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Is a patient with neurogenic shock at risk for MODS or ARDS?


Is a patient with neurogenic shock at risk for MODS or ARDS?

This article will give you a better insight:

Nursing Process III -Impaired Tissue Perfusion: Shock & MODS - Lewis Ch 65


A quick review
鈥? Shock is a clinical syndrome resulting in decreased blood flow to body tissues causing cellular dysfunction and eventual organ failure
鈥? End result is inadequate supply of oxygen and nutrients to the tissues or IMPAIRED TISSUE PERFUSION
鈥? Not simply a matter of low blood pressure


Classifications of Shock
鈥? Hypovolemic shock 鈥?loss of intravascular volume
鈥? Cardiogenic shock 鈥?loss of ability of heart to pump
鈥? Distributive shock 鈥?loss of vascular tone
w neurogenic shock
w septic shock
w anaphylactic shock


Stages
鈥? Compensatory
鈥? Progressive
鈥? Irreversible/Refractory


General Collaborative Care
鈥? Identify the client at risk
鈥? Recognize impending shock
鈥? Eliminate or treat the primary cause
鈥? Initiate therapy to correct pathologic changes, modify systemic response, and enhance tissue perfusion
鈥? Protect target organs from dysfunction
鈥? Provide supportive care

Hypovolemic Shock
鈥? Absolute vs. Relative

鈥? Causes of each:

鈥? Assessment:

鈥? Emergency management:

鈥? Nursing interventions:




Cardiogenic
鈥? Causes:

鈥? Assessment:

鈥? Emergency management:

鈥? Nursing interventions:




Neurogenic shock
鈥? Definition: Impairment of autonomic nervous system resulting in massive vasodilation without compensation (loss of sympathetic vasoconstrictor tone in the vascular smooth muscle)


Neurogenic shock

鈥? Causes:

鈥? Assessment:

鈥? Emergency management:

鈥? Nursing interventions:

Anaphylactic shock
鈥? Definition: an acute & life threatening allergic reaction. Classified as an immediate hypersensitivity reaction.
鈥? Massive vasodilation and 颅capillary permeability occur


Anaphylactic shock
鈥? Causes:

鈥? Assessment:

鈥? Emergency management:

鈥? Nursing interventions:





Septic shock
鈥? Definition: sepsis with hypotension despite adequate fluid resuscitation.
鈥? What is sepsis: a systemic inflammatory response syndrome (SIRS) due to an infection
鈥? What is SIRS:




Pathophysiology of SIRS
鈥? Insult
鈥? Inflammatory response goes wild
鈥? Damage to vascular endothelium and hypermetabolism
鈥? Increased vascular permeability
鈥? Hypotension, microemboli, shunting reduces tissue perfusion to organs

Septic shock
鈥? Causes:

鈥? Assessment:

鈥? Emergency management:

鈥? Nursing interventions:

MODS
鈥? Multiple organ dysfunction syndrome - progressive failure of more than one organ generally from SIRS
鈥? Occurs 2-3 weeks after initial insult



SIRS to MODS
鈥? Clinical manifestations:
End organ effects
鈥? Lungs: ARDS
鈥? CV: myocardial depression and vasodilation
鈥? Neurologic: acute alteration in mental status
鈥? Kidneys: renal failure
鈥? Coagulation problems: DIC


鈥? GI: paralytic ileus, ischemia, bleeding

鈥? Liver: failure results in jaundice, 颅 PT

鈥? Acid base imbalance 鈥?respiratory alkalosis & metabolic acidosis (hi levels of lactic acid)

鈥? Hypermetabolic state 鈥?hyperglycemia, then hypoglycemia

Management
鈥? Most important goal is to prevent SIRS/MODS from starting
w nursing role is vigilant assessment to detect early assessment findings and to initiate care
鈥? Once SIRS/MODS begins
prevent and treat infection
maintenance of tissue oxygenation
nutritional and metabolic support
support individual failing organs

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