Medical shock is a shock is different than emotional or psychological shock that can occur after a traumatic emotional event or scary.
Etiology
1. Hypovolemic shock
- Bleeding
- Loss of fluid volume
- Displacement of fluid from the vascular to the interstitial cells
2. Cardiogenic shock
- Impaired the ability of the heart pump (cardiac arrest, arrhythmia, valve disease, myocardial degeneration, systemic infection drugs.
3. Vasogenic shock
- Decrease simpatic tone, vasodilatation, increased capillary permeability
4. Septic shock
- Cause of gram-negative organisms (P. aerogenosa, Escherichia coli, Klebseilla pneomoni, Staphylococcus, Streptococcus).
- Predisiposisi: malnutrition, large open wounds, ischemia of the gastrointestinal tract (GI), immunosuppression.
- Host interactions - toxin stimulates systemic complement activity - changes in organ microcirculation, increased capillary permeability, cell injury, increased cell metabolism.
Signs of shock :
- General state: weak.
- Perfusion: pale skin, cold, wet.
- Tachycardia.
- Peripheral vein is not visible.
- Decreased blood pressure, systolic less than 90 mmHg or a fall of more than 50 mm Hg of pressure before.
- Hyperventilation.
- Peripheral cyanosis.
- Restlessness, decreased consciousness.
- Decreased urine production.
2 Nursing Interventions for Shock
1. Fluid Volume Deficit
a. Intravenous therapy (according to type of shock):
Crystalloid (to restore the liquid electrolyte).
b. Colloid (to restore plasma volume and restore the osmotic pressure): WB, PRC, plasma.
2. Decrease Cardiac Output
Goal:
- Increase the vascular fluid.
- Support the compensatory mechanisms.
- Prevent ischemic complications.
- Improve venous return.
- Improve myocardial contraction.
- Ensure adequate myocardial perfusion:
- Vasoconstrictor agents.
- Agents that increase myocardial contraction.
- Myocardial perfusion agent adds.
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