Shock
Jonathan Peter
Nursing Educator
SINAHS
Objectives
• Define shock
• Types of shock
• Medical and nursing management of all types of shocks.
What is Shock :
• The term “shock” may refer to a psychological or a
physiologic type of shock.
• Shock is a life-threatening condition of circulatory failure,
causing inadequate oxygen delivery to meet cellular metabolic
needs and oxygen consumption requirements, producing
cellular and tissue hypoxia.
• Psychological shock is caused by a traumatic event and is also
known as acute stress disorder. This type of shock causes a
strong emotional response and may cause physical responses
as well.
• Your body experiences shock when you don’t have enough
blood circulating through your system to keep organs and
tissues functioning properly.
Sign and symptoms
• If you go into shock, you may experience one or more of the
following:
• rapid, weak, or absent pulse
• irregular heartbeat
• rapid, shallow breathing
• lightheadedness
• cool, clammy skin
• dilated pupils
• lackluster eyes
• chest pain
• nausea
• confusion
• anxiety
• decrease in urine
• thirst and dry mouth
• low blood sugar
• loss of consciousness
Causes:
• Severe allergic reaction
• Blood infections
• Dehydration
• poisoning
• Burns
• Heart failure
MAJOR TYPES OF SHOCK:
• Obstructive Shock
• Cardiogenic Shock
• Distributive Shock
• Hypovolemic Shock
OBSTRUCTIVE SHOCK:
• Obstructive shock occurs when blood can’t get where it needs
to go. A pulmonary embolism is one condition that may cause
an interruption to blood flow. Conditions that can cause a
buildup of air or fluid in the chest cavity can also lead to
obstructive shock.
• These Include:
• Pneumothorax (Collapsed Lung)
• Hemothorax (Blood Collects In The Space Between The
Chest Wall And Lung)
• Cardiac Tamponed (Blood Or Fluids Fill The Space Between
The Sac That Surrounds The Heart And The Heart Muscle)
Medical management:
• Possible obstructive shock treatments include:
• Removing an embolism with surgery or a catheter.
• Replacing a severely narrowed aortic valve. Reducing
heart muscle wall thickness, either with surgery or
catheter-based alcohol ablation.
Nursing management
• The nursing role in managing the patient with shock
• Common interventions include adequate oxygen, fluid and/or
drug therapy.
• In all cases the nurse needs to provide a safe environment for
the patient who may be at risk due to a reducing level of
consciousness and deteriorating vital signs.
Cardiogenic shock:
• Damage To Your Heart Can Decrease The Blood Flow To Your
Body, Leading To Cardiogenic Shock. Common Causes Of
Cardiogenic Shock Include:
• Damage To Your Heart Muscle
• Irregular Heart Rhythm
• Very Slow Heart Rhythm
MEDICAL MANAGEMENT:
• The aim of treatment is to enhance cardiovascular status by:
• Oxygen. Oxygen is prescribed to minimize damage to muscles and
organs.
• Angioplasty and stenting. A catheter is inserted into the blocked artery to
open it up.
• Balloon pump. A balloon pump is inserted into the aorta to help blood
flow and reduce workload of the heart.
• Pain control. In a patient that experiences chest pain, IV morphine is
administered for pain relief.
• 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 overload. therapy. Administration of fluids must be monitored
closely monitored signs of fluid
NURSING MANAGEMENT :
• The appropriate nursing interventions for a patient with cardiogenic shock
includes:
• 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 equipment must be
well maintained and functioning; changes in hemodynamic, cardiac, and
pulmonary status and laboratory values are documented and reported; and
adventitious breath sounds, changes in cardiac rhythm, and other abnormal
physical assessment findings are reported immediately.
Distributive shock
• Conditions that cause your blood vessels to lose their tone can cause
distributive shock. When your blood vessels lose their tone, they can
become so open and floppy that not enough blood pressure supplies
your organs. Distributive shock can result in symptoms including:
• flushing
• low blood pressure
• loss of consciousness
TYPES OF DISTRIBUTIVE SHOCK
• Anaphylactic shock: is a complication of a severe allergic
reaction known as anaphylaxis. Allergic reactions occur when
your body mistakenly treats a harmless substance as harmful.
This triggers a dangerous immune response.
• Anaphylaxis is usually caused by allergic reactions to food,
insect venom, medications, or latex
SEPTIC SHOCK:
• Septic shock : is another form of distributive shock. Sepsis, also
known as blood poisoning, is a condition caused by infections that
lead to bacteria entering your bloodstream. Septic shock occurs
when bacteria and their toxins cause serious damage to tissues or
organs in your body.
• Drug toxicities and brain injuries can also lead to distributive
shock.
NEUROGENIC SHOCK:
• Neurogenic shock is caused by damage to the central nervous
system, usually a spinal cord injury. This causes blood vessels
to dilate, and the skin may feel warm and flushed. The heart
rate slows, and blood pressure drops very low.
Hypovolemic shock:
• Hypovolemic shock is characterized by decreased
intravascular volume and increased systemic venous assistance
(compensatory the mechanism to maintain perfusion in the
early stages of shock). In the later stages of shock due to
progressive volume depletion, cardiac output also decreases
and manifest as hypotension. Hypovolemic shock divides into
two broad subtypes:
• Hemorrhagic And Non-hemorrhagic.
HEMORRHAGIC SHOCK:
• Common Causes Of Hemorrhagic Hypovolemic Shock Include
• Gastrointestinal Bleed (Both Upper And Lower Gastrointestinal Bleed (E.G.,
Variceal Bleed, Portal Hypertensive Gastropathy Bleed, Peptic Ulcer,
Diverticulosis) Trauma
• Vascular Etiologies (E.G., Aortoenteric Fistula, Ruptured Abdominal Aortic
Aneurysm, Tumor Eroding Into A Major Blood Vessel)
• Spontaneous Bleeding In The Setting Of Anticoagulant Use (In The Setting Of
Supra therapeutic INR From Drug Interactions)
NON-HEMORRHAGIC SHOCK:
• Common Causes OF Non-hemorrhagic Hypovolemic Shock Include:
• Gi Losses - The Setting Of Vomiting, Diarrhea, Ng Suction, Or Drains.
• Renal Losses - Medication-induced Diuresis, Endocrine Disorders Such
As Hypoaldosteronism.
• Skin Losses/Insensible Losses - Burns, Stevens-johnson Syndrome, Toxic
Epidermal Necrolysis, Heatstroke, Pyrexia.
• Third-space Loss - In The Setting Of Pancreatitis, Cirrhosis, Intestinal
Obstruction, Trauma.
MEDICAL MANAGEMENT
• Volume expansion. Saline solution or lactated Ringer’s
solution, then possibly plasma proteins or other plasma
expanders, may produce adequate volume expansion until
whole blood can be matched
• Redistribution of fluid. Positioning the patient properly assists
fluid redistribution, wherein a modified Trendelenburg
position is recommended in hypovolemic shock.
NURSING MANAGEMENT
• Safe administration of blood. It is important to acquire blood
specimens quickly, to obtain baseline complete blood count,
and to type and cross match the blood in anticipation of blood
transfusions.
• Safe administration of fluids. The nurse should monitor the
patient closely for cardiovascular overload, signs of difficulty
of breathing, pulmonary edema, jugular vein distention, and
laboratory results.
• Monitor vital signs. Monitor vital signs of patients with
deficient fluid volume every 15 minutes to 1 hour for the
unstable patient, and every 4 hours for the stable patient.
