Exam 3 Study Guide Shock Syndromes:

Shock Syndromes: 
Shock is a systemic condition where there is an imbalance between the oxygen supply to the tissues/organs and the oxygen needs of those tissues/organs. There are different types of shock. Any situation that decreases vascular volume, blood pressure, or cardiac function can lead to shock.

Shock can be divided according to the cause. There are three main types of shock. Distributive shock is further divided into another three categories.

Cardiogenic: pump (heart) failure
Hypovolemic: lack of circulating volume in the vascular space
Distributive: alteration in the vascular bed size
⦁    Neurogenic: impaired sympathetic nervous system
⦁    Anaphylactic: hypersensitivity response due to antigen-antibody reaction
⦁    Septic: Due to systemic infection
Complications of each type
⦁    Multiple Organ Dysfunction Syndrome (MODS)
⦁    Disseminated Intravascular Coagulation (DIC)
⦁    Acute respiratory Distress Syndrome (ARDS)
Treatment goals of each type
⦁    Identify and treat the underlying cause
⦁    Deliver oxygen to the tissues
⦁    Maintain Circulation
⦁    Monitor for complications
⦁    Provide comfort and emotional support
4 stages of shock: 
⦁    Initial: decreased CO and impaired tissue perfusion
⦁    Compensatory: activation of sympathetic nervous system (SNS)
⦁     Progressive: every system in the body is affected and MOD happens
⦁     Refractory: body will no longer respond to therapy
SIRS is a clinical response to a nonspecific insult. Regardless of the etiology of the insult, the body responses are similar. If the process cannot be contained by the innate counter-inflammatory response, there is an increased activation of the inflammatory cells, including release of neutrophils, macrophages, and lymphocytes; and additional damage to the vascular epithelium, deterioration in distribution of nutrients to the organs, and subsequent complication of multiple organ dysfunction syndrome (MODS) or multiple organ failure (MOF). Conditions commonly associated with SIRS include infection, pancreatitis, ischemia, trauma, hemorrhagic shock, aspiration of gastric contents, massive transfusions, and host defense deficiencies 
It is essential that you assess all patients at risk for SIRS, especially for the cardinal signs of the body’s inflammatory response. At least two or more of the following findings will be present in SIRS:
⦁    Change in temperature either higher than 38° C (100.4° F) or lower than 36° C (96.8° F)
⦁    Pulse greater than 90 beats per minute
⦁    Respiratory rate greater than 20 breaths per minute or a partial pressure of carbon dioxide (PC02) less than 32 mm Hg
⦁    White blood cell (WBC) count higher than 12 × 103/mm3, or with more than 10% band cells

BOX 65-3: ASSESSMENT AND DIAGNOSIS OF SHOCK
Common clinical manifestations of the shock syndrome will vary according to the underlying cause, the stage of shock, and the individual person’s response to shock. The exact course of events can be variable. Each person must be assessed individually prior to any intervention:
⦁     Regardless of the type of shock, it leads to a systolic blood pressure (SBP) of less than 90 mm Hg and the narrowing of pulse pressure that is inadequate to meet the tissue needs. (SBP may be elevated initially.)
⦁    Early shock symptoms are subtle, requiring close surveillance to avoid overlooking their presence.
⦁    All persons in shock are at risk of deterioration in status. Prompt intervention is required.
⦁    Nurses must have a clear understanding of the pathophysiology of the different etiologies of shock.
⦁     In all instances of shock following a trauma incident, consider hypovolemia or hemorrhage unless proven otherwise.
⦁    Shock is a frightening experience for the patient and family. Effective psychological support is essential.
Symptoms include:
⦁    Hypothermia
⦁    Tachycardia or bradycardia
⦁     Rapid thready pulse, slow capillary refill, or collapse of superficial veins in extremities
⦁    Altered mental status—dissociation from normal thought processes, detached, a feeling of numbness, and impaired sensory-emotional response. Loss of consciousness, restlessness, anxiety, irritability, and weakness may be present.
⦁    Clinical findings correlated with organs compromised by inadequate oxygen supply and the phases of the shock syndrome. Examples:
⦁    a. Skin: cold, clammy, cyanotic, poor capillary refill, or warm dry skin due to pooling of blood in extremities. Cyanosis (circumoral, earlobes, finger tips, or toes).
⦁    b. Kidneys: decreased urine output; anuria, or oliguria.
⦁    c. Lungs: dyspnea, crackles, or wheezes.
⦁    d. GI system: thirst, dry mucous membranes; nausea and vomiting; or decreased bowel sounds.