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

Answer 1

This article will give you a better insight:

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


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


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


Stages
• Compensatory
• Progressive
• Irreversible/Refractory


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

Hypovolemic Shock
• Absolute vs. Relative

• Causes of each:

• Assessment:

• Emergency management:

• Nursing interventions:




Cardiogenic
• Causes:

• Assessment:

• Emergency management:

• Nursing interventions:




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


Neurogenic shock

• Causes:

• Assessment:

• Emergency management:

• Nursing interventions:

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


Anaphylactic shock
• Causes:

• Assessment:

• Emergency management:

• Nursing interventions:





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




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

Septic shock
• Causes:

• Assessment:

• Emergency management:

• Nursing interventions:

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



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


• GI: paralytic ileus, ischemia, bleeding

• Liver: failure results in jaundice, ­ PT

• Acid base imbalance – respiratory alkalosis & metabolic acidosis (hi levels of lactic acid)

• Hypermetabolic state – hyperglycemia, then hypoglycemia

Management
• 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
• Once SIRS/MODS begins
prevent and treat infection
maintenance of tissue oxygenation
nutritional and metabolic support
support individual failing organs