07.08 Shock

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Overview

  1. Shock
    1. Overview
    2. Hypovolemic
    3. Cardiogenic
    4. Neurogenic
    5. Septic Shock

Nursing Points

General

  1. Overview
    1. Decreased oxygen
    2. Decreased blood flow
    3. Results in tissue and organ damage
    4. Recognizing symptoms of shock
      1. Low blood pressure
      2. Excessively high or low temperature
      3. Cool or clammy skin
      4. Change in mentation
      5. Rapid heart rate
      6. Decreased urine output
  2. Hypovolemic
    1. Low volume
    2. Causes
      1. Trauma
      2. Injury
      3. Surgery
    3. Treatment
      1. Correct volume loss
  3. Cardiogenic
    1. Broken pump
    2. Causes
      1. Heart attack
      2. Heart failure
    3. Treatment
      1. Increase contractility
  4. Neurogenic
    1. Nervous system disruption
      1. Loss of sympathetic tone
        1. No “input” to circulatory system
        2. Creates loss of pressure and decreased cardiac output
    2. Causes
      1. Trauma
      2. Injury
      3. Surgery
    3. Treatment
      1. Manage low blood pressure
      2. Allow time for healing
  5. Septic shock
    1. Systemic inflammation and infection
    2. Causes
      1. Infection
    3. Treatment
      1. Manage pressure
      2. Treat infection

Nursing Concepts

  1. Perfusion
  2. Oxygenation
  3. Cellular Regulation
  4. Patient-Centered Care

Reference Links

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Video Transcript

In this lesson we’re really going to focus on the important points of shock.

Before you really get started, what you need to know is that there are lessons on each one of the types of shock that we’re going to go over today, so we’re really just going to hit the high points.

The most important thing that you need to know about shock is that it’s inadequate perfusion to organs and tissues. What do I mean by that?

Well, what I mean is that shock is the result of decreased oxygen and decreased blood flow that affects organs and tissues, and is most commonly characterized by low blood pressure, and there’s usually a primary cause.

But your main job is to recognize shock early and intervene. Let’s go over some general symptoms real quick. Your patient may have a rapid heart rate, low blood pressure, decreased urine output, excessively high or low temperatures, cool or clammy skin and maybe they are confused, dizzy or have a change in consciousness. Pay attention to these signs, because they could be pointing you to early signs of shock.

For today, we’re going to hit the four most common ones – hypovolemic, cardiogenic, neurogenic and septic shock.

Now remember, there are lessons that go much more into depth then these, but I really just want to hit the high points. So be sure to check those other lessons out.

Hypovolemic shock is where your patient basically loses volume inside the blood vessels, and as a result they don’t get oxygen and blood delivered to all the tissues.

Most common types of causes of this are trauma, injury, or surgery. So you’ll see things like gunshot wounds, stab wounds, bleeding after surgery, or other things like that. Because the blood isn’t staying where it’s supposed to, the overall volume decreases, and they end up getting low blood pressure, the heart can’t keep up, and tissues are affected.

The best way to treat this is to actually increase the volume, and this is commonly done with fluids and blood transfusion. Also it’s really important to identify the cause of the hypovolemia so that you can stop the bleeding.

Now look at cardiogenic shock.

Now if we were remember, the heart is a pump. And if the pump is broken, it can’t get out the fluid that it needs to. So for our patients that are in cardiogenic shock, the pump is broken, and because it’s broken, it won’t deliver blood and oxygen to the tissue and organs.

When that happens, what ends up happening is that tissue is damaged, and the blood vessels begin to not respond and a blood pressure drops. This actually creates another problem and that the heart itself is not getting enough blood supply, actually create damage to the heart itself. The most common causes of cardiogenic shock are heart attack and heart failure.

So what we want to do in order to fix this, is essentially to increase the contractility of the heart or increase the pump so that every squeeze pushes out more blood and supplies more oxygen to the tissue. Another thing that we can focus on to in correcting. So if your patient is having a heart attack, if you correct the heart attack, Then you can improve perfusion to the heart, and correct the cardiogenic shock. But in the meantime, we want to make sure that we’re supporting that blood pressure with fluids.

Now we’re going to take a look at neurogenic shock.
Neurogenic shock is going to be a little bit more complicated, because we have to understand a little bit better. But the thing that we need to remember is that the nervous system supplies a signal to the body and to all the organs. It also supplies a signal for the blood vessels to constrict and relax, and also for the heart to beat a certain way.

