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    Multisystem Problems - NCM 410 LEC 1

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    Ruthmarie Cataraja
    This document discusses multisystem problems including shock, systemic inflammatory response syndrome (SIRS), and multiple organ dysfunction syndrome (MODS). It defines shock as a clinical syndrome characterized by an imbalance between oxygen supply and demand. It describes the pathophysiology of shock and classifications including cardiogenic, hypovolemic, distributive, obstructive, and others. It discusses SIRS as a generalized inflammatory response in remote organs and MODS as the failure of two or more organ systems. It outlines nursing assessments and interventions for shock, SIRS, and MODS.

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    Multisystem Problems - NCM 410 LEC 1

    Uploaded by

    Ruthmarie Cataraja
    48 views48 pages
    This document discusses multisystem problems including shock, systemic inflammatory response syndrome (SIRS), and multiple organ dysfunction syndrome (MODS). It defines shock as a clinical syndrome characterized by an imbalance between oxygen supply and demand. It describes the pathophysiology of shock and classifications including cardiogenic, hypovolemic, distributive, obstructive, and others. It discusses SIRS as a generalized inflammatory response in remote organs and MODS as the failure of two or more organ systems. It outlines nursing assessments and interventions for shock, SIRS, and MODS.

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    Multisystem_Problems_-_NCM_410_LEC_1

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    This document discusses multisystem problems including shock, systemic inflammatory response syndrome (SIRS), and multiple organ dysfunction syndrome (MODS). It defines shock as a clinical syndrome characterized by an imbalance between oxygen supply and demand. It describes the pathophysiology of shock and classifications including cardiogenic, hypovolemic, distributive, obstructive, and others. It discusses SIRS as a generalized inflammatory response in remote organs and MODS as the failure of two or more organ systems. It outlines nursing assessments and interventions for shock, SIRS, and MODS.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    48 views48 pages

    Multisystem Problems - NCM 410 LEC 1

    Uploaded by

    Ruthmarie Cataraja
    This document discusses multisystem problems including shock, systemic inflammatory response syndrome (SIRS), and multiple organ dysfunction syndrome (MODS). It defines shock as a clinical syndrome characterized by an imbalance between oxygen supply and demand. It describes the pathophysiology of shock and classifications including cardiogenic, hypovolemic, distributive, obstructive, and others. It discusses SIRS as a generalized inflammatory response in remote organs and MODS as the failure of two or more organ systems. It outlines nursing assessments and interventions for shock, SIRS, and MODS.

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    © All Rights Reserved
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    of 48

    MULTISYSTEM

    PROBLEMS
    NCM 410 LECTURE
    Table of contents

    01 02 03
    SYSTEMIC MULTI-ORGAN
    INFLAMMATORY DYSFUNCTION
    SHOCK RESPONSES SYNDROME(MODS)
    SYNDROME(SIRS)
    The person experiencing shock
    01
    SHOCK
    Shock is a clinical syndrome characterised by a systemic imbalance between
    oxygen supply and demand. This imbalance results in a state of inadequate
    blood flow to body organs and tissues, causing life-threatening cellular
    dysfunction. (Pearson, 2017)
    Overview of cellular homeostasis and
    haemodynamics
    FOUR PHYSIOLOGIC COMPONENTS:

    1. A sufficient cardiac output


    2. An uncompromised vascular system
    3. A sufficient volume of blood
    4. Tissues that are able to extract and use the oxygen delivered through the
    capillaries.
    baSIC HEMODYNAMICS
    ■ BP = CO x SVR (Systemic Vascular Resistance)

    ● Stroke volume (SV) is the amount of blood pumped


    into the aorta with each contraction of the left ventricle.

    ■ Cardiac output (CO) is the amount of blood pumped per


    minute into the aorta by the left ventricle.

