Shock: Shock Can Refer To A Range of Related Medical Conditions in Which The Victim's Heart, Lungs and
Shock: Shock Can Refer To A Range of Related Medical Conditions in Which The Victim's Heart, Lungs and
Shock: Shock Can Refer To A Range of Related Medical Conditions in Which The Victim's Heart, Lungs and
Introduction
Shock can refer to a range of related medical conditions in which the victim's heart, lungs and
blood cannot deliver oxygen to the body properly. Shock is not a diagnosis or condition, it is
always a symptom of a larger problem, and is a medical emergency that requires immediate
attention. One should never confuse true shock with a feeling of extreme surprise - one does not
lead to the other.
Definition
mate interventions before shock ensues. Shock is defined as failure of the circulatory system to
maintain adequate perfusion of vital organs. Disorders lading to inadequate tissue perfusion
result in decreased oxyenation at the cellular level. Inadequate oxygen results in anaerobic
cellular metabolism and accumulated waste products in cells. If this condition is untreated, cell
and organ death occur.
classification
Hypovolemic
due to inadequate circulating blood volume resulting from haemorrhage with actual blood loss,
burns with a loss of plasma proteins and fluid shifts, or dehydration with a loss of fluid volume.
It is the most common type of shock and develops when the intravascular volume decreases to
the point where com peasantry mechanisms are unable to maintain organ and tissue perfusion.
Cardiogenic shock
that early Cardiogenic shock is due to inadequate pummping, of the heart because of primary
cardiac muscle dysfunction or mechanical obstruction of blood flow caused by myocardial
infarction (MI), valvular insufficiency caused by disease or trauma, cardiac dysrhythmias, or all
obstructive condition, such as pericardial tamponade or pulmonary embolus.
incidence
Etiology of shock was more distributed with 26.9% of patients in cardiogenic shock, 16.8%
distributive, and 10.7% classified as mixed.
Distributive shock
(also called 1rasogenic shock) is due to changes in blood vessel tone that increase the size of the
vascular space without an increase in the circulating blood volume. The result is a relative
hypovolemia (total fluid volume remains the same but is redistributed). Distributive shock is
further divided into three types:.
Anaphylactic shock. A severe hypersensitivity reaction resulting in massive systemic
vasodilation.
Neurogenic shock interference with nervous sys tem control of the blood vessels, such as with
spinal cord injury ( cervical spine injury , spinal anaesthesia, or severe vasovagal reactions
caused by pain or psychic trauma.
Septic shock, caused by a release of vasoactive sub stances
1.Hypovolemic shock
due to inadequate circulating blood volume resulting from haemorrhage with actual blood loss,
burns with a loss of plasma proteins and fluid shifts, or dehydration with a loss of fluid volume.
It is the most common type of shock and develops when the intravascular volume decreases to
the point where com peasantry mechanisms are unable to maintain organ and tissue perfusion.
Hypovolemic shock is a life-threatening condition that results when you lose more (1_25 20)
percent (500_1500) of your body’s blood or fluid supply. This severe fluid loss makes it
impossible for the heart to pump a sufficient amount of blood to your body. Hypovolemic shock
can lead to organ failure.
Etiology
Hypovolemic shock results from significant and sudden blood or fluid losses within your body.
Blood loss of this magnitude can occur because of:
Endometriosis
headache
fatigue
Severe symptoms
headache
fatigue
Weakness
Thirst
Dizziness.
The more severe signs and symptoms are often associated with hypovolemic shock. These
include
oliguria
cyanosis
abdominal and chest pain
hypotension
tachycardia, cold hands
and feet
progressively altering mental status.
2.Cardiogenic shock
that early Cardiogenic shock is due to inadequate pummping, of the heart because of primary
cardiac muscle dysfunction or mechanical obstruction of blood flow caused by myocardial
infarction (MI), valvular insufficiency caused by disease or trauma, cardiac dysrhythmias, or all
obstructive condition, such as pericardial tamponade or pulmonary embolus.
