Shock

a state of cellular and tissue hypoxia due to

either reduced oxygen delivery, increased
oxygen consumption, inadequate oxygen
utilization, or a combination of these
processes.
Types of Shock

• Hypovolemic
• Cardiogenic
• Anaphylactic
• Neurogenic
an emergency condition in which severe blood or
other fluid loss makes the heart unable to pump
enough blood to the body
 TYPES & CAUSES

Non-hemorrhagic
• Vomiting
• Diarrhea
• Bowel obstruction, pancreatitis
• Burns
 TYPES & CAUSES

Hemorrhagic
GI bleed
Trauma
Massive hemoptysis
AAA rupture
Ectopic pregnancy, post-partum bleeding
 Clinical Manifestations
• Hypotension
• Cognitive. The patient experiences decreased
sensorium.
• Tachycardia
• Rapid, shallow respirations
 Oliguria. There is oliguria or decreased urine
output of less han 25ml/hour.
 Cool Clammy skin.
 Prevention
 Early detection. Recognize patients with
conditions that reduce blood volume as at-risk
patients.
 Accurate I&O. Estimate fluid loss and replace,
as necessary, to prevent hypovolemic shock.
 Medical Management
 Volume expansion : plasma proteins or other plasma
expanders, may produce adequate volume expansion
until whole blood can be matched.
 Pneumatic antishock garment
 Treat underlying cause.
 Redistribution of fluid. Positioning the patient
properly assists fluid redistribution, wherein a
modified Trendelenburg position is recommended in
hypovolemic shock.
 Pharmacologic Therapy
 Vasoactive drugs : that prevent cardiac failure are
given.
 Insulin is administered if dehydration is secondary to
hyperglycemia.
 Desmopressin (DDAVP). Desmopressin is
administered for diabetes insipidus.
 Antidiarrheal drugs: if dehydration is due to diarrhea.
 Antiemetics. If the cause is vomiting
 Nursing Management
 History
 Vital signs :prior to arrival at the emergency
department, should also be noted.
 In patients with trauma, determine the mechanism
of injury and any information that may heighten
suspicion of certain injuries.
 Safe administration of blood.
 Safe administration of fluids.
 Monitor weight: for sudden decreases, especially
in the presence of decreasing urine output or active
fluid loss.
 Monitor vital signs.
 Oxygen administration..
also known as cardiac shock, happens when
your heart cannot pump enough blood and
oxygen to the brain and other vital organs
 CAUSES

 HEART FAILURE
 MYOCARDIAL INFARCTION
 MYOCARDITIS
 End stage of cardiomyopathy
Cardiogenic Shock
 Clinical Manifestations
 Clammy skin..
 Decreased systolic blood pressure.
 Tachycardia.
 Rapid respirations.
 Oliguria.
 Mental confusion..
 Cyanosis.
 Medical Management
 Oxygen..
 Angioplasty and stenting.
 Balloon pump.
 Pain control..
 Hemodynamic monitoring.
 An arterial line is inserted to enable accurate and continuous
monitoring of BP and provides a port from which to obtain
frequent arterial blood samples.
 Fluid therapy
 Pharmacologic Therapy
 IV dopamine : a vasopressor, increases cardiac output,
blood pressure, and renal blood flow.
 IV dobutamine : is an inotropic agent that increase
myocardial contractility.
 Norepinephrine: is a more potent vasoconstrictor that
is taken when necessary.
 IV nitroprusside: is a vasodilator that
 Nursing Management
 Vital signs. Prevent recurrence.
 Identifying at-risk patients early, promoting adequate
oxygenation of the heart muscle, and decreasing cardiac
workload can prevent cardiogenic shock.
 Hemodynamic status. Arterial lines and ECG
monitoring
 Fluids. IV infusions must be observed closely.
 The nurse makes ongoing timing adjustments of the
balloon pump to maximize its effectiveness by
synchronizing it with the cardiac cycle.
 Enhance safety and comfort.
 Monitor ABG values to measure oxygenation and
detect acidosis from poor tissue perfusion.
 Positioning.
Anaphylactic Shock

• is a systemic, Type I hypersensitivity

reaction that often has fatal consequences.
• Anaphylaxis causes the immune system to
release a flood of chemicals that can cause
a person to go into shock.
 Types of hypersensitivity

 Type I: reaction mediated by IgE antibodies.

