Week 8 503B Pathology Paper

Week 8 503B Pathology Paper

Shock is a life-threatening syndrome characterized by impaired cellular metabolism and reduced tissue perfusion due to an imbalance between the demand and supply for nutrients and oxygen. It is classified into two broad categories: resulting from reduced flow of blood and shock arising from blood flow maldistribution. Under the first category, there is cardiogenic and hypovolemic shock. There is septic, anaphylactic, and neurogenic shock in the second category. The purpose of this paper is to analyze the causes, clinical manifestations, evaluation, and treatment of the various types of shock.

Cardiogenic Shock

Cardiogenic shock results from diastolic (relaxation and filling) and systolic (emptying and pumping) dysfunction, causing compromised cardiac output. Vahdatpour et al. (2019) assert that in cardiogenic shock, the primary insult is reduced myocardial contractility, causing systemic vasoconstriction, decreased cardiac output, hypotension, and cardiac ischemia. Hinkle and Cheever (2018) explain that precipitating factors for cardiogenic shock include blunt cardiac injury, heart attack, severe pulmonary or systemic hypertension, cardiomyopathy, obstructive cardiac tamponade, and myocardial depression resulting from metabolic issues.

Early clinical manifestations of cardiogenic shock include tachycardia, narrowed pulse pressure, hypotension, and increased myocyte oxygen usage, all arising from low blood flow. A patient may be tachypneic on physical examination, have pulmonary congestion, cool and clammy skin, agitation, reduced capillary refill time, pallor, confusion, anxiety, reduced renal perfusion, and urine output. On evaluation, the clinician performs a thorough physical examination and history taking. Tests ordered include blood gas tests, cardiac CT scans, cardiac angiography, echocardiography, and electrocardiograms (NHLBI, 2018). Treatment aims at rectifying the problems with the heart to restore perfusion to the body’s vital organs. Options include medications such as thrombolytics, surgery and heart procedures such as angioplasty, and the use of medical devices.

Hypovolemic Shock

It results when the body losses 20% or more of its intravascular volume. Absolute hypovolemic shock results when the intravascular fluid volume is lost. In relative hypovolemic shock, fluid moves from the vascular space into the extravascular space, for instance, from the interstitial to the intracavitary space. Taghavi and Askari (2021) note that precipitating factors for hypovolemic shock includes hemorrhage, gastrointestinal losses (vomiting, diarrhea), diabetes insipidus, diuresis, hyperglycemia, and fistular damage.

The clinical manifestations include anxiety, tachypnea, dizziness, sweating, decreased stroke volume, increased heart rate and cardiac output (a compensatory mechanism), confusion, shallow and rapid breathing. Laboratory tests are helpful in evaluation and diagnosis. Tests include BUN, sodium levels, central venous pressure, hemoglobin, and hematocrit levels. Treatment of hypovolemic shock aims to cut down the bleeding source and replace lost fluids by blood transfusion and administration of IV crystalloids .Drugs like epinephrine and dopamine are also administered to increase the heart’s pumping strength.

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Neurogenic Shock

Neurogenic shock refers to a hemodynamic phenomenon occurring within 30 minutes of injury to the spinal cord at the T5 vertebra or above. This disrupts the sympathetic nervous system with loss of sympathetic tone, resulting in massive venous and arterial vasodilation and pooling of blood in vessels. Clinical manifestations include instantaneous low blood pressure, slowed heart rate, warm and flushed skin, hypotension, bradycardia, dry skin, poikilothermia, and temperature dysregulation. With advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, hemodynamic monitoring, and clinical examinations, neurogenic shock can be accurately diagnosed (Dave & Cho, 2022). Treatment includes administering medications such as vasopressin, atropine, and dopamine to correct symptoms. Management also focuses on hemodynamic stabilization, IV fluids resuscitation to treat hypotension, and immobilizing the c-spine to prevent further injury.

Anaphylactic Shock

Anaphylactic shock results from various allergic reactions. Common anaphylactic triggers include foods such as shellfish, celery, nuts, medications such as aspirin and penicillin, latex, and bee stings. The allergic reactions result in massive vasodilation, increased capillary permeability, and the release of mediators of inflammation. The clinical manifestations include anxiety, dizziness, confusion, tachypnea, tachycardia, and hypotension. A patient also presents with stridor and wheezing (due to a constricted airway), chest pains, swollen lips or tongue, flushed skin, hives, tingling extremities, and severe pruritus. McLendon and Sternard (2021) explain that diagnosis of anaphylaxis is based on the presenting clinical picture, and thus diagnostic studies and laboratory tests may not be necessary. Rapid recognition and action are imperative to prevent anaphylactic deaths. Treatment involves intramuscularly injecting epinephrine at a dose of 0.3 to 0.5mls (McLendon & Sternard, 2021), followed by IV cortisones and antihistamines. Airway management is also paramount, and albuterol or supplemental oxygen may be administered for breathing difficulties.

Septic Shock

Septic shock is the severest complication of sepsis and refers to sepsis associated with perfusion abnormalities and hypotension despite adequate fluid resuscitation. The primary causative organisms include gram-negative and gram-positive bacteria and endotoxins, stimulating inflammatory responses. When the invading organisms release pro-inflammatory cytokines, there is endothelial damage resulting in increased permeability of the capillary membranes, selective vasoconstriction, hypermetabolic state, and peripheral vasodilation. Clinical manifestations of septic shock include increased inflammation and coagulation, reduced fibrinolysis obstructing microvasculature, and a hyperdynamic state causing increased cardiac output. Patients also have tachypnea, decreased urine output, cyanosis, tachycardia, GI dysfunction, fever, and altered neurologic status (Mahapatra & Heffner, 2021). Management aims at fighting the underlying infections to prevent further organ damage. Treatment includes intravenous antibiotics, corticosteroids, fluid therapy, and vasopressors.

Conclusion

Shock is life-threatening. The effects of shock are reversible at the early stages. Health care providers should be more apt in correctly identifying the type and cause of presenting shock to institute timely management approaches to prevent multi-organ failure and even death.

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References

Dave, S., & Cho, J. J. (2022). Neurogenic Shock. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459361/

Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Philadelphia Wolters Kluwer Health, Lippincott Williams & Wilkins.

Koya, H. H., & Paul, M. (2021). Shock. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531492/

Mahapatra, S., & Heffner, A. C. (2021). Septic Shock (Sepsis). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430939/

McLendon, K., & Sternard, B. T. (2021). Anaphylaxis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482124/

NHLBI. (2018). Cardiogenic Shock | National Heart, Lung, and Blood Institute (NHLBI). Nih.gov. https://www.nhlbi.nih.gov/health-topics/cardiogenic-shock

Taghavi, S., & Askari, R. (2021). Hypovolemic Shock. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513297/

Vahdatpour, C., Collins, D., & Goldberg, S. (2019). Cardiogenic Shock. Journal of the American Heart Association, 8(8). https://doi.org/10.1161/jaha.119.011991

 

Week 8 Final
Summarize the causes, clinical manifestations, evaluation, and treatment for cardiogenic, hypovolemic, neurogenic, anaphylactic, and septic shock.