Types of Shock
and
the Management
Prepared by: Mazin Mohammed Al abri
Designation: Staff Nurse
Staff Number: 61621
Hypovolemic Shock
Cardiogenic Shock
Definition
- Definition
- Causes
- Signs & symptoms
- Medical management
- Nursing management
- Collaborative care :
- (Oxygenation, Circulation ,Drug therapy , Supportive therapies )
Septic Shock
Occurs when the volume of the circulatory system lost more than 20 percent (one-fifth) of your body’s blood or fluid supply.
Causes
Introduction
- Bleeding
- Severe burn
- excessive diarrhea
- protracted and excessive vomiting
- could be other type of shock ( cardiogenic or septic)
- Definition
- Causes
- Signs & symptoms
- Medical management
- Nursing management
- Collaborative care :
- (Oxygenation, Circulation ,Drug therapy , Supportive therapies )
Signs & symptoms
- low or no urine output
- shallow breathing,
- dizziness, Confusion or even coma,
- low BP, rapid HR, weak P
- Look pale
Nursing management
Definition
Reference
Is occurring when the heart has been damaged to the point where it is unable to pump enough blood to the organs as body need. As a result of that, blood pressure begins to fall and organs may begin to fail.
Is a serious condition of a full-body inflammatory response as a complication of an infection where toxins can leads to life-threatening low blood pressure.
- Pharmacologic therapy
- Monitoring hemodynamic status
- Administering medications and IV fluids
- Maintaining Intra-Aortic balloon counter pulsation
- Enhancing safety and comfort
Medical management
Causes
- Treatment of the underlying cause
- Fluid and blood replacement
- Redistribution of fluid
- Pharmacologic therapy
Gram-negative and gram-positive bacteria.
Collaborative care
- Drug therapy
- Nitrates (e.g., nitroglycerin)
- Inotropes (e.g., dobutamine)
- Diuretics (e.g., furosemide)
- B-Adrenergic blockers
- Aspirin
- Thrombolytics
Signs & symptoms
Medical management
- Fluid replacement therapy
- Pharmacologic therapy:
- IV antibiotics to fight infection
- vasopressor and inotropes Drugs to treat low blood pressure
- Oxygen
- Nutritional therapy
- Sedatives
- Surgery if needed
- Increased CO in ABG and decreased SVR
- Low BP
- Low urine output
Nursing management
- Hemodynamic monitoring
- Physiotherapy should be used if there are clinical signs of a chest infection
- Nutritional support.
- Oxygen therapy
- Fluid/electrolyte management
Collaborative care
- Drug therapy
- Vasopressor (e.g., dopamine)
- Inotropes (e.g., dobutamine)
- Anticoagulation (e.g, low-molecular-weight heparin)
- Antibiotic as ordered
Objectives
Signs & symptoms
Nursing management
- consider as one of life threating condition
- The care providers must appreciate the physiologic and pathologic effects and management of the shock
- And understanding of some vasoactive medication that is essential for a proper management.
- Administering blood and fluid safely
- Hemodynamic monitoring
- Monitor intake and output.
- Assess color and amount of urine.
