Shock

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Shock – a syndrome characterized by decreased

tissue perfusion (decreased oxygenation of tissue) and impaired cellular metabolism that results in an imbalance

between the supply of and the demand for oxygen and nutrients, p. 1960

Understand the various types of

shock: causes, pathophysiology, and chief

characteristics of various types of shock p. 1964, 1965, (emergency management

p. 1973, Fluid therapy for shock p. 1974

Hypovolemic

Shock: shock that is caused by a loss

of intravascular fluid p. 1961. The volume is inadequate to fill the vascular

space

Absolute

hypovolemia – when fluid is lost through haemorrhage, gastrointestinal (GI)

loss e.g., through vomiting, diarrhea), fistula drainage, DI, hyperglycemia, or

diuresis.

Relative

hypovolemia – fluid moves out of the vascular space into the extravascular

space e.g., interstitial or intracavity space. This fluid shift is called

“third spacing.”

Distributive

– Maldistribution of Blood Flow

Anaphylactic

Shock: an acute and life-threatening hypersensitivity (allergic) reaction to a

sensitizing substance, sucha s a drug, chemical, vaccine, food, or insect

venom, p. 1962

Neurogenic

shock: a hemodynamic syndrome of massive vasodilation without compensation that

results from the loss of sympathetic nervous system vasoconstrictor tone,

caused by spinal cord injury at the fifth thoracic (T5) vertebra or above;

characterized by hypotension and bradycardia p. 1962

Septic

shock: the presence of sepsis with hypotension despite adequate fluid

resuscitation, along with the presence of tissue perfusion abnormalities , p.

1965

Cardiogenic

Shock: shock occurring when either

systolic or diastolic dysfunction of the pumping action of the heart results in

compromised cardiac output p. 1960

Discuss the complications of shock p.

Understand the diagnostic tests and

assessments related to shock

p. 1963, 1971

There is no

single diagnostic study to determine whether a patient is in shock.

Physical exam and a through history, documented from patient,

family and friends.

Medical and surgical history and history of recent events

i.e. URI, surgery, chest pain, trauma, provide valuable data.

Decreased

tissue perfusion in shock initially leads to elevated LACTATE LEVELS OF >4

mmol/L

Additional

diagnostic studies include 12-lead ECG, continuous cardiac monitoring, chest

radiography, continuous pulse OXIMETRY, and hemodynamic monitoring.

Identify the rational for treatment measures

to correct and reverse shock

p. 1971

Hypovolemic shock you will need to work to keep the volume up and then treat the underlying cause. Treat with IV fluids, pressers which help vessels clamp down, blood transfusion of platelets or coagulation factors, albumin to keep blood volume in the vascular and out of third spaces

Cariogenic shock: symptoms - pulmonary congestion, increased JVD, angina (chest pain), cool skin

Diagnosis - serum lactate, ABG,troponin, CXR (chest xray), EKG, ultrasound ECG, PCWP > 18mmHg and CO cardiac output / C index < 2.2 L/min/m2

Treatment: O2, cardio vascular support, repair the cause of cardio vascular shock.

Neurogenic shock symptoms: organ dysfunction, bradycardia (only shock that has it), warm skin b/c of dilation of all blood vessels.

Treatment: try to maintain the blood pressure i.e. pressers, IV fluids, atropine to block the parasympathetic system increasing fight or flight and heart rate

Anaphylactic shock: symptoms - decrease in BP, flushing of skin, swelling, itchiness, bronco spasms, runny nose

treatment: ABC airways - give oxygen, maintain blood pressure with epinephrin (opening lungs and veins), IV fluids, anti-histamines

Septic shock:

Apply nursing actions for a patient at risk

for shock p. 1979

ABC's - Airway, Breathing, Circulation

Assessment of tissue perfusion and includes evaluation of vital signs, level of consciousness, peripheral pulses, capillary refill, skin temp colour and moisture, urine output decreases, peripheral pulses diminish, and neurological status continues to deteriorate.

Brief history, description of events leading to the shock condition, time at onset and duration of symptoms, and a h health history, details regarding any care the patient received before hospitalization .

Discuss the emotional, psychological and

spiritual needs of a patient / family who is experiencing shock p. 1982

Emotional support and comfort- address any anxiety, fear, or pain b/c such symptoms may aggravate respiratory distress and increase release of catecholamines.

meds to decrease anxiety and pain

talk to patient and encourage family to talk to the patient even if intubated, sedated or comatose. help person write if intubated, simple explanation os of procedures, advanced directives discussed and documented.

the family primarily needs to be kept informed of the patients condition

support should be given when making decisions regarding difficult decisions regarding continuation of life support.

Following the nursing action:

Notice and

record patient cues and responses to the action

Disposable

garbage or sharps in appropriate waste disposal unit

Follow

principles of medically sepsis when performing hand hygiene

Thoroughly

document all of your actions inpatient responses

Reflect on

your actions and and to identify strengths and areas to improve

Continue

with follow-up assessment of your patient

Include

salient information related to your nursing actions in transfer of

accountability with your nurse (SBAR)

https://www.youtube.com/watch?v=AvtS_IrlbYk (Enclavar)