SHOCK ;CARDIOGENIC, ANAPHYLATIC, NEUROGENIC, HYPOVOLEMIC, SEPTIC SHOCK

SHOCK#MEDICAL-SURGICAL NURSING

2. SHOCK
Presented by,
Ms. Gautami Tirpude
S.Y.MSc Nursing,
B.V.C.O.N, Pune

3. Master Outline
Introduction
Definition of shock.
Review of anatomy and physiology.
classification of shock.
causes of shock.
clinical manifestation of shock.
complication of shock.
Nursing management of shock
Summary, Conclusion, Bibliography

4. INTRODUCTION
•Shock is a condition in which tissue
perfusion is inadequate to deliver
oxygen and nutrients to support vital
organ and cellular function.

5. Anatomy of heart and
Skin

6. Anatomy of Spinal Cord
And Blood Vessels

7. CLASSIFICATION OF SHOCK
1.•Cardiogenic shock
2.•Hypovolemic shock
3.•Septic shock
4.•Anaphylactic shock
5.•Neurogenic shock

8. It happens when the heart is
damaged and unable to supply
sufficient blood to the body.

9. CONTD.
Causes
•Acute myocardial infarction resulting
in massive damage to myocardium.
•CHF ,Pulmonary embolism
•Cardiac temponade
Cardiomyopathy
•Hypovolemia,Septicemia

10. CONTD.
Clinical features
•—Decreased cardiac out put
•Pulmonary oedema
•Chest pain
•Weak or absent pulse
•Tachycardia
•Shortness of breath

11. •It is a serious and life-threatening medical
condition which occurs when a person has
lost more than 20% of the body’s blood or
fluid.
•This severe loss of body fluids leads to
substantial decrease in the ability of the
heart to pump sufficient amount of blood
to the entire body.

12. CONTD.
CAUSES
•Severe bleeding e.g. ; PPH, ectopic pregnancy,
uterus rupture , severe polytrauma, hematemesis,
haemoptysis.
•Severe persistent vomiting eg ;minor and major
disorder in pregnancy , prolong vomiting.
•Severe diarrhea eg ; cholera
•Diuresis and rapid removal of amniotic fluid.
•Severe burns
•Inadequate fluid

13. CONTD..
CLINICAL FEATURES
•Decreased cardiac out put
•Hypotension
•Cool and clammy skin
•Cyanosis
•A rapid, weak pulse
•Anxiety, restlessness
• Dry mouth
• Oliguria <20 ml/hr

14. CONTD.
•—Nausea and vomiting , thirst
•—Irritability
•—Respiration rate rapid >20b/min,
shallow —Increased serum electrolyte
,bloodglucose ,serum creatinine ,
sodium, potassium
•—Anuria , renal failure

15. •Septic shockresults from bacteria
multiplying in the blood and
releasing toxins.
•It is the most common type of
shock.

16. CONTD.
Causes
•Pneumonia,urinary tract infections,
skin infections (cellulitis), intra-
abdominal infections (such as a
rupturedappendix), andmeningitis.
•Indwelling lines and catheter
•Improper wound care and
management

17. CONTD.
•Clinical features
•Pyrexia
•Hypotension
•Warm and sweaty skin
•Skin rash
•Low or absent urine output
• Headache
•Reduced contractility of the heart

18. Anaphylactic shockis a type of severe
hypersensitivity orallergicreaction.
•Causesincludeallergyto insect stings,
medicines, or foods (nuts, berries,
seafood), Blood
Transfusion,
Dusting smokes,
Sudden climate changes

19. CONTD..
Clinical features
•—Breathlessness and cough
•Tachycardia and tachypnea
•Localized oedema specially around the face
•Laryngeal oedema
•Hypotension
•Cyanosis

20. •Neurogenicshock is a distributive type
of shock resulting in low blood pressure,
occasionally with a slow heart rate,
•That is attributed to the disruption of
the autonomic pathways within the spinal
cord.

21. Contd.
•Neurogenicshockis caused byspinal
cord injury, usually as a result of a
traumatic accident or injury.

22. Clinical features
•Hypotension
•Altered mental status
•Bradycardia
•Skin is warm and dry
•Tachycardia and tachypnea

23. DIAGNOSTIC EVALUATION
•History taking and physical examination
•Complete blood count-Heamogram, blood
pH, lactic Acid
•Arterial Blood Gases (ABG) analysis
•Urinalysis
•CVP Measurement
•Blood, urine, sputum culture
•Kidney function test
•Cardiac catheterization and coronary
angiography
•Chest X ray
•Echocardiogram
•Computer tomogragry

24. PREVENTION OF SHOCK
•Hypovolemicshock can be prevented in some
instances by closely monitoring patients who is at
risk for fluid deficit and assisting with fluid
replacement before Intravascular volume is
depleted.
•Safe administration of prescribed fluids and
medication and proper documentation, monitoring
sign of complication and side effects and early
reporting

25. Contd..
•Safe blood administration
•Cross match grouping before BT.
•Patient receiving BT must be closely monitored
for adverse effect.
–Proper care of wound and using aseptic
technique in any invasive procedures.
–Proper pain management.
–Skin test should be done before giving
antibiotics as anaphylaxis reaction may
occur.
–Early detection and management of
cardiac diseases.

