Drugs for Shock Causes: trauma or bleeding,
Fluid Replacement Agents
Blood and blood Products
Crystalloid Solutions : normal serum albumin
(Albuminar, Albutein)
Vasoconstrictors/ Vasopressors: norepinephrine
(Levarterenol, Levophed)
Inotropic Agents: dopamine (Dopastat, Inotropin)
Drugs for Anaphylaxis: epinephrine (Adrenalin)
SHOCK
- wherein the vital tissues and organs are not
receiving enough blood to function properly.
- Without adequate oxygen, cells cannot carry out
metabolic processes
- It is considered as medical emergency and may
lead to irreversible organ damage and death
- Thirst is a common complaint, skin may feel cold
or clammy.
- Inability of the cardiovascular system to send
sufficient blood to the vital signs: heart and brain
- - Quiet and warm psychological support and
Cardiovascular: BP low, CO diminished, HR may be
rapid with weak thread pulse
Respiratory: Breathing is rapid and shallow
Metabolism: Low temperature, thirst, acidosis, low urine
output
Neurologic: restless, anxious, lethargic, confusion
a. Hypovolemic (volume depletion) hemorrhage,
extensive burns, DHN, vomit and diarrhea.
b. Neurogenic shock: sudden loss of nerve impulse
communication
c. Cardiogenic shock: inadequate CO due to pump
failure • Septic shock: presence of bacteria and
toxins in the blood.
d. Anaphylactic shock: food or drug intake, most
severe type I allergic response
TREATMENT:
- The goal is to maintain BLS basic life support
ABC, to restore normal fluid volume and
composition and maintain adequate BP.
- Connect to cardiac monitor and pulse oximeter
- BP readings on the opposite of pulse oximeter as
peripheral vasoconstriction with the inflation of BP
cuff.
- Oxygen at 15L/min via a nonrebreather mask.
- LOC and neurological status are monitored.
reassurance
a. Anaphylaxis
- to prevent or stop the hypersensitive inflammatory
response
b. Fluid Replacement Agents
- blood, blood products, colloids and crystalloids.
c. Treating Shock with IV infusion therapy:
- Whole blood, plasma proteins, fresh frozen
plasma and globulins. properly typed and cross
matched
- Whole blood thou being carefully screened has the
potential to transmit serious infections (hepatitis or
HIV)
COLLOIDS (PROTEINS AND CRYSTALLOIDS)
- Infusions are often used when up to 1/3 of adults
blood volume has been lost: Hetastarch (Hespan).
- Massive hemorrhage, burns, acute liver failure and
neonatal hemolytic disease
- Common crystalloids: normal saline, lactated
Ringer’s, Plasmalyte, and hypertonic saline (3%
NaCl, 5% D5W)
- Prototype Drug: normal Serum Albumin
(Albuminar, Albutein, Buminate, Plasbumin) : Fluid
Replacement Agent/Colloid
SYMPATHOMIMETIC VASOCONSTRICTORS
- also known as vasopressors.
- Used to stabilize BP, discontinuation is gradual,
possible for rebound hypotension and undesirable
cardiac effects
- norepinephrine (Levophed) as prototype drug
- isoproterenol (Isuprel)
- phenylephrine (Neo-Synephrine)
Nursing Considerations
- Monitor clients condition provide education as it
relates to the prescribed drug treatment. Monitor
mental status, skin temp, ear lobes color, nail beds
and lips.
- Assess BP and HR
- History for CV disease ( vasoconstrictors are
contraindicated in severe CV disease)
- Obtain ECG reading, monitor chest pain (reduce
dosage if HR exceeds 110bp
- monitor UO (may lead to renal perfusion)
- Telemetry for IV therapy duration
- May increase IOP, assess for narrow angle
glaucoma
- Ensure IV patency and monitor site.
- Titrate IV rate if BP is elevated
- Severe headache (early sign of vasopressor
overdose)
Client Teaching:
- Report immediately any pain on IV site
- Blanching or blueness of fingers
- Chest pain or palpitations
INOTROPIC AGENTS
- Also called cardiotonic drugs
- Used to increase the cardiac output
 - Digoxin (Lanoxin), increases myocardial - Bronchodilator albuterol (Ventolin) for SOB.
contractility and CO, thus bringing critical tissues High flow O2.
their essential oxygen. - Systemic glucocorticoids such as
- Dobutamine (Dobutrex) hydrocortisone for inflammation.
- Dopamine (Dopastat, Intropin) as prototype drug,
INOTROPIC AGENT Most common drugs causing anaphylaxis include:
- Have the potential to reverse the cardiac - antibiotics,
symptoms of shock by increasing the strength of - NSAIDs (aspirin, ibuprofen, naproxen),
myocardial contraction - ACEI,
- opioids and iodine-based contrast media for
TREATING SHOCK WITH INOTROPIC AGENTS: radiographic exams
- dobutamine – HF as a cause.
- Dopamine activates beta and alpha adrenergic Symptoms:
receptors. - histamine release
- Used to increase BP by causing peripheral - fast HR
vasoconstriction and increasing force of - decrease CO
myocardial contraction. Given only as IV infusion - Vasodilation
- Edema
ANAPHYLAXIS - itchy skin
- Fatal condition in which body defenses hyper - Bronchoconstriction
response to a foreign chemical known as antigen - dyspnea
or allergen.
- Treatment depending on the severity of the Prototype Drug: epinephrine (Adrenalin)
symptoms sympathomimetic /Anaphylaxis Drug
- Epinephrine 1:1000, given SC or IM as DOC. It
can rapidly reverse hypotension.
- May be repeated 3 times at 10-15 minute interval
- Antihistamines such as diphenhydramine
(Benadryl) maybe ordered