Pathophysiology
Cardiogenic shock is characterized by inadequate tissue perfusion due to cardiac dysfunction,
and it is often caused by acute myocardial infarction.The pathophysiology of cardiogenic shock
involves a vicious spiral circle: ischemia causes myocardial dysfunction, which in turn
aggravates myocardial ischemia. Myocardial stunning and/or hibernating myocardium can
enhance myocardial dysfunction, thus, worsening the cardiogenic shock. Low perfusion
pressures with global ischemia leads to muthliorgan dysfunction.
Symptoms
Cardiogenic shock signs and symptoms include:
Rapid breathing
Severe shortness of breath
Loss of consciousness
Weak pulse
Sweating
Pale skin
Septic Shock
Causes
Pathophysiology
Sepsis is the systemic response to infection. The process begins with the growth of
microorganisms at the site of infection, organisms may invade the bloodstream directly or may
remain in one area. organisms release various substances into the blood stream such as
endotoxins and elements synthesized them called exotoxins. Once these substances are released
into the body they activate the
Neurogenic Shock
Pathophysiology
With injury to he cervical spine, the autonomic nervous system is afected, Below the level of
injury, there is blocking of sympathetic nervous stimulation and the parasympathetic system goes
unopposed. This unopposed stimulation causes vasodilation, decreased venousreturn], decrease
cardiac output, and decreased tissue perfusion), Teaching clients safety measures may help
prevent spinal Cord in jury and neurogenic shock. Health maintenance actions are to protect the
client 's spine, maintain the client' s airway and breathing, pro vide circulatory support, and
provide for thermoregulation tion). Health restoration involves rehabilitation when the client is
stable,
complement cascade and a complex shock occurs.
forms of result, The massive distributive shock has several major causes. Acute Allergic
Reaction (
Anaphylactic Shock
Anaphy - begin lactic shock occurs as a result of an acute allergic reintion from exposure to a
substance to which the client has alemd been sensitized. Common sensitizing agents are peni
berries, peanuts, snake venom, iodine - based coritrast for X - ray studies, foods, and
nonsteroidal anti - inflammatory drugs (NSAIDs). Re - exposure to the foreign substance results
in the offending antigen binding to previously made in immunoglobulins (i, e, lgE) located on
the mast cell. This binding causes the release of several chemical mediators from the cell, such
as histamine, platelet - activating factor leukotrienes, and prostaglandins (see Chapter 78)
Manifestations include massive vasodilation, Urticaria (hives), laryngeal derma, and bronchial
construction, Without prompt treatment, a person with anaphylactic shock will die of
cardiovascular collapse and respiratory failure
Symptoms
fever
confusion
dizziness
Tachypnea
Cyanosis
Electrocardiogram (ECG).
Chest X-ray
Cardiac catheterization (angiogram).
Blood test
Blood count
WBC
Body fluid study
ABG
RFT
Electrolyte test
Treatment
Hypovolemic shock treatment
blood loss
Stop external bleeding With direct pressure dressing tomiquet (as last resort) .
Reduce intra - abdominal or retroperitoneal bleeding by applying Mas garment of prepare
for emergency Surgery lesion, tubes Administer lactated Ringer 's solution of normal
saline Transfuse with fresh whole blood ,packed Cells, fresh frozen Plasma platelets, or
other Clotting factors,
if significant improvement does riot occur with crystalloid administration.
Use non - blood plasma expanders (albumnin, hetastarch dextran blood is available
Conduct autotransfusion if appropriate
Plasma loss
Administer low dose Cardiotonics (dopamine dobutamine)
Administer lactated Ringer 's solution of normal saline Administer albumnin. fresh frozen
plasma, hetastarch, or dextran if cardiac output is still low
Crystalloid loss
Administer isotonic or hypotonic saline with electrolytes as needed tomaintain normal
circulating volume and electrolyte balance.
surgery for removal of clot or air accumulation with needle thoracotomy or chest tube in
insertion.
prepare for prompt cardiac surgery.
Underlying causes (injury..GIT bleeding...)
