SUBJECT- MEDICAL SURGICAL NURSING

TOPIC- SHOCK

-MR. MIGRON RUBIN

 INTRODUCTION

Cells need two things to function: oxygen and glucose. This allows the
cells to generate energy and do their specific jobs. When cells don’t
receive either of them or both, they stop functioning.
 DEFINITION

Shock is defined as a condition where the tissues in the body don't receive
enough oxygen and nutrients to allow the cells to function.
 CLASSIFICATION
1. Cardiogenic shock- It occurs due to systolic or diastolic dysfunction.
2. Hypovolemic shock- It occurs due to intravascular fluid volume.
3. Obstructive shock- It occurs when there is physical obstruction in blood flow.
4. Distributive shock- (neurogenic, anaphylactic & septic)

• Neurogenic shock- It occurs from trauma that leads

to spinal cord injuries.

• Anaphylactic shock- It is acute life threatening

hypersensitivity reaction to a sensitizing
substance like drug, chemical, vaccine, food etc.

• Septic shock- Also known as blood poisoning,

is a condition caused by infections that lead to bacteria
entering blood.
 ETIOLOGY

• Severe allergic reaction

• Significant blood loss
• Heart failure
• Blood infections
• Dehydration
• Poisoning
• Burns
 PATHOPHYSIOLOGY
CARDIOGENIC SHOCK
STRUCTURAL DEFECTS IN HEART, DYSRHYTHMIAS ETC.

SYSTOLIC & DIASTOLIC DYSFUNCTION

DECREASED CARDIAC OUTPUT & INCREASED PULMONARY PRESSURE

PULMONARY EDEMA

DECREASED CELLULAR OXYGEN SUPPLY

DECREASED TISSUE PERFUSION

 HYPOVOLEMIC SHOCK
DECREASED BLOOD VOLUME DUE TO ACCIDENT, BURN ETC.

DECREASED VENOUS RETURN

DECREASED CARDIAC OUTPUT

DECREASED TISSUE PERFUSION

DECREASED CELLULAR METABOLISM

 NEUROGENIC SHOCK
DISRUPTION OF SYMPATHETIC NERVOUS SYSTEM

VASODILATION

DECREASED BP

DECREASED CARDIAC OUTPUT

DECREASED CELLULAR OXYGEN SUPPLY

DECREASED TISSUE PERFUSION

IMPAIRED CELLULAR METABOLISM

 ANAPHYLACTIC SHOCK
ALLERGEN , DRUG ETC.

ANTIGEN ANTIBODY REACTION

VASODILATION

CAPILLARY PERMEABILITY

SEVERE BRONCHO CONSTRICTION

DECREASED OXYGEN SUPPLY AND UTILIZATION

INADEQUATE TISSUE PERFUSION

 SEPTIC SHOCK
INFECTION

RELEASE OF TOXIN

PERIPHERAL VASCULAR EFFECTS MYOCARDIAL PROBLEMS

ENDOTHELIAL DESTRUCTION DECREASED CONTRACTILITY

MICROVASCULAR INSUFFICIENCY INADEQUATE BLOOD FLOW

TO TISSUE

INADEQUATE BLOOD FLOW TO THE TISSUE TISSUE HYPOXIA

CELL DEATH
 OBSTRUCTIVE SHOCK
PHYSICAL OBSTRUCTION IN BLOOD FLOW

DECREASED VENOUS RETURN

DECREASED CARDIAC OUTPUT

DECREASED CELLULAR OXYGEN SUPPLY

DECREASED TISSUE PERFUSION

IMPAIRED CELLULAR METABOLISM

 CLINICAL MANIFESTATIONS

• Extremely low blood pressure

• Weakness
• Chest pain
• Weak pulse
• Profuse sweating
• Dizziness
• Moist, clammy skin
• Unconsciousness
• Rapid, shallow breathing
• Feeling anxious, agitated or confused
• Cyanosis
 DIAGNOSTIC EVALUATION

• History collection

• Physical examination

• Blood culture & sensitivity test

• CBC- increased WBC & ESR level

• Arterial blood gas analysis- respiratory alkalosis

• ECG-dysarrthmias

• Echocardiogram-to rule out aortic stenosis and pulmonary embolism.

• X-ray & CT scan

• Cardiac monitoring-Spo2,pulse,temp,BP are monitored continuously.

• Central venous pressure -fluid loss.

 COMPLICATIONS

• Loss of consciousness
• Respiratory failure
• Coagulation disorder
• Multi organ damage
• Coma
• Death
 MANAGEMENT
I. MEDICAL MANAGEMENT
A. PHARMACOLOGICAL MANAGEMENT
• Crystalloids: ringer’s solution and normal saline
• Inotropic agents: like dopamine , dobutamine and epinephrine
• Vasodilators : nitroglycerine
• Diuretics : lasilactone, furosemide
• Antibiotics : ciprofloxacin, amoxicillin and clavulanic acid
• Antihistamines : epinephrine used in anaphylactic shock.
• Corticosteroids : dexamethasone
• Sodium bicarbonate :used to treat metabolic acidosis
• Broncodilators : like atropine , aminophylline etc.
• B. NON- PHARMACOLOGICAL MANAGEMENT
• Modified trendelenberg position

• Assessment of vital signs

• Oxygen administration

• Parenteral nutrition support

II. SURGICAL MANAGEMENT

• Wound debridement- in case of chronic infected wound, burns wound

debridement to be done for fast healing

• Angioplasty-in case of myocardial infarction angioplasty can be

performed

• Tracheostomy
III. NURSING MANAGEMENT

ASSESSMENT
• Continuous monitoring of vital signs should be done.
• Assess Airway, breathing & circulation of the patient.
• Monitor for ABG value
• Check for urine output of the client.
•
• NURSING DIAGNOSIS

• Impaired tissue perfusion related to decrease cardiac output, decreased

venous return
• In effective breathing pattern related to hypoxia, bronchospasm
• Fluid volume deficit related to vomiting hemorrhage
• Acute pain related to myocardial infarction
• Imbalanced nutrition less then body requirement related to vomiting,
low intake of food