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2 Shock
3 Definition of Shock
Shock is a term used to refer to a group of signs & symptoms that can be caused by a variety of
problems.
Shock is an abnormal physiologic state in which there is a disproportion between the circulating blood
volume and the size of the vascular bed resulting in circulatory failure and anoxia.
4 Types of Shock
Hypovolemic.
Cold shock because the extremities become cold.
Cardiogenic Shock.
Neurogenic Shock.
Vasogenic Shock.
Warm Shock because the extremities remain warm.
5 Hypovolemic Shock
Hypovolemic shock is loss of blood the point where the metabolic needs of the body cannot be met.
An individual who loses approx. 1/3 or 1000 ml of their normal blood volume will probably go into
shock.
Hypovolemia can also be caused by burns.
Referred to as: BURN SHOCK.
7 Hypovolemic Shock
Treatment
Stop blood or plasma loss
Fluid replacement is primary concern
Albumin, hetastarch,
hetastarch, blood products
Position in modified trendelenburg
8 Cardiogenic Shock
1
Failureof the cardiac muscle to act as a pump
The heart can no longer perform adequately and is unable to pump sufficient blood to the
organs
MI’s are the most common cause
9 Cardiogenic Shock
Treatment
O2 at 3 - 5 L/min
Control chest pain with morphine
Vasoactive drugs
IV Nitro
Fluid support
10 Cardiogenic Shock
Treatment/Nursing Management
Safety and comfort
Reduce anxiety
11 Distributive Shock
Caused by an increase in the size of the vascular bed due to massive vasodilation or.
Peripheral pooling of blood.
Still have a normal blood volume, but even the normal amt. of blood cannot adequately fill
the increased size of the capillary bed.
Neurogenic, septic, or anaphylactic.
12 Neurogenic
Neurogenic Shock is caused by dilation of blood vessels secondary to nervous factors such as:
Brain damage.
Bradycardia.
Decrease in cardiac output which results in inadequate tissue perfusion and anoxia.
13 Neurogenic Shock
Treatment/Nursing Management
Positioning during anesthesia
2
Elastic stockings, elevating foot of bed
Passive range of motion to immobile extremities
All the above serve as ways to decrease potential for neurogenic shock
14 Septic Shock
Caused by bacterial infection, immunosuppression
Signs and Symptoms
Infection
Warm phase
Cold phase
Treatment/Nursing Management
Antibiotics
Fluid replacement
15 Septic Shock
Treatment/Nursing Management.
Use of aseptic technique.
Monitor for signs of infection.
Reduce temps over 104 with aspirin, hypothermia blankets.
Monitor therapeutic blood levels of meds.
IV fluids and meds.
16 Anaphylactic Shock
A massive allergic reaction
Adrenaline/ Epi is given many times to combat it
Treatment/Nursing Management
Screen for allergies
CPR
Documents
An Increase in HR.
Increase in CO.
Vasoconstriction.
3
18 Stages of Shock - 1 St and 2nd Stages
Also observe for.
Metabolic acidosis in compensatory stage.
Treatment/Nursing Management.
Correct underlying cause of shock.
Fluid replacement.
Promote safety.
Falling B/P.
Oliguria.
Positioning
Family support
Treatment/Nursing management
Much family support in addition to physical care
4
1. It tends to dilute the blood
2. It causes tissue dehydration
vasoconstriction
24 As Shock Progresses
The systemic circulation remains vasoconstricted to get blood back to the heart. At this
point, the cells are becoming anoxic because there has been a decreased amt. of blood
given to them because the systemic circulation has been constricted.
As a result, the microcirculation ( down near the cells) dilates in order to get blood to the tissue.
Decreased CO, falling B/P begin to appear.
25 Intestinal Changes During Shock
Because the intestines really aren't vital to life, they are the 1st organs in the body to lose their supply
of blood.
Tissue necrosis results & bacteria are released into the abdominal cavity.
26 Kidney’s During Shock
The kidneys can compensate fairly well for a time
Oliguria results in kidneys losing their ability to regulate electrolytes & acid base balance
Changes in the acid base balance
5
patient can be dead in a matter of minutes.
Increase in HR.
Vasopressors
Dopamine
Diuretics
33 General Nursing Management of Shock
Maintenance of patient airway.
Patient positioning.
Maintenance of body temperature.
Maintenance of skin integrity.
Psychological support.
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Keep patient as calm as possible because the more agitated & excited they get, the faster they breathe &
the more 02 compromised they become.
Pain deepens shock.
Give explanations to decrease anxiety levels.
Cover lightly.