Week 12: Shock, SIRS & MODS Flashcards
SHOCK, SIRS, MODS
-Shock decreased tissue perfusion
SIRS – Systemic Inflammatory Response Syndrome
MODS- Multiple organ dysfunction syndrome
Shock
-Syndrome characterized by decreased tissue perfusion & impaired cellular metabolism
-Results in an imbalance between the supply of and the demand for oxygen and nutrients
Classified As:
-LOW FLOW: low blood flow
-DISTRIBUTIVE: maldistribution of blood flow
Shock: Classifications (Low Flow)
Cardiogenic
-Related to the heart
Hypovolemic
-Massive tissue injury
-Hemorrhage
Shock : Classifications (Distributive)
Neurogenic
-Related to spinal cord
Anaphylactic
-Severe allergic reaction
Septic
-infection
Shock Low Flow (Cardiogenic Shock)
Systolic or diastolic dysfunction of the pumping action of the heart resulting in compromised cardiac output
Shock Low Flow (Hypovolemic Shock)
-Occurs when intravascular fluid volume is lost and the remaining volume is inadequate to fill the vascular space
ABSOLUTE: fluids leave the body
RELATIVE: fluid shifts from the vascular space into the interstitial or intracavitary space (third spacing)
SHOCK LOW FLOW MANIFESTATIONS
-Tachycardia
-Hypotension
-Pulmonary congestion
-Decreased renal perfusion
SHOCK LOW FLOW PHYSICAL EXAM
-Tachypnea
-Pale, cool, clammy skin
-Decreased capillary refill time
-Anxiety, confusion, agitation
-Decreased urinary output
SHOCK DISTRIBUTIVE (NEUROGENIC SHOCK)
-Hemodynamic phenomenon that can occur within 30mins of a spinal cord injury at the T5 vertebra or above & lasts up to 6wks
-Results in a massive vasodilation without compensation caused by the loss of SNS vasoconstrictor tone
-This massive vasodilation leads to a pooling of blood in the blood vessels
SHOCK NEUROGENIC MANIFESTATION
-Hypotension
-Bradycardia
-Temperature dysregulation
SHOCK NEUROGENIC PHYSICAL EXAM
-Heat loss
-Potential for hypothermia
-Skin is warm and dry
SHOCK DISTRIBUTIVE (ANAPHYLACTIC SHOCK)
-Acute, life-threatening allergic reaction to a substance
-Causes massive vasodilation with fluid shifting from the vascular to interstitial space: EDEMA
Respiratory distress
-Laryngeal
-Severe bronchospasm
-Circulatory failure
SHOCK ANAPHYLACTIC MANIFESTATIONS
-Angioedema
-Swelling of lips and tongue
-Wheezing and stridor
-Flushing
-Pruritus and urticaria
-Sense of impending doom
SHOCK DISTRIBUTIVE (SEPSIS)
Sepsis:
-systemic inflammatory response to a documented or suspected infection
Severe Sepsis:
-sepsis complicated by organ dysfunction, hypoperfusion, or hypotension
The body’s response to infection is exaggerated
↑ inflammation ↑ coagulation ↓ fibrinolysis
Septic Shock
-Develops in the presence of sepsis with hypotension despite fluid resuscitation
SHOCK SEPTIC
-The clinical presentation of sepsis is complex, and no single specific symptom
-↑CO: stresses myocardium
-Tachycardia
-Tachypnea
SHOCK SEPTIC MANIFESTATION
-Fever
-Hyperglycemia
-Edema
-Hypotension
-Oliguria
-Decreased capillary refill
Respiratory failure is common (85%)
A.) Patient hyperventilates to compensate
B.) Respiratory alkalosis
C.) Respiratory acidosis
Stages of Shock
1.) INITIAL STAGE:
-Occurs at a cellular level & not usually clinically apparent
-Metabolism changes from aerobic to anaerobic, causing lactic acid build-up (waste product)
-Lactic acid must be removed by the liver.
-However, this process requires oxygen, which is unavailable because of the ↓ in tissue perfusion
2.) Compensatory
3.) Progressive
4.) Refractory
Stages: Compensatory
The body activates compensatory mechanisms in an attempt to:
-overcome the increasing consequences of anaerobic metabolism
-to maintain homeostasis
You begin to see the body’s response to the imbalances in oxygen supply & demand
Stages: Compensatory
One of the first clinical signs of shock is hypotension, which occurs because of ↓CO & narrowing of the pulse pressure:
a.) Baroreceptors in carotid & aorta activate the SNS
b.) Stimulates vasoconstriction
c.) Releases epinephrine & norepinephrine
d.) Blood flow to heart & brain is maintained
e.) Blood diverted away from kidneys, GI tract, skin, & lungs
A multisystem response to decreasing tissue perfusion is initiated in the compensatory stage of shock
Stages: Progressive
-The progressive stage of shock begins as compensatory mechanisms fail
-In this stage, aggressive interventions are necessary to prevent MODS
-Distinguishing feature of this stage is continued ↓ cellular perfusion & resulting altered capillary permeability
-Interstitial edema
-Anasarca (general swelling of the whole body)
-Changes in the client’s mental status are important findings in this stage
STAGES PROGRESSIVE (PULMONARY SYSTEM)
-Blood flow is already reduced
-Arterioles constrict
-Edema
-Bronchoconstriction
-Impaired gas exchange
STAGES PROGRESSIVE (CARDIOVASCULAR SYSTEM)
-CO falls
-Hypotension
-↓ perfusion to coronary, cerebral & peripheral arteries
-Weakening of peripheral pulses
-Ischemia of distal extremities
-MI, dysrhythmias
-Acute tubular necrosis: AKI
STAGES PROGRESSIVE (GI SYSTEM)
-↓ blood supply
-Mucosal barrier becomes ischemic
-Ulcers
-GI bleeding
-Liver fails to metabolize drugs & waste: jaundice
Pt is at risk for disseminated intravascular coagulation (DIC) which is abnormal clotting that uses up platelets & clotting factors which then lead to bleeding.
Stages- Refractory
Patients demonstrate profound hypotension & hypoxemia
-Exacerbation of anaerobic metabolism
-Accumulation of lactic acid
-Fluids continue to shift out of the vascular space
-Blood pools in the capillary beds r/t constricted venules & dilated arterioles
-Hypotension & tachycardia worsen
-↓ coronary blood flow leads to worsening myocardial depression & further decline in CO
-The failure of the liver, the lungs, and the kidneys results in an accumulation of waste products, such as lactate, urea, ammonia, and carbon dioxide
-In this final stage, recovery is unlikely. The organs are in failure, and the body’s compensatory mechanisms are overwhelmed