    CO = SV × HR
    baSIC HEMODYNAMICS
    ■ Mean arterial pressure (MAP) is the product of cardiac
    output and systemic vascular resistance (SVR):
    MAP = CO × SVR
    MAP normal range = 70 to 110

    ■Sympathetic tone.
    Increased sympathetic stimulation increases
    vasoconstriction and SVR; decreased sympathetic
    stimulation allows vasodilation which decreases SVR.
    pathophysiology

    Altered Hemodynamics

    Inadequate tissue perfusion

    SHOCK

    SYSTEMIC INFLAMMATORY RESPONSE SYNDROME( SIRS)

    MULTIPLE ORGAN DYSFUNCTION SYNDROME(MODS)


    SHOCK CLASSIFICATIONS

    ● CARDIOGENIC shock
    ● Hypovolemic shock
    ● distributive/vasogenic
    ● Anaphylactic shock
    ● Neurogenic shock
    ● Septic shock
    ● Obstructive shock
    assessment
    SHOCK MANIFESTATIONS

    HYPOtension - TACHYcardia- TACHYpnea


    01

    Cardiogenic SHOCK
    Cardiogenic shock manifestations

    ● Blood pressure: hypotension


    ● Pulse: rapid, thready; distension of veins of
    hands and neck
    ● Respirations: increased, laboured; crackles
    and wheezes; pulmonary oedema
    ● Skin: pale, cyanotic, cold, moist
    ● Mental status: restless, anxious, lethargic
    progressing to comatose
    ● Urine output: oliguria to anuria
    ● Other: dependent edema; elevated central
    venous pressure (CVP); elevated pulmonary
    capillary wedge pressure; arrhythmias
    02

    hypovolemic SHOCK
    is caused by a decrease in intravascular
    volume of 15% or more (Huether & McCance,
    2013)
    Hvs manifestations

    1. INITIAL STAGE
    2. COMPENSATORY
    3. PRORESSIVE STAGES
    4. IRREVERSIBLE/refractory STAGE
    Distributive/
    vasogenic shock

    - includes several types of shock that result from


    widespread vasodilation and decreased peripheral
    resistance.
    -Because the blood volume does not change,
    relative hypovolemia results.

    -Examples of distributive shock include septic,


    neurogenic and anaphylactic shock.
    -Treatment is based on the underlying
    pathogenesis.
    03

    anaphylactic SHOCK

    Is the result of a widespread hypersensitivity


    reaction (called anaphylaxis).
    Anaphylactic
    shock
    04

    neurogenic SHOCK
    Neurogenic shock is the result of an
    imbalance between parasympathetic and
    sympathetic stimulation of vascular smooth
    muscle.
    neurogenic
    shock
    05

    septic SHOCK
    Septic shock, the leading cause of death for
    people in critical care units, is one part of a
    progressive syndrome called systemic
    inflammatory response syndrome (SIRS).
    Septic
    shock
    ● Toxic Shock syndrome
    ● Disseminated intravascular coagulation
    (DIC)
    06

    obstructive SHOCK
    is caused by an obstruction in the heart or
    great vessels that either impedes venous
    return or prevents effective cardiac pumping
    action.
    obstructive
    shock
    ● Jugular vein distension
    ● Pulsus paradoxus
    Diagnostic studies
    ● Hx and PE
    ● labs ● 12 leads ecg
    ● Continuous ecg
    monitoring
    ● Chest x-ray, mri, ct scan
    ● Cont. pulse oximetry
    ● Invasive and
    non=invasive
    hemodynamic monitoring
    shock Interprofessional care

    Focus (COP) Interventions (MOxFEm)


    Treating the underlying Cause Medications
    Increasing arterial Oxygenation Oxygen therapy
    Improving tissue Perfusion Fluid Replacement
    Emergency care measures
    shock medications
    adrenergics vasodilators
    vasoconstrictors
    inotropes Nitroglycerine
    Adrenaline Dopamine, (Glycerol trinitrate)
    Noradrenaline Dobutamine,
    Aramine Isoprenaline Nitroprusside(Nipride)
    Sodium
    diuretics
    bicarbonate
    Oxygen therapy
    Fluid resuscitation

