressive intervention are necessary to prevent the development of MODS o Changes in pt mental status are important in this stage and a move to ICU is necessary o Cardiovascular system is profoundly affected at this stage  Continued decreased cellular perfusion and resulting altered capillary permeability are the distinguishing features of this stage  Myocardial dysfunction and decreased perfusion results in dysrhythmias, myocardial ischemia and possible MI. End result is complete deterioration of the CV system o The respiratory system is usually the first to display signs of critical dysfunction [Show More]

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