Sepsis: Shock and Tissue Perfusion Essay

Submitted By Sara-Durrani
Words: 700
Pages: 3
Open Document
Overview of Shock

Definition
Acute, widespread process of impaired tissue perfusion
Imbalance btwn cellular oxygen supply and demand
An impaired cardiac pump, circulatory system, and/or volume can lead to compromised blood flow to tissues
Causes problems with: cellular, metabolic or hemodynamic alteration
Etiology
Hypovolemic = ↓ in circulating volume
Cardiogenic = heart not pumping enough blood to organs
Distributive
Septic = invasion of bacteria that causes misdistribution of blood
Anaphylactic
Neurogenic
Pathophysiology of Stages
Initial – ↓CO…↓ tissue perfusion
Compensatory – kicks in quickly (attempt to ↑CO…maintain BP and tissue perfusion)
Progressive – compensatory mechanisms begin to fail, body cannot meet metabolic needs
Refractory – unresponsive to tx/therapy (there’s no going back)
[Results in MODS; failure of 2 or more body systems] – Will ultimately die
Assessment and Diagnosis
Shock state
Clinical Manifestations
Global indicators – MAP 40% (>2000ml)
Medical Management
Correct cause of Hypovolemia
Restore tissue perfusion
Prevent complications
Nursing Management
Give fluids! – NS (#1 thing to give for volume)
Continuous evaluation
Strict I&O’s
Daily weights
Physical assessment

Cardiogenic Shock

Description
Failure of heart to pump effectively
Inability of ventricle to pump blood forward…↓SV…↓CO…↓ cellular O2 supply…↓ tissue perfusion
Etiology
Mechanical failure
Most common cause = MI (results in destruction of >40% of functioning myocardium)
Assessment
Decline in CO (and CI)
Chest pain
Tachycardiac
Tachypnea
Resulting in respiratory alkalosis
Then as LV fails : hear crackles and rhonchi, so…
Pulmonary edema, then
Hypoxemia
[As compensatory mechanisms fail: other s/s come  change to respiratory & metabolic acidosis, dysrhythmias, ↓LOC and renal failure]
Diagnosis
Echo confirms dx!*
Medical Management
Requires aggressive approach
Treat underlying cause
Enhance pump effectiveness & Improve tissue perfusion
Dobutamine (only affects beta-receptors) – causes heart to beat stronger & faster
If drugs don’t help
Intra-aortic balloon pump
LV assist device

Anaphylactic Shock (Distributive)

Description
Hypersensitivity reaction (Antibody-Antigen response)
[IgE mediated or non-mediated response]
Food
Bee sting
Venom
Etiology
Immunologic
Nonimmunologic
**Emergent! Requires prompt intervention!!**
Assessment and Diagnosis
Severe systemic reaction hoTn & tachycardia (almost immediately)
Pruritis
Erythema
Urticaria (hives)
Angioedema
↓LOC
↓Preload
↓CO
Biphasic reaction
Protracted anaphylaxis
Eventual outcome = circulatory failure
Medical Management
Removal of offending agent
Reverse effects of the biochemical mediators (Epinephrine)
Promote adequate tissue perfusion
Nursing Management
Volume replacement (NS)
Look @ history of allergies
Will need emergency epi kit
[Requires lots of teaching from RN]

Neurogenic Shock (Distributive)

Description
Loss or suppression of sympathetic tone
Etiology
Disruption of sympathetic nervous system
Massive peripheral vasodilation (relative Hypovolemia)
[Causes pooling of blood…↓preload, SV and CO]
Effects baroreceptors response (inhibition) resulting in bradycardia…↓tissue perfusion
[Impairs thermoregulation – body temp!!!]
#1 patient affected is SCI
Assessment and Diagnosis hoTN Bradycardia
Warm extremities (r/t vasodilation)
Medical Management
Remove cause
Prevent cardiovascular instability
Promote tissue perfusion
Nursing Management
Fluids! (observe for fluid
Show More

Related Documents: Sepsis: Shock and Tissue Perfusion Essay

Adult Health III Essay

Shock Syndrome characterized by decreased tissue perfusion and impaired cellular metabolism Imbalance in supply and demand for oxygen and nutrients Hypovolemic Shock Total body fluid decreased (all fluid compartments) Cause/Risk Hemorrhage Trauma, GI ulcer, surgery, inadequate clotting (hemophilia, liver disease, malnutrition, bone marrow suppression, cancer, anticoagulant therapy) Dehydration Vomiting, diarrhea, heavy diaphoresis, diuretic therapy, nasogastric suction, diabetes insipidus…

