Interventions for Clients in Shock

1. Interventions for Clients in Shock

2. Shock • Can occur when any part of the cardiovascular system does not function properly for any reason • Begins with abnormal cellular metabolism that occurs when too little oxygen is delivered to tissues

3. Review of tissue perfusion • Organ perfusion is related to mean arterial pressure (MAP). Because the cardiovascular system is a closed but continuous circuit, the factors that influence MAP include the following: • Total blood volume • Cardiac output • Size of the vascular bed • Total blood volume and cardiac output are directly related to MAP — increases in either total blood volume or cardiac output usually raise MAP. Decreases in either total blood volume or cardiac output eventually lower MAP. • The size of the vascular bed is inversely (negatively) related to MAP — increases in the size of the vascular bed lower MAP, and decreases raise MAP

5. Processes of Shock • Initial stage (early shock) • Nonprogressive stage (compensatory stage) • Progressive stage (intermediate stage) • Refractory stage (irreversible stage)

6. Multiple Organ Dysfunction Syndrome • Cell damage is caused by the massive release of toxic metabolites and enzyme. • Metabolites trigger small clots to form that block tissue oxygenation and damage more cells, continuing the devastating cycle.

8. Hypovolemic Shock • Occurs when low circulating blood volume causes a mean arterial pressure decrease; the body’s oxygen need is not met • Caused by external hemorrhage; common after trauma and surgery or reduction in levels of clotting factors (Continued)

9. Hypovolemic Shock (Continued) • Caused by internal hemorrhage as occurs with blunt trauma, gastrointestinal ulcers, and poor control of surgical bleeding

10. Cardiogenic Shock • Actual heart muscle is unhealthy and pumping is directly impaired. • Cardiac output and afterload are reduced, thus reducing mean arterial pressure.

11. Distributive Shock • Caused by loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds, and increased blood vessel permeability • Neural-induced distributive shock • Chemical-induced distributive shock (Continued)

12. Distributive Shock (Continued) • Anaphylaxis • Sepsis • Capillary leak syndrome

13. Obstructive Shock • Shock is caused by problems that impair the ability of the normal heart muscle to pump effectively. • Heart is normal but conditions outside the heart prevent either adequate filling of the heart or adequate contraction of the healthy heart muscle.

14. Physical Assessment/Clinical Manifestations • Cardiovascular changes • Pulse • Blood pressure • Oxygen saturation • Skin changes • Respiratory changes • Renal and urinary changes • Central nervous system changes • Musculoskeletal changes

15. Interventions • Reverse the shock. • Restore fluid volume. • Prevent complications through supportive and drug therapies. • Nonsurgical management includes oxygen therapy, fluid replacement, and monitoring.

16. Drug Therapies • Vasoconstrictors, such as dopamine, epinephrine, norepinephrine, phenylephrine • Agents that enhance contractility • Agents that enhance myocardial perfusion

18. Collaborative Management of Septic Shock • Manifestations of the first phase: unique to septic shock and often opposite from those seen with all other types of shock • Cardiovascular changes • Respiratory changes • Skin changes: in the hyperdynamic phase of septic shock, the skin is warm with no cyanosis evident

21. Interventions for Septic Shock • Focus on correcting conditions causing shock and preventing complications. • Give oxygen therapy. • Drug therapy: antibiotics and anticoagulants, clotting factors and blood products, activated protein C, and antibodies, such as interleukin-1, interleukin-6, and tumor necrosis factor