Lay the person flat, face - up, but do not move him or her if you suspect a head, back, or neck
injury. . Raise the person's feet about 2 inches. Use a box, etc. If raising the legs will cause
pain or further injury, keep him or her flat. Keep the person still.
Do not raise the feet or move the legs if hip or leg bones are broken. Keep the person lying flat.
Fluid and blood replacement: Open MV line on both hands with two wide bore Cannula and start
fluid rapidly as advised
Turn the person on his or her side to prevent choking if the person vomits or bleeds from the
mouth. Keep the person warm and comfortable.
Loosen belt (s) and tight clothing and cover the person with a blanket
: Even if the person complains of thirst, give nothing by mouth. If the person wants water,
moisten the lips.
Decreased Cardiac Output: Inadequate blood pumped by the heart to meet metabolic demands
of the body.
May be related to
Possibly evidenced by
Desired Outcomes
Client will maintain adequate cardiac output, as evidenced by strong peripheral pulses,
systolic BP within 20 mm Hg of baseline, HR 60 to 100 beats per minute with regular
rhythm, urinary output 30 ml/hr or greater, warm and dry skin, and normal level of
consciousness.
Deficient Fluid Volume
May be related to
Active fluid volume loss (abnormal bleeding, diarrhea, diuresis or abnormal drainage).
Internal fluid shifts.
Inadequate fluid intake and/or severe dehydration.
Regulatory mechanism failure.
Trauma.
Possibly evidenced by
Desired Outcomes
May be related to
Possibly evidenced by
Desired Outcomes
Client will maintain maximum tissue perfusion to vital organs, as evidenced by warm
and dry skin, present and strong peripheral pulses, vitals within patient’s normal
range, balanced I&O, absence edema, normal ABGs, alert LOC, and absence of
chest pain.
May be related to
Change in health status.
Fear of death.
Unfamiliar environment.
Possibly evidenced by
Agitation.
Apprehensive.
Difficulty in concentrating.
Increased awareness.
Increased questioning.
Sympathetic stimulation.
Verbalized anxiety.
Desired Outcomes
Complication
Cardiopulmonary arrest.
Dysrhythmia.
Renal failure.
Multisystem organ failure.
Ventricular aneurysm.
Thromboembolic squealed.
Stroke
DIC
Death.
Health Education
Teaching clients safety measures may help prevent spinal Cord in jury and neurogenic shock.
Encraging clients to treat infections immediately and completely may help reduce the incidence
of septic shock , older and immune compromised clientits should be closely monitored closely
For infection and treatment should begin immediately when infection is diagnosed. Shock is a
serious development, Identify high - risk clients and implement measures to prevent shock
whenever possible.
To help prevent the onset of anaphylactic shock clients to avoid precipitators and to use
epinephrine injection (e.. EpiPen). Encouraging clients to wearmedical alert bracelets and to
seek allergy desensitizah also decreases their potential for anaphylactic shock for receives
Prevention of cardiogenic shock related to MI begins with health promotion activities directed at
client education for decreasing the risk factors associated with coronary artery disease (
increasing exercise modifying dietary intake) Supportive oxygenation and administrate tion of
inotropic agents and vasodilators are health maintenance activities
Conclusion
Treatment should generally be instituted for shock whenever at least two of the following three
conditions occur: systolic BP of 80 mm Hg or less, pulse pressure of 20 mm Hg or less, and
pulse rate of 120 or more.
REFRENCES
1. Medical surgical Nursing
EIGHTH EDITION
Joyce Black
PHD, RN, CPSN, CWSN, Associate professor
College of nursing University of Nebraska Medical Centre OMAHA Nebraska
2. Medical and surgical Textbook
Edited by,
WILMA J. PHIPPS. PhD, RN,FAAN
Professor Emeritus of Medical-Surgical Nursing
3. Internet references.
4. Medical and surgical Nursing
7th edition
Joyce M. Black & Jane Hokanson Hawks
Volume-1
Saunders publisher
5. Medical surgical Nursing
2 edition
BT Basavanthappa
Japee publisher