With neurogenic shock, there’s an injury to the nervous system, and it basically turns the signal to the blood vessels in the heart either off or turns it down. We call the signal to the blood vessels and heart sympathetic tone. So there is a loss of sympathetic tone. And when it does that everything relaxes, and you get this drop in blood pressure. So what you have to do in the meantime is that you have to support the patient’s blood pressure with fluids and medications that help constrict the blood vessels, and allow the spinal cord in the nervous system to heal so that it actually starts to kick in. Neurogenic shock is really about supportive therapy for the patient and managing the blood pressure to make sure that it’s getting the right amount of oxygen and blood and nutrients.

Now I’m sure you’ve all heard of septic shock or sepsis, and what we’re really going to focus on is that septic shock is the body’s response to an infection in a very very dramatic and bad way. Basically the body creates such an inflammatory response to infection that that the body essentially just goes haywire.

And when it does, you get this tissue damage and this response from the immune system where the blood pressure just drops and the patient doesn’t get adequate oxygenation and blood flow to all the tissues. Again, you’re going to have low blood pressure so you want to manage the pressure in these patients, and you also want to work on treating the infection. This is not something that’s just going to correct itself quickly, it’s going to take some time and a lot of support.

For today we really focus on nursing concepts on perfusion and oxygenation and we do this by supporting our patients through patient-centered care.
Okay so let’s recap.

Hypovolemic shock is a loss of volume. So the way you fix that is to make sure that you correct the volume loss.

Cardiogenic shock focuses on the broken pump. So fix the broken pump, and make sure that you support your patients low blood pressure.

Remember that neurogenic shock usually as a result of some for an injury to the spinal cord or the nervous system, so you want to support your patients while their nervous system heals.

Septic shock is a result of inflammation and infection, so make sure you treat the infection, and also make sure that you’re focusing on managing your patients blood pressure while they heal.

And most importantly, shock is a result of not getting oxygen in blood to the tissues, usually by low blood pressure. So find the cause, and support the patient’s blood pressure so that you can get the oxygen in blood to all those necessary tissues.

So that’s our lesson on shock.Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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  • Question 1 of 10

A 22-year-old client has suffered a spinal cord injury in which he is experiencing spinal shock and cannot feel his legs. Twenty-four hours after the injury, the client tells the nurse, “This will be good for me. I can handle this and I’m doing fine.” Which response from the nurse is most likely indicated?

  • Question 2 of 10

A 28-year-old client is brought to the emergency department after a motor vehicle accident and has suffered a fractured pelvis. The client is demonstrating signs of hemorrhagic shock as a result of his injuries. Which of the following types of fluids would be most appropriate to administer initially during the resuscitation period?

  • Question 3 of 10

A client who had surgery two days ago has developed a systemic bloodstream infection and has entered a state of septic shock. Their vital signs are as follows: HR 108 bpm, RR 30/min, BP 90/50 mmHg, O2 84% on room air, T 101.8 F. Which of the following nursing diagnoses would be most appropriate for this client? Select all that apply.

  • Question 4 of 10

A nurse is assisting with placement of a pulmonary artery (PA) catheter to monitor a patients hemodynamic status and prevent cardiogenic shock. During placement of the catheter, the physician initially moves the tip of the catheter through the superior vena cava, into the right atrium, and then into the right ventricle while the nurse watches the monitor. While the catheter tip is in the right atrium, the nurse would expect to see systolic pressures of:

  • Question 5 of 10

A client who was diagnosed with heart failure has developed cardiogenic shock as a complication of the condition and needs an intra-aortic balloon pump placed. Which of the following statements accurately describes an intra-aortic balloon?

  • Question 6 of 10

A client who has been injured in a construction accident is bleeding profusely from a femoral artery laceration. The nurse estimates that the client has lost 700 mL of blood. The client has the following vital signs: HR 98 bpm, BP 100/70 mmHg, RR 20/min. In which class of hypovolemic shock would this client be classified?

  • Question 7 of 10

A nurse is assessing a client. Which of the following behaviors would indicate the client is in shock?

  • Question 8 of 10

Which best describes the difference between septic shock and multiple organ dysfunction syndrome (MODS)?

  • Question 9 of 10

A nurse is caring for a client who is experiencing postpartum hemorrhage as a result of uterine atony. In which position should the nurse place the client that would best help to prevent hemorrhagic shock?

  • Question 10 of 10

A nurse is assessing a client. Which of the following signs and symptoms would indicate the client is in shock? Select all that apply.

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