- Medication administration
- Monitor serum electrolytes
- Nutritional support
- Tachycardia
- Hypotension
- a narrowed pulse pressure
Causes
Medical management
Collaborative care
Types of Shock and their classification
- Drug therapy:
- Vasopressor (e.g., dopamine)
- MI
- Cardiomyopathies
- blunt cardiac injury
- Correction of underlying causes
- Initiation of first-line treatment:
- Oxygenation
- Pain control
- Hemodynamic monitoring
- Laboratory marker monitoring
- Fluid therapy
- Hilarie Surrena, Renee Gagliardi, Martha Cushman\Megan Klim Duttera, Jobi Bukowski, Joan Wendt, Brett MacNughton\Bob Galindo, Karin Duffield, Aptara. Icu, (2010),BRUNNER & SUDDARTH’S Textbook of Medical-Surgrical Nursing, 12th EDITION,philadephia, Lippincott, Cina ,Library of Congress Cataloging, chapter 15,pp(312-335)
- L.Lewis Sharon, Mclean Heitkemper Margaret, Ruff Dirsksen Shannon, Graber O'Brien Patricia, Bucher Linda (2004). Assessment and Management of Clinical Problems, Medical-Surgical Nursing, 7th EDITION,philadephia,Lippincott, Nursing Management, chapter 67,pp(1772-1798)
- Refried on 23.12.2013:Indian J Plast Surg. 2010 September; 43(Suppl): S29–S36. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038406/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038406/
- Refried on 1.12.2013: - Management of hyperglycaemia. Resistance to insulin is common (Bongard and Sue, 2002).http://www.nursingtimes.net/managing-patients-with-sepsis-in-the-general-ward-environment/199628.article
- Refried on 1.12.2013: http://www.nlm.nih.gov/medlineplus/ency/article/000185.htm .S. National Library of Medicine 8600 Rockville Pike, Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: 31 October 2013
The participants will be able to:
- Describe the organ damage that may occur with shock
- Compare hypovolemic, cardiogenic and distributive shock in terms of causes, pathophysiologic effects and describe the medical and nursing management
- Identify the vasoactive medications used in treating shock and describe the nursing implication associated with their use
Definition of shock
- Low Blood Flow
- Maldistribution of Blood Flow
"Shock, is a life-threatening medical condition that in which widespread perfusion to the cells is inadequate to deliver oxygen and nutrients to support vital organs and cellular function."
( VonRueden, Bolton & Vary 2008, p313)
Definition
Is an acute and life-threating hypersensitivity (allergic) reaction to a sensitizing substance
Low Blood Flow
Compensatory stage
Maldistribution of Blood Flow
In the compensatory stage, the body activates neural, hormonal, and biochemical compensatory mechanisms in an attempt to overcome the increasing consequences of anaerobic metabolism and to maintain homeostasis.
(Renee Gagliardi,2010)
- Cardiogenic
- Hypovolemic
- Absolute Hypovolemic
- Relative Hypovolemic
- Neurogenic
- Anaphylactic
- Septic
Definition
Causes
Causes
Nursing management
Is a hemodynamic phenomenon that can occur within 30 minutes of a spinal cord injury at the fifth thoracic (T5) vertebra or above and last up to 6 weeks.
- Spinal cord injury
- Spinal anesthesia
- Or other nervous system damage
Severe allergic reaction when patient who have already produced antibodies to foreign substance (antigen) develop a systematic antigen-antibody reaction.
Stages of Shock
- The nurse must be knowledgeable about the clinical signs of anaphylaxis
- Must be prepared to begin CPR if cardiorespiratory arrest occurs
Signs & symptoms
Anaphylactic Shock
Collaborative care
- Drug therapy
- Antihistamines (e.g., diphenhydramine)
- Epinephrine
- Bronchodilators nebulized
- Corticosteroids (if hypotension persists)
- hydrocortisone (after initial resuscitation)
- Hypotension
- Bradycardia
- an inability to regulate temperature
- massive vasodilation
- Compensatory stage
- Progressive stage
- Irreversible stage
- Definition
- Causes
- Signs & symptoms
- Medical management
- Nursing management
- Collaborative care :
- (Oxygenation, Circulation ,Drug therapy , Supportive therapies )
Medical management
- Stabilizing of spinal cord injury
- Specific treatment depend on the cause of shock
- If hypoglycemia is the cause, glucose is rapidly administered
Progressive stage
Irreversible stage
The progressive stage of shock begins as compensatory mechanisms fail. In this stage, aggressive interventions are necessary to prevent development of multi organ dysfunction syndrome.
(Renee Gagliardi,2010)
Collaborative care
The irreversible (or refractory) stage of shock represents that point along the shock continuum at which organ damage is so severe that the patient does not respond to treatment and cannot survive.
(Renee Gagliardi,2010)
- Drug therapy :
- Vasopressors (e.g., phenylephrine)
- Atropine (for bradycardia)
Nursing management
Medical management
Signs & symptoms
- Positioning the patient properly
- Supporting cardiovascular and neurologenic function until the usually transient episode of neurogenic shock resolve.
- Removing the causative antigen
- Administering medication that restore vascular tone
- Providing emergency support of basic life function
- Dizziness
- Tachycardia
- chest pain
- Shortness of breath
- Incontinence
- swelling of the lips and tongue
- wheezing and stridor.
Neurogenic Shock