 Type II: cytotoxic reaction mediated by IgG or
IgM antibodies.
 Type III: reaction mediated by immune
complexes.
 Type IV: delayed reaction mediated by cellular
response
 CAUSES
 Food allergies. The most common anaphylaxis
triggers
 Medication allergies.
 Insect allergies.
 Latex allergy.
 Prevention
 Avoid exposure to allergens.
 Desensitization.
 Monitoring. Closely monitor a patient undergoing
diagnostic tests that use radiographic contrast
media, such as excretory urography, cardiac
catheterization, and angiography.
 Medical Management
 Remove antigen
 Administer medications.
 Cardiopulmonary resuscitation. If cardiac arrest and
respiratory arrest are imminent or have occurred,
cardiopulmonary resuscitation is performed.
 Endotracheal intubation or tracheostomy may be
necessary to establish an airway.
 Intravenous therapy.
 Pharmacologic Therapy
 Epinephrine: is given for its vasoconstrictive
reaction; for emergency situations,
 Diphenhydramine(Benadryl) : is administered to
reverse the effects of histamine, thereby reducing
capillary permeability.
 Albuterol(Proventil) : may be given to reverse
histamine-induced bronchospasm.
 Nursing Management
 Assess any kind of allergy.
 Assess patient’s knowledge/ understanding of
previous reactions and steps taken by the patient
and the family to prevent further exposure to
antigens.
 Advises the patient to wear or carry identification
that names the specific allergen
 Monitor client’s airway.
 Monitor the oxygenation status. Monitor oxygen
saturation and arterial blood gas values.
 Instruct the client to breathe slowly and deeply.
 Positioning
 Encourage adequate rest and limit activities to within
client’s tolerance.
 Monitor urine output.
It is a type of shock that is caused by the sudden
loss of signals from the sympathetic nervous
system that maintain the normal muscle tone in
blood vessel walls.
 Causes
 Spinal cord injury (SCI) is recognized to cause
hypotension and bradycardia (neurogenic shock).
 Spinal anesthesia—injection of an anesthetic into
the space surrounding the spinal cord
 Clinical Manifestations
 Dry, warm skin. Instead of cool, moist skin, the patient
experiences dry, warm skin due to vasodilation and inability
to vasoconstrict.
 Hypotension
 Bradycardia. Instead of getting tachycardic, the patient
experience bradycardia.
 Diaphragmatic breathing.
 Respiratory arrest
 Medical Management
 Restoring sympathetic tone. It would be either through the
stabilization of a spinal cord injury or, in the instance of
spinal anesthesia, by positioning the patient appropriately.
 Immobilization. If the patient has a suspected case of
spinal cord injury, a traction may be needed to stabilize the
spine to bring it to proper alignment.
 IV fluids. Administration of IV fluids is done to stabilize
the patient’s blood pressure.
 Pharmacologic Therapy
 Inotropic agents such as dopamine may be infused for
fluid resuscitation.
 Atropine is given intravenously to manage severe
bradycardia.
 Steroids
 Administration of heparin or low molecular-weight
heparin as prescribed may prevent thrombus formation.
 NURSING ASSESSMENT
 ABC assessment.
 The prehospital provider should follow the basic airway,
breathing, circulation approach to the trauma patient while
protecting the spine from any extra movement.
 Neurologic assessment.
 Neurologic deficits and a general level at which abnormalities
began should be identified.
 NURSING MANAGEMENT
 Elevate head of bed : helps prevent the spread of the
anesthetic agent up the spinal cord when a patient receives
spinal or epidural anesthesia.
 Lower extremity interventions. Applying anti-embolism
stockings and elevating the foot of the bed may help
minimize pooling of the blood in the legs and prevent
thrombus formation.
 Exercise. Passive range of motion of the immobile
extremities helps promote circulation.
 NURSING MANAGEMENT
 Airway patency. Maintain patent airway: keep head in
neutral position, elevate head of bed slightly if tolerated, use
airway adjuncts as indicated.
 Administer oxygen by appropriate method (nasal prongs,
mask, intubation, ventilator).
 Plan activities to provide uninterrupted rest periods
 BP monitoring. Measure and monitor BP before and after
activity in acute phases or until stable.
 Reduce anxiety. Assist patient to recognize and compensate
for alterations in sensation.