Chapter 37 - Chapter 37 Care of Patients with Shock Shock widespread abnormal cellular metabolism that occurs when gas exchange w oxygenation and tissue

Chapter 37 - Chapter 37 Care of Patients with Shock Shock...

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Chapter 37: Care of Patients with Shock Shock – widespread abnormal cellular metabolism that occurs when gas exchange w/ oxygenation and tissue perfusion needs are not met sufficiently to maintain cell function The whole body response that occurs when too little oxygen is delivered to the tissues Problems resulting from shock occur in a predictable sequence (which makes it a syndrome) Any problem that impairs oxygen perfusion to tissues and organs can start the syndrome of shock and lead to a life-threatening emergency Often a result of cardiovascular problems Classified by the type of impairment causing it o Hypovolemic shock Overall Cause: decrease in total body fluid in all fluid compartments Risk factors: hemorrhage (trauma, GI ulcer, surgery, and inadequate clotting [ hemophilia, liver disease, cancer therapy, and anticoagulation therapy]), dehydration (vomiting, diarrhea, heavy diaphoresis, diuretic therapy, NG suction, and diabetes insipidus) o Cardiogenic shock Overall cause: direct pump failure (fluid volume is NOT effected) Risk factors: MI, cardiac arrest, ventricular dysrhythmias, cardiac amyloidosis, cardiomyopathies, myocardial degeneration o Distributive shock Overall cause: fluid shifted from central vascular space (total body fluid volume is normal or increased) Risk Factors: neural induced ( pain, anesthesia, stress, spinal cord injury, head trauma) or chemical-induced ( anaphylaxis, sepsis, capillary leak [burns, extensive trauma, liver impairment, and hypoproteinemia) Types Septic shock, Neurogenic shock, Anaphylactic shock o Obstructive shock Overall cause: cardiac function decreased by noncardiac factor (indirect pump failure), total body fluid is not affected although central volume is decreased
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Risk Factors: cardiac tamponade, arterial stenosis, pulmonary embolus, pulmonary HTN, constrictive pericarditis, thoracic tumors, and tension pneumothorax Manifestations result from compensatory mechanisms the body makes in an effort to ensure continued perfusion of vital organs o Cardiovascular manifestations: decreased cardiac output, increased pulse rate, thready pulse, decreased BP, narrowed pulse pressure, orthostatic HOTN, low central venous pressure, flat neck and hand veins in dependent positions, slow cap refill, diminished peripheral pulses o Respiratory manifestations: increased respiratory rate, shallow depth of respirations, increased PaCO2, decreased PaO2,cyanosis (especially around lips and nail beds) o GI manifestations: decreased motility, diminished/absent bowel sounds, nausea/vomiting, constipation o Early Neuromuscular manifestations: anxiety, restlessness, increased thirst o Late Neuromuscular manifestations: decreased central nervous system activity (lethargy to come), generalized muscle weakness, diminished/absent deep tendon reflexes, sluggish pupillary response to light o Kidney Manifestations: decreased urine output, increased specific gravity, sugar and acetone in urine o
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  • hypovolemic shock, septic shock, urine output

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