Professional Documents
Culture Documents
NPN 205
Medical Surgical II
Physiology of Hypoperfusion:
Shock
Inadequate tissue perfusion
Inadequate delivery of O2 and
nutrients to the body tissues
Inadequate elimination of metabolic
wastes
A & P of Perfusion
Perfusion: delivery of O2 and
nutrients and the elimination of CO2
requires four things
1. a properly beating heart
2. adequate transport medium: blood
and hemoglobin
3. an intact functioning vessel system
4, a functioning respiratory system
Stages of Shock
Compensated ---- body is able to
compensate and maintain tissue
perfusion
Progressive ---- body begins to lose
its ability to compensate---inadequate
perfusion begins
Irreversible---cell and tissue damage
result in multi-system organ failure
Types of Shock
Hypovolemic
Obstructive
Cardiogenic
Distributive
Anaphylactic
Septic
Hemorrhage
Severe diarrhea
Vomiting
Excessive perspiration
Third Spacing
Shift of fluid in severe burns can lead to
hypovolemic shock
Peritonitis
Intestinal obstruction
Cardiogenic Shock
Heart pump failure (40% of
myocardium damaged by an MI)
Cardiac trauma
Cardiomyopathy
Congestive heart failure
Cardiac dysrhythmias
Vasodilators
Diuretics
If from obstructive may need surgical
repair, chest tube, pacemaker, needle
aspiration of fluid
Obstructive Shock
Can be classed as a type of
cardiogenic shock
Pulmonary embolism/Blocked
pulmonary circulation
Tension pneumothorax/Increased
intrathoracic pressure
Cardiac tamponade/Pressure on
myocardium. Decreased preload
Distributive Shock
Anaphylactic Shock
Mechanism: severe allergic reaction
Skin: hives, possible petechia. Urticaria,
pallor, cyanosis
Blood pressure: abrupt fall in cardiac
output
Respiration: rapid shallow, dyspnea with
stridor, wheezes, crackles, leading to
respiratory arrest
Other: swelling of mucus
membranes/pulmonary edema
Maintain airway
Ice to site of injection or sting
Gastric lavage
Isotonic IV fluids D5W, NACL, LR
Epinephrine and theophylline
Antihistamines (H2 blockers)
Steroids
Vasopressors to constrict blood
vessels and raise BP
Distributive Shock
Septic shock
Mechanism: overwhelming infection
Skin: varies form flushed pink (if fever is
present) to pale and cyanotic. Purple blotches
possible, peeling skin, general or on palms and
soles of feet
Blood pressure: earlycardiac output
increases but toxins prevent increase in BP.
Late --- drop in BP, hypotension
Respiratory: dyspnea with altered lung sounds
Other: high fever, (except in elderly and very
young), Late sign is pulmonary edema
Distributive Shock
Neurogenic Shock
Mechanism: vasodilation
Skin: areas of vasodilation, at first become
warm, pink and dry. Later with pooling:
mottling of dependent areas, pallor and
cyanosis to the upper surfaces
Pulse: highly variable depending on injury or
action of drug/poison: May be abnormally slow
or abnormally fast, usually not normal
Respiration: severely compromised: becoming
slow, shallow, with abnormal patterns. Patient
may loose stimulus to breath
Other: hypothermia. Pulmonary edema with
drug or poisoning
Nursing Diagnosis