Words 688 - Pages 3

Kidney Failure Essay

diagnosed patients should receive IV fluid therapy to correct dehydration, improve perfusion, and promote diuresis while being monitored for body weight changes and urine output. Fluid loss from the vomiting, or diarrhea, polyuria or decreased water intake is considered Hypovolemia, this is described as the fluid loss from intravascular space and may also be caused by hemorrhage. Signs include changes in perfusion indices: pale pink mucous membranes, prolonged capillary refill time (>3 seconds),…

Words 337 - Pages 2

Respiratory Failure Case Study

Sepsis and Respiratory Failure Sepsis is defined as systemic inflammatory response syndrome in response to infection, and, when associated with acute organ dysfunction, it is considered severe sepsis (Durthaler, Ernest, & Johnston, 2009, p.45). As describe on the case study, septic patients can show a multi system infection process in response to the invading microorganism like bacteria, fungi, parasites, and viruses. What is the process involved in sepsis? The process involved in sepsis consists…

Words 1262 - Pages 6

Septic Shock: A Case Study

Shock is the condition that occurs when the body’s organs lack the oxygen they need due to a lack of blood supply. This can be due to a decreased total blood volume, decreased cardiac output, or improper vasodilation (de Moya, 2013). This widespread hypoxia causes cell dysfunction that causes tissue injury and eventually death (Ignatavicius & Workman, 2013). Septic shock results from improper vasodilation that causes blood to inappropriately disperse throughout the body, and is a form of distributive…

Words 2788 - Pages 12

Essay on Critical Analysis of Patient Care Utilising John’s Model of Structured Reflection

The complex nature of septic shock and MODS is one good example where proactive and creative nursing measures need to be implemented. In dealing with Mr Cox, I was caught in the situation where critical decision-making was required to determine the priority of care. My awareness of the nursing process (assessment, nursing diagnosis, planning, intervention and evaluation) and the background knowledge of MODS and septic shock, made it possible for me to intervene appropriately…

Words 5701 - Pages 23

Cardiogenic Shock Research Paper

INTRODUCTION Septic shock is associated with severe hypotension, and tissue hypoperfusion . If this is not rapidly corrected, will lead to organ failure and often death. Septic shock is characterized by the requirement for vasopressors to maintain a mean arterial pressure of over 65 mmhg , and a serum lactate level of over 2mmol/l, in the absence of hypovolaemia.(1) In the early stages of sepsis, there is a high cardiac output, vaso dilatation and warm extremities. This is followed by, hypotension…

Words 1021 - Pages 5

Nursing: Sepsis and Therapeutic Effects Essay

Diagnosis: Sepsis Allergies: morphine Chief Complaint: bacterial sepsis History of Present Illness: Pathophysiology: Sepsis can occur as a result of infection at any body site, including the lungs, abdomen, skin or soft tissue, or urinary tract and as a result of a primary blood stream infection, such as in meningococcemia. Bacteria are the pathogens most commonly associated with the development of sepsis, although fungi, viruses, and parasites can cause sepsis. The pathophysiology of sepsis can be…

Words 2820 - Pages 12

Importance Of Palliative Care

Palliative care→ aims to prevent and relieve suffering and support the best possible QOL for pt and their family; regardless of stage of disease..just must be symptomatic ­can be given with curative care ­introducing palliative care early ^ QOL ­interdisciplinary approach CLOSED AWARENESS – PT. doesn’t know SUSPECTED AWARENESS – they know something is wrong but no one tells them MUTUAL PRETENSE AWARENESS – both the PT. & family knows but no one is talking about it OPEN AWARENESS – everyone knows & is talking about it…

Words 3686 - Pages 15

AKA Case Study Summary

PATHOPHYSIOLOGY: The patient in the case study possible medical condition is Alcoholic ketoacidosis (AKA), with underlying sepsis, which has caused septic shock. AKA is an acute metabolic acidosis, which results from the metabolism of alcohol when the body has little or no glucose, this causes a build-up of ketones in the blood. Ketone, an acid that forms when the body has to break down fat for energy (Heller, 2013). AKA in most patients will present after a period of heavy drinking, and show as…

Words 1915 - Pages 8

Essay about Acute Care Nursing

this assignment is to critically discuss the nursing assessment individualised care and nursing interventions of the acutely ill patient. The patient discussed developed severe sepsis due to a urinary tract infection and her condition deteriorated during the recovery process in the nurse’s care. Lovick (2009) defines sepsis ‘as a known or suspected infection accompanied by evidence of two or more of the SIRS criteria’. SIRS is outlined as a ‘systemic inflammatory response’ consisting of two or more…

Words 2093 - Pages 9