    ● Crystalloid Solutions (Isotonic or Hypotonic)


    ● Colloid Solutions (Plasma Expanders)
    ● Blood and Blood Products
    Nursing assessment
    ABC’s:
    Airway
    Breathing
    Circulation
    Tissue perfusion
    Nursing diagnosis
    Includes:
    ● Decreased cardiac output
    ● Ineffective tissue perfusion
    ● Anxiety
    nursing interventions
    Decreased cardiac
    output
    Assess and monitor cardiac anxiety
    function Assess cause of anxiety
    Measure and record I&O Administer pain meds
    Monitor bowel sounds Increase comfort and
    Maintain bed rest and calm envi. reduce restlessness
    Provide support
    Ineffective tissue
    perfusion
    Monitor skin color, temp,
    turgor, moisture
    Assess LOC
    Monitor body
    temperature
    02
    Systemic
    Inflammatory response
    syndrome
    Generalized inflammation in organs remote
    from the initial insult characterizes SIRS.
    Many different mechanisms can trigger SIRS.
    These include:
    • Mechanical tissue trauma: burns, crush injuries, surgical
    procedures
    • Ischemic or necrotic tissue: pancreatitis, vascular disease, MI
    • Microbial invasion: bacteria, viruses, fungi, parasites
    • Endotoxin release: gram-negative and gram-positive
    bacteria
    • Global perfusion deficits: post cardiac resuscitation, shock
    states
    • Abscess formation: intraabdominal, extremities
    • Regional perfusion deficits: distal perfusion deficits
    03
    Multiple organ
    Dysfunction syndrome
    (mods)
    is the failure of 2 or more organ systems in an
    acutely ill patient such that homeostasis cannot
    be maintained without intervention.
    Clinical
    manifestations
    OF SIRS AND MODS
    CLINICAL MANIFESTATIONS
    of
    SIRS AND MODS
    RESPIRatory CNS
    ● Acute changes to
    Neurological status
    ● Development of
    (confusion,
    ARDS
    disorientation,
    delirium, fever, etc.)

    cardiovascular endocrine

    ● Biventricular Failure ● hyperglycemia->hypoglycemia


    CLINICAL MANIFESTATIONS
    of
    SIRS AND MODS
    REnal system Hepatic
    ● Prerenal -Renal
    hypoperfusion
    ● Intrarenal -acute ● Bilirubin > 2 mg/dl,
    tubular necrosis jaundice

    Gi system hematologic
    ● GI bleeding, mucous ● Bleeding times, PT, PTT
    ischemia ● Platelet count
    Sequential organ failure assessment
    (sofa)

    ● can be used to ● is a mortality prediction ● It is believed to


    determine level of score that is based on the provide a better
    organ dysfunction degree of dysfunction of six stratification of the
    and mortality risk in
    organ systems mortality risk in ICU
    ICU patients
    patients
    ABC’s:
    Nursing interventions
    Airway (optimize O2 delivery, minimize consumption, MV)
    Blood (volume management to increase preload,
    vasopressors, optimize cerebral blood flow, monitor bleeding)
    Continuous ECG monitoring, Calcium channel blockers
    Decrease cerebral O2 requirements
    Enteral nutrition, stress ulcer prophylaxis, dietician consult
    Factors being lost, replace(platelets)
    Elaborate class discussion
    lesson highlights

    shock Sirs
    early sign of shock is
    Characterized by
    a change in the level
    generalized
    of consciousness, with
    inflammation in
    restlessness being a
    organs remote from
    common symptom of
    the initial insult
    cerebral hypoxia.
    types Mods
    Cardiogenic the failure of 2 or
    Hypovolemic more organ systems
    Anaphylactic in an acutely ill patient
    Neurogenic
    Septic
    Obstructive
    “
    “I attribute my success to this, I never gave nor took
    any excuse.”

    —florence nightingale
    “I attribute my success to this, I
    never gave nor took any excuse.”
    —florence nightingale
    Thanks!
    Do you have any questions?

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