Management of Patient with

Shock and Multiple

Dysfunction Syndrome
• SHOCK
- is a serious life-threatening medical emergency and one of the
most common causes of death for critically ill people
- process of blood entering the tissues . ( perfusion), so when
perfusion is not occurring properly ( hypoperfusional)
• Definition :
Shock - is defined as inadequate tissue perfusion can be caused
disease that result in decreased oxygenation at the
cellular level.
Stages of Shock
1. initial stage/early stage ( diminished cardiac output without any
clinical symptoms)
2. Compensatory stage/non progressive stage ( is which the body
is still able to compensate for absolute or relative fluid loss
3. Progressive stage/intermediate stage ( is the point at which
the compensatory mechanism will begin to fail)
4. Irreversible stage/refractory stage ( when the vital organs have
failed and shock can no longer be reversed leading to imminent
death )
Shock is categorize into
• Low Blood Flow Shock
- Cardiogenic shock
- Hypovolemic shock
• Maldistribution of blood flow
- Septic shock
- Anaphylactic shock
- Neurogenic shock
 Definition :
Cardiogenic shock – is a condition in which heart suddenly
can’t pump enough blood to meet the body’s needs.
Risk Factors
- old age
- history of heart failure or heart attack
- blockage( coronary artery disease) in several of the heart’s main
arteries
- with diabetes or high BP
- existing cardiac disease
• Causes of cardiogenic shock
- Myocardial ischemia : compensatory mechanisms may initially
stabilize the patient but later on would cause deterioration with
the rising demands of oxygen
- Myocardial infraction (MI) : the underlying cause, left ventricular
dysfunction sets in motion a series of compensatory mechanism
that attempt to increase cardiac output, but later on leads
to deterioration.
• Other possible causes of cardiogenic shock
- Inflammation of the heart muscle ( myocarditis)
- Infection of the heart valves ( endocarditis)
- Weakened heart from any cause
- Drug overdose or poisoning with substances that can affect
your heart’s pumping ability.
• Classification :
Coronary : Coronary cardiogenic shock is more common than
non- coronary cardiogenic shock and is seen most
often in patients with acute myocardial infraction.
• Symptoms
- clammy skin - severe shortness of breath
- decreased systolic blood pressure
- tachycardia
- rapid respiration
- oliguria
- cyanosis
- mental confusion
• Diagnosis
- Physical examination
- history collection
- chest x-ray
- electrocardiogram
- echocardiogram
- cardiac catheterization ( angiogram)
- antiplatelet medication ( drugs similar to aspirin to prevent blood
clot)
• Prevention :
- don’t smoking
- maintain a healthy weight
- eat less fat
- limit added sugar and alcohol
- exercise regularly
• Treatment :
- emergency life support
- vasodilators ( drugs act as blood vessel dilator)
* Nitrates
- beta-blockers ( decrease work load in heart)
* propranolol 20-40mg
- calcium channel blocker ( improve coronary blood flow)
* nifedipine * verapamil
- thrombolytic drugs ( used to dissolve certain types of blood clot)
* streptokinase
*
• Nursing Management : Nursing Assessment
- Vital sign - assess the patient vital sign especially the blood
pressure.

- Fluid overload - the ventricles of the heart cannot fully eject the
the volume of blood at systole, so fluid may accumulate in the
lungs.
• Nursing Diagnosis
- Impaired gas exchange related to decreased blood flow as
evidence by breathless
- Acute pain related to disease condition as evidenced by
patient verbalization
- Impaired physical mobility related to weakness as evidenced
by patient is unable to perform daily activity
- Imbalanced nutrition less than body requirement related
to less intake of food as evidenced by weight loss
- Disturbed sleep pattern related to evidenced by patient
verbalization.
• Hypovolemic Shock
- an emergency condition in which severe blood or other fluid loss
makes the heart unable to pump enough blood to the body due
to increase preload.
- occurs when there is a loss of intravascular fluid volume
- the volume is inadequate to fill the vascular space, so the volume
loss may be either an absolute and relative volume loss
 
• Absolute hypovolemia
- is a decreased preload due to loss of volume of circulating blood,
lost through hemorrhage, gastrointestinal (GI) loss
( e.g vomiting, diarrhea) fistula drainage, diabetes insipidus
or diuresis.
• Relative hypovolemia
- is a decreased preload due to an increase in the capacity of
blood vessels to sequester bld volume away from the heart
- volume move out of the vascular space into intravascular
space. ( e.g intestinal or intracavitary space)
- example of relative volume loss is leakage of fluid from
increase capillary permeability. ( sepsis)
- abnormal separation of fluid into the colon from bowel obstruction,
loss of blood volume into fracture sites ( pelvic fracture) burns and
ascites.
• Causes of Hypovolemic Shock
- Internal fluid loss ( hemorrhage)
- External fluid loss ( severe bleeding or severe diarrhea,
diuresis or vomiting)
- Inadequate vascular volume ( decreased venous return and
cardiac output )
• Clinical Manifestation
- Hypotension
- Cognitive
- Tachycardia
- Rapid, shallow respiration
- Oliguria
- Clammy skin
• Prevention
- Early detection
- Accurate intake and output
• Complications
- Acute respiratory distress syndrome
- Acute tubular necrosis
- Disseminated intravascular coagulation
- Multiple organ dysfunction syndrome
• Assessment and diagnostic test
- Laboratory findings . ( elevated potassium,serum lactate and
blood urea nitrogen ).
- Urine Characteristics ( specific gravity and urine osmolality
are increased. )
- Blood considerations ( decreased blood pH, partial pressure
of oxygen and increased partial pressure of carbon dioxide)
• Nursing Management
- Nursing Assessment
- History
- Vital sign
- Trauma
• Nursing Diagnosis
- Risk for metabolic acidosis related to a decrease in the amount
of blood in the capillaries
- Deficient fluid volume related to active fluid loss
- Ineffective tissue perfusion
- Self-care deficit related to physical weakness
- Anxiety
• Nursing Care Plan Goal
- Maintain fluid volume at a functional level
- Report understanding of the causative factors of fluid volume
deficit.
- Maintain normal blood pressure, temperature and pulse
- Maintain elastic skin turgor, most tongue and mucous
membranes and orientation to person, place and time.
• Nursing Intervention
- Safe administration of blood
- Safe administration of fluids
- Monitor weight
- Monitor vital signs
- Oxygen administration