Nursing Management: Shock and Multiple Organ Dysfunction Syndrome Chapter 67 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 67-1. Relationship of shock, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome. CNS, Central nervous system. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Classification of Shock Cardiogenic shock Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-2. The pathophysiology of cardiogenic shock. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Classification of Shock, continued Hypovolemic shock Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-3. The pathophysiology of hypovolemic shock. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Classification of Shock, continued Distributive shock Neurogenic shock Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-4. The pathophysiology of neurogenic shock. BP, Blood pressure. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Classification of Shock Distributive shock, continued Anaphylactic shock Septic shock Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-5. The pathophysiology of septic shock. CNS, Central nervous system. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Classification of Shock, continued Obstructive shock Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-6. The pathophysiology of obstructive shock. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Stages of Shock Compensatory stage Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-7. Compensatory stage: reversible stage during which compensatory mechanisms are effective and homeostasis is maintained. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Stages of Shock, continued Progressive stage Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-8. Progressive stage: compensatory mechanisms are becoming ineffective and fail to maintain perfusion to vital organs. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Stages of Shock, continued Irreversible stage Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Fig. 67-9. Irreversible or refractory stage: compensatory mechanisms are not functioning or are totally ineffective, leading to multiple organ dysfunction syndrome. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Collaborative Care: General Measures Oxygen and ventilation Fluid resuscitation Drug therapy Sympathomimetic drugs Vasodilator drugs Nutritional therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Collaborative Care: Specific Measures Cardiogenic shock Hypovolemic shock Septic shock Neurogenic shock Anaphylactic shock Obstructive shock Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

Nursing Management: Shock Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health promotion Acute intervention Neurologic status Cardiovascular status Respiratory status Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22

Nursing Management: Shock Nursing Implementation Acute intervention, continued Renal status Body temperature and skin changes Gastrointestinal status Personal hygiene Emotional support and comfort Ambulatory and home care Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Systemic Inflammatory Response Syndrome (SIRS) and Multiple Organ Dysfunction Syndrome (MODS) Etiology and Pathophysiology Organ and metabolic dysfunction Clinical Manifestations of SIRS and MODS Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24

Nursing and Collaborative Management: SIRS and MODS Prevention and Treatment of Infection Maintenance of Tissue Oxygenation Nutritional and Metabolic Needs Support of Failing Organs Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25