management shock

MANAGEMEN KEPERAWATAN PADA PASIEN SHOCK

Oleh :

Tri Cahyo S

Definisi

  Suatu sindroma dimana perfusi jaringan tidak adekuat, akibat dari ketidak mampuan sistem sirkulasi untuk mensuplai oksigen

Shock

Perfusi jaringan tidak adekuat

Penurunan suplai oksigen

Metabolisme anaerobik

Akumulasi “metabolic waste”

PUMP tdk bekerja scr optimal 

       cardiogenic

FLUID  tidak cukup dlm sistem 

      hypovolaemia

TUBING : gangguan fungsi distribusi

         distributive

Kondisi normal

satu komponen mengalami gangguan fungsi

komponen lain berusaha melakukan kompensasi

Pada kondisi shock

satu komponen mengalami gangguan fungsi

elemen lain gagal melakukan kompensasi secara adekuat

Penyebab Shock

Serangan jantung

Kehilangan darah yg berat atau tiba-tiba

Penurunan cairan tubuh

Infeksi

Terpapar lama pada kondisi panas/dingin yg ekstrem

Klasifikasi Shock

ØSyok Kardiogenik

ØSyok Hipovolemik

ØSyok Distributif

ØSyok Obstruktif

Cardiogenic shock

Jantung kehilangan kemampuan u/ memberikan suplai darah ke seluruh bagian tubuh

Biasanya akibat kegagalan ventrikel kiri sekunder thd  infark miokardial akut & gagal jantung

DISTRIBUTIVE SHOCK

NEUROGENIC SHOCK

ANAPHYLAKTIC SHOCK

SEPTIC SHOCK

Anaphylactic shock

ØReaksi antigen antibodi

Ø Pelepasan histamin

Ø Peningkatan permeabilitas kapiler

Ø Dilatasi arteriole

Venous return ↓

Tanda Shock Akut

Pe↓ TD sistolik & diastolik secara progresif

Kulit dingin, pucat, dan lembab

Sianosis

Nadi kecil dan cepat

Pernafasan cepat dan dangkal

Oliguria

Perubahan/Pe↓ tingkat kesadaran

Clinical Signs of Acute Hemorrhagic Shock

Tingkatan Shock

Compensatory stage

  Respon kompensatorik dpt menstabilkan sirkulasi

Progressive stage

  Manifestasi dari sistemik hipoperfusi & kemunduran fungsi organ

Irreversible stage

  Kerusakan sel yg hebat tdk dpt dihindari yg akhirnya menuju kematian

Compensatory stage assessment

Restlessness

oriented

pupils normal

heart rate increased

systolic B/P normal or slight decrease

Diastolic B/P normal or slight increase

respirations faster and deeper

output = or <

pale, cool, may be thirsty

Role of the RN

Continuous in-depth assessment of the patient’s hemodynamic status

Prompt recognition of problems

Accurate use of emergency orders

Prompt and accurate reports of deviations in assessment to physician

Reducing patient anxiety

Promoting patient safety

Progressive stage assessment

Listless, agitated, apathetic, confused

speech slowed

pupils dilated

tachycardia

pulses weak

systolic B/P < 90

Diastolic B/P falling

respirations rapid and shallow

oliguria

cold, clammy, cyanotic, marked increase in thirst

Role of the RN

Requires expertise in assessing and understanding shock and the significance of changes in assessment data

Managing, implementing and documenting treatments, medications, fluids along with continuous assessment and collaboration

Irreversible shock assessment

Confused, disoriented or unconscious

reflexes absent

pupils dilated with minimal response to light

HR slow and irregular

pulses absent (or very weak)

Systolic B/P falling to unobtainable

Diastolic B/P approaching 0

Respirations slow and shallow, irregular

output very <or absent

cold, clammy

absent bowel sounds

Role of the RN

Continuing the astute assessment and interventions begun in previous stages

Recognizing that the patient is very likely to be terminal

Initiating palliative and end-of-life activities

Support and explanation to family members

Treatment of Shock

Maintain airway

Control bleeding

Baseline vital signs

Level of consciousness

Treatment  of  Shock

Positioning

ABCD approach

Fluid therapy

Drug therapy

Keep patient at normal temperature

Prevent hypothermia

Minimize effect of shock

On-going assessment - every 10-15 minutes

Fluid Replacement

Crystalloid replacement:  NS and LR

Easily available, but can cause rebound overload, much is lost to tissues

No oxygen carrying capacity 

Colloids:  plasma proteins such as albumin

Large molecules that pull fluids into tissues, but are harder to obtain, more expensive and run risk of anaphylaxis

No oxygen carrying capacity

Blood:  if the patient is in hypovolemic shock, this is the fluid of choice

Does have oxygen carrying capacity

Harder and slower to obtain, generally needs to be cross-matched

Vasoactive medications

Vasopressors:   Intropin (dopamine), Dobutrex (dobutamine)

 Vasodilators:  Nipride (nitroprusside), Tridil (nitroglycerine)

Other medications

Corticosteroids

Antibiotics

THANK’S