SHOCK

SHOCK

1. Shock is a life threatening conditions that occurs when the vital organs (brain, heart, etc.) are deprived of oxygen due to a problem affecting the cardiovascular system

2. Types of shock

   • hypovolaemic shock - loos of fluid
   • cardiogenic shock - reduced CO (MI/HF)
   • septic shock - bacterial, fungal or viral infection
   • anaphylatic shock - severe allergic reaction
   • neurogenic shock - spiral shock

3. Stages of shock

   • 1. cardiovascular system fails to deliver enough oxygen and nutrients to meet the needs of the body
   • 2. Cellular Hypoxia
   • 3. impairs aerobic cell respiration -> anaerobic respiration
   • 4. Lactic acid accumulates which results in organ hypoxia

4. HYPOVOLAEMIC SHOCK

   • Haemorrhage (trauma or complication during surgery)
     • All post-op patients
     • trauma patients
     • patients with coagulation problems
     • warfarinised or heparinised patients
     • Patients with oesphageal varices
     • internal ruptures
   • Severe fluid loss (dehydration, vomitting, diarrhoea)
   • Patients with burns
   • Signs and Symptoms
     • Tachypnoea
     • Hypotension
     • Tachycardia
     • Pale cold clammy skin
     • Thirst
     • Cognitive changes; confused, agitated, unconscious
   • Nursing Interventions
     • 1. A-E Assessment 2. Recognise signs and symptoms 3. high flow oxygen therapy 4. Assess vital signs (pulse, BP, SpO2) 5. detect signs of deterioration 6. monitor fluid intake and output 7. Monitor temp. to prevent a drop in core temp. 8. warm blankets or fluids adminsitered via a fluid warmer 9. fluid replacement (colloids/ crystalloids) 10.ongoing monitoring
       • Crystalloid solution- used in large volumes 0.9% NaCl .. large volumes may cause pulmonary oedema or electrolyte imbalance. MONITOR PT CLOSELY Colloid Solution- used for initial treatment of hypovolaemic shock (Gelofusine, Albumin) Works by drawing fluid from the extravascular space tot the intravascular space. Higher risk of anaphylatic shock

5. CARDIOGENIC SHOCK

   • failure of the left ventricle
   • present in patients w/ hypotension (systolic lower than 90 for 30mins) and reduced CO <30mls/hr and prolonged capillary refill
   • 3 Stages
     • 1. Compensatory (early and reversivble)
     • 2. Progressive
     • 3. Irreversible

6. Prevention of Shock

   • 1. A-E assessments 2. Identify patients at risk 3. Close monitoring 4. Identify signs and symptoms 5. Prompt reporting of EWS 6. early intervention 7. Pyshological care