Askep Shock Sepsis, Anafilaktik

7/22/2019 Askep Shock Sepsis, Anafilaktik

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ASKEP SHOCK SEPSIS,

DISTRIBUTIF & ANAFILAKTIK

Disampaikan pada :

Pelatihan Intensive Care Unit Dewasa

Cilegon 2013


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Distributive Shock

Inadequate perfusion of tissues through

maldistribution of blood flow Intravascular volume is maldistributed

because of alterations in blood vessels

Cardiac pump & blood volume arenormal but blood is not reaching the

tissues


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Vasogenic/Distributive Shock

Etiologies

Septic Shock (Most Common)

Anaphylactic Shock

Neurogenic Shock


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Anaphylactic Shock

A type of distributive shock that results

from widespread systemic allergic reaction

to an antigen This hypersensitive reaction is LIFE

THREATENING


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Pathophysiology Anaphylactic

ShockAntigen exposure

body stimulated to produce IgE antibodiesspecific to antigen

drugs, bites, contrast, blood, foods,vaccines

Reexposure to antigen

IgE binds to mast cells and basophils

Anaphylactic response


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Anaphylactic Response

Vasodilatation

Increased vascular permeability

Bronchoconstriction Increased mucus production

Increased inflammatory mediators

recruitment to sites of antigen interaction


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Clinical Presentation

Anaphylactic ShockAlmost immediate response to inciting

antigen Cutaneous manifestations

urticaria, erythema, pruritis, angioedema Respiratory compromise stridor, wheezing, bronchorrhea, resp.

distress

Circulatory collapse tachycardia, vasodilation, hypotension


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KENALI DINI, TERAPI SCR AGRESIF

AIRWAY SUPPORT

IV EPINEPHRINE (buka jalan nafas)

Antihistamines, diphenhydramine 50mg IV

Corticosteroids

SECEPATNYA JAUHKAN DARI

ANTIGEN JIKA MUNGKIN PENCEGAHAN

PenatalaksanaanAnaphylactic Shock


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Management Anaphylactic

Shock

Pemberian cairan kristaloid scr tepat

Vasopressors mempertahankanperfusi organ

Inotropik positif

penyuluhan pasien


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NEUROGENIC SHOCK

A type of distributive shock that results from

the loss or suppression of sympathetic tone

Causes massive vasodilatation in the venous

vasculature, venous return to heart,cardiac output.

Most common etiology:Spinal cord injury

above T6

Neurogenic is the rarest form of shock!


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Pathophysiology of Neurogenic Shock

Distruption of sympathetic nervous systemLoss of sympathetic tone

Venous and arterial vasodilation

Decreased venous return

Decreased stroke volume

Decreased cardiac output

Decreased cellular oxygen supply

Impaired tissue perfusion

Impaired cellular metabolism


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Assessment, Diagnosis and

Management of Neurogenic Shock

PATIENT ASSESSMENT

Hypotension

Bradycardia

Hypothermia

Warm, dry skin

RAP

PAWP CO

Flaccid paralysis below

level of the spinal lesion

MEDICAL

MANAGEMENT

Goals of Therapy are totreat or remove the

cause & prevent

cardiovascular

instability, & promoteoptimal tissue

perfusion


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PENATALAKSANAAN SHOCK

NEUROGENIk

Jika Hipovolemia terapi cairan dng hati-hati.Th cairan jika TD


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Lanjutan.

Observasi adanya Bradycardia-majordysrhythmia

Observasi DVT ( trombus vena dalam )penumpukan

cairan vena di ekstremitas beresiko tinggi tjd>>P.E.

(emboli paru )

K/P gunakan Use peralatan pencegahan [TEDS,

ROM,Sequential stockings, anticoagulation]

NURSING DIAGNOSIS

Fluid Volume Deficit r/t relative loss Decreased CO r/t sympathetic blockade

Anxiety r/t biologic, psychologic or social integrity


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Lanjutan .

Kolaborasi : Alpha agonist tomeningkatkan ketonusan jika perfusi

masih tetap tidak adequate

dopamine at alpha doses (> 10

mcg/kg per min)

ephedrine (12.5-25 mg IV every 3-4

hour)

Terapi bradikardi dng:

atropine 0.5-1 mg dosis maximum

3 mg Mungkin membutuhkan pace maker

transcutaneous or transvenous

temporer


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SEPSIS

Systemic Inflammatory Response

(SIRS) to INFECTION manifested

by two or > of following:

Temp > 38 or < 36 centigrade

HR > 90

RR > 20 or PaCO2 < 32

WBC > 12,000/cu mm or > 10%Bands (immature wbc)


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SEPTIC SHOCK

SEPSIS WITH:

Hypotension (SBP < 90 or > 40reduction

from baseline) &

Tissue perfusion abnormalities invasion of

the body by microorganisms & failure of

bodys defense mechanism.


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Risk Factors Associated with Septic

Shock Age Malnutrition

General debilitation Use of invasive catheters

Traumatic wounds

Drug Therapy


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Pathophysiology of Septic shock

Initiated by gram-negative (most common) orgram positive bacteria,fungi, or viruses

Cell walls of organisms contain Endotoxins

Endotoxins release inflammatory mediators(systemic inflammatory response) causes...

Vasodilation & increase capillary permeability

leads toShock due to alteration in peripheral circulation

& massive dilation


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Pathophysiology of Septic Shock

IMMUNE / INFLAMMATORY RESPONSE

Microorganisms enter body

Mediator Release

Activation of Complement, kallikrein / kinin/ coagulation

& fibrinolytic factors platelets, neutrophils &macrophages>>damage to endothelial cells.

ORGAN DYSFUNCTION


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Clinical Presentation Septic

Shock

Two phases:

Warm shock - early phase

hyperdynamic response,VASODILATION

Cold shock - late phase

hypodynamic response

DECOMPENSATED STATE


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Clinical Manifestations

EARLY---HYPERDYNAMIC

STATE---COMPENSATION

Massive vasodilation

Pink, warm, flushedskin

Increased Heart Rate

Full bounding pulse Tachypnea

Decreased SVR*

Increased CO & CI

SVO2 will be

abnormally high

Crackles


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Clinical Manifestations

L ATE--HYPODYNAMIC

STATE--

DECOMPENSATION

Vasoconstriction

Skin is pale & cool

Significant

tachycardia

Decreased BP

Change in LOC

Increase SVR

Decreased CO Decreased UOP

Metabolic &

respiratoryacidosis with

hypoxemia


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PENATALAKSANAAN KOLABORATIF

PeNCEGAHAN !!

ASEPTIK TEHNIK

Cari & matikansumber infeksi

Resusitasi Cairan

Vasoconstrictors

Obat-obat Inotropik

Maksimalkan O2

delivery Support

Nutritional Support

Comfort & Emotional

support


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Sequelae Septic Shock

EFEK dari Endotoxin-endotoksin bakteri dapatterus berlanjut walaupunbakteri telah mati !!


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RangkumanTerapi Shock

Identifikasi pasien dng resiko tinggiterkena shock

Kontrol atau kurangi PENYEBAB

LAKUKAN & KOLABORASI TINDAKAN-TINDAKAN u/ peningkatan perfusi

jaringan

KOREKSI Ketidak seimbangan asam basa TERAPI disarithmia jantung


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Askep Shock Sepsis, Anafilaktik

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