26. Immediate Nursing Care
For Shock
Check for a response.
Give Rescue Breaths or CPR as
needed.
Lay the person flat, face-up, but do
not move him or her if you suspect a
head, back, or neck injury.
Keep the person still and don't move
him or her unless necessary.

27. Raise the person's feet about 12 inches.
Use a box, etc. If raising the legs will
cause pain or further injury, keep him or
her flat.
Check for signs of circulation.

28. Begin CPR if the person shows no
signs of life, such as breathing,
coughing or movement.
Loosen tight clothing and, if needed,
Cover the person with a blanket to
prevent chilling.
Don't let the person eat or drink
anything. (NPO)

29. If the person is bleeding, hold
pressure over the bleeding area,
using a towel or sheet.
If the person vomits or begins
bleeding from the mouth, turn him or
her onto a side to prevent choking,
unless you suspect a spinal injury.

30. •Reassure the person. Make him or her as
comfortable.
•Fluid and blood replacement: Open IV line on
both hands and start fluid rapidly as
advised.
•Vasoactive medication to restore vasomotor
tone and improve cardiac function.
•Nutritional support to address metabolic
requirement.

31. Contd.
–Administer oxygen via face mask.
–Identify the cause and treat
accordingly.

32. Fluid replacement
Intravenous fluid, crystalloids (0.9%
sodium chloride), colloids(Plasma
Protein), or blood products may be
administered to increase or
maintain intravascular fluid volume.

33. Vasoactive medication
A) Vasoconstriction: vasoconstriction
drugs contract the smooth muscle in
blood vessels, which cause the vessels
to constrict.
Eg. Dopamine, Dobutamine, Norepineprrine.
B) Vasodilators: Vasodilators drugs
relax the smooth muscle in blood
vessels, which cause the vessels to
dilate.
• Eg. Nitroglycerin, Sodium
Nitroprusside.

34. Nutritional support
•Nutritional support
refers to enteral or
parenteral provision
of calories, protein,
electrolytes,
vitamins, mineral,
trace elements and
fluids.

35. NURSING MANAGEMENT
•Assessment of the patient in shock
must be carried out quickly and
should always start with the ABCDs.
•Monitor cardiovascular status,
including arterial blood pressure;
rate, rhythm and quality of pulses,
central venous pressure and cardiac
output.

36. •Obtain ABG measurements and
monitor for hypoxemia and acid-
base imbalance
•Monitor SPO2 with a pulse
oximeter.
•Assess ECG rhythm
•Observe and check for vital
signs, peripheral pulses mental
status, heart, lung and bowel
sound, urinary out put.

38. IDENTIFY
•Dehydration
•Heart failure
•Heavy bleeding
•Vomiting or diarrhoea
•Spinal injury
•Drug reaction
•Allergy
•Poisoning
•Burns
•Infection

40. CONCLUSION
•Shock is a life threatening medical
condition where emergency
treatment is require; if untreated,
result in multiple failure , coma and
death will be occur.

41. Books
1. JavedAnsari and Davinder Kaur A Text Book of
Medical Surgical Nursing, Part A, Pee Vee Books,
Chapter No.2 Page no. 159-177.
2. Brunner and Siddharth A Text Book of Medical
Surgical Nursing, Volume 2, 13
th
edition Wolters Kluwer
publishers, Unit No. 5 Page No.460-461.
3. Joseph T. Catalano,CriticalCare Nursing
Certification,SecondEdition,Libraryof congress
cataloguing-in-Publications, Page No. 237-239.
4. BT BasavanthappaEssential of Medical Surgical
Nursing, jaypeePublication, unit no. 5, Page No. 205-
214.
•

42. Journals And Website:-
•journal Medicine & Science in Sports
& Exercise.
•https://medlineplus.gov/ency/article
/000039.htm
•https://en.wikipedia.org/wiki/Shock_
(circulatory)
•https://www.healthline.com/symptom
/shock

43. ASSIGNMENT
•Formulate 5 nursing diagnosis of
hypovolemic shock and write three
nursing care plans for it.