DEFINITION OF SHOCK

Shock is defined as a complex, life

threatening condition or syndrome
characterized by inadequate blood flow to
the tissues and cells of the body.
WHAT HAPPENS IN SHOCK?

1. Inadequate
• 1. Inadequate perfusion

5. Respiratory rate
increases in response 2. Anaerobic
to metabolic acidosis metabolism
& Cell death

4. Metabolic 3. Buildup of
acidosis acidosis lactic Acid
 STAGES OF SHOCK

There are four stages of shock.

a) INITIAL STAGE:

The cardiac output is insufficient to supply the normal nutritional needs of tissues but not low
enough to cause serious symptoms

b) COMPENSATORY STAGE:

The cardiac output is reduced further but due to compensatory vasoconstriction, the BP tends
to remain within the normal range.

Blood flow to the skin and kidney decrease while blood flow to CNS and myocardium is
maintained.
 STAGES OF SHOCK
C) PROGRESSIVE STAGE :

• The unfavorable change become more and more apparent falling BP ,

increased vasoconstriction, increased heart rate and oliguria .

• If compensatory mechanism are unable to cope with the reduced output,

shock becomes progressively more severe and passed onto .
d) IRREVERSIBLE STAGE:

In this stage of shock no type of therapy can save the patients life. BP
decreases, blood volume can be normal in this stage. Fluid transfusion may
restore BP but only temporary. BP declines until DEATH occurs.
 TYPES OF SHOCK

• • A) Hypovolemic Shock

• • B) Cardiogenic Shock

• • C) Neurogenic Shock

• • D) Septic Shock

• • E) Anaphylactic Shock
 HYPOVOLEMIC SHOCK

• It occurs when a significant amount of fluid is lost from the intravascular space, fluid are may
be blood, plasma, electrolytes solution . It is the most common type of shock .

CAUSES
• a) Severe Bleeding : PPH , Ectopic Pregnancy ,Uterus Rupture , Severe Polytrauma ,
Hemopneumothorax , UGI Bleeding , Hematemesis , Haemoptysis.

• b) Severe Persistent Vomiting : Minor and major disorder in pregnancy , prolonged vomiting.

• c) Severe Diarrhea : Cholera

• d) Severe Edemas Or A scities ,Peritonitis , Pancreatitis

 HYPOVOLEMIC SHOCK

CAUSES

• e) Diuresis and rapid removal of amniotic fluid

• f) Severe burns

• g) Inadequate fluid intake

CLINICAL FEATURES OF HYPOVOLEMIC SHOCK

• a) Hypotension • Pulse rapid , weak and thready

• b) Skin cold and clammy • Irritability

• c) Pallor • Dilated Pupil with decreased response to

light
• d) Tachycardia , Tachypnea
• Increased serum electrolyte, blood glucose ,
• e) Restlessness , Anxiety , Weakness
serum creatinine , Sodium, potassium
• f) Altered sensorium
• Unconsciousness
• g) Oliguria<20 ml/hour • Anuria , renal failure
 CARDIOGENIC SHOCK

DEFINITION:
Cardiogenic shock occurs when the heart’s ability to pump blood is impaired.

• This is a condition results from inadequate perfusion of body tissue with oxygenated

blood that is insufficient to sustain life , cardiac output is decreased.

CAUSES

• 1.Acute myocardial infraction

•2.CHF ,Pulmonary Embolism
•3.Cardiac Tamponade, Cardiomyopathy
•4. Myocarditis
CLINICAL FEATURES OF CARDIOGENIC SHOCK
Angina Pectoris

Dysrhythmias

Diminished Heart Sounds

Acute Drop In Blood Pressure > 30 Mm Hg

Tachypneas, Shortness Of Breath

Weak, Thready Pulse

Sweating, Cold Hand & Feet

Urine Output < 30 Ml/Hr

Cool, Pale, Moist Skin

NEUROGENIC SHOCK

INTRODUCTION
• Inability of nervous system to control dilation of blood vessels due to complete loss of sympathetic
tone

• It causes

1. Massive increase in vascular capacity

2. Pooling of blood in peripheral blood vessels

3. Decreased venous return to heart

4. Inadequate blood supply to vital centers

 CAUSES OF NEUROGENIC SHOCK
• Brain traumatic injury

• Brain damage

• Spinal cord injury

• Deep spinal anesthesia

• During LP injury to SC

• Drugs causing sympathetic nervous depression

• Anti snake venom (Neurotoxicity)

CLINICAL FEATURES OF NEUROGENIC SHOCK

• Nervousness

• Loss of Consciousness

• Confusion

• Skin Warm but Dry

• Depressed Respiration

• Hypotension
 ANAPHYLACTIC SHOCK

Anaphylaxis is a life threatening systemic hypersensitivity reaction

contact with an allergen.
CAUSES
• Drugs: Penicillin , Radio Contrast, Lignocaine, Anaesthetic Drug, Iron
injectable etc.
• Blood transfusion
• Stings and Snake Bite
• New clothes
• Dusting Smokes
• Suddenly Climate Change
Clinical features OF ANAPHYLACTIC SHOCK
• Cough, Wheezing, Laryngeal Edema,

• Bronchospasm

• Hypotension, Tachycardia, Palpitation

• Syncope

• Urticaria, Pruritus

• Nausea ,Vomiting

• Seizures

• Respiratory Depression, Cardiovascular Collapse

• Coma
 SEPTIC SHOCK

INTRODUCTION

• It is the most common type of shock and caused by widespread infection due to
gram positive and negative bacteria and viruses.

CAUSES
• UTI , Abortion
• RTA
• Severe Burn
• CSOM
• Chronic Diseases : AIDS
• Indwelling Lines and Catheter
• Improper Wound Care and Management
 CLINICAL FEATURES OF SEPTIC SHOCK

• • Hyperthermia

• • Severe headache
• • Respiration distress
• • Decreased cardiac output
• • Hypotension
• • Skin cold and pale
• • Multiple organ failure
• • Anuria
 Prevention of Shock

 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

 Monitoring sign of complication and side effects and early reporting

 Safe blood administration

 Blood sample should be obtained for CBC, cross match grouping before BT
 Prevention of Shock

 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.

NURSING CARE OF PATIENT with
SHOCK
• Check for a response. Give Rescue Breaths or CPR as needed.

• Check for signs of circulation. If absent, begin CPR

• Start an IV infusion of 5% D/W before BP gets low bcoz it is difficult or impossible to get vein

• Administer whole blood if shock is due to hemorrhage

• Plasma if shock is due to Burns

• Plasma substitute Haemoccel

• In severe cases it may be necessary to give IV in more than one extremity at a time
NURSING CARE OF PATIENT with
SHOCK
•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 12 inches. 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.
•Turn the person on his or her side to prevent choking if the person vomits or bleeds from the
mouth.
•Loosen belt (s) and tight clothing and cover the person with a blanket.
•NPO: Even if the person complains of thirst, give nothing by mouth. If the person wants water,
moisten the lips.
NURSING CARE OF PATIENT ON
SHOCK
• Monitor Level of consciousness

• Keep the patient warm but not over heated (NO HOT WATER BOTTLES)

• Over heating causes dilation of cutaneous blood vessels which take away blood
from vital organs

• Give warm drinks if he is able to take

• Insert retention catheter and measure and record output every hour or as orders

• Monitor and record BP at regular intervals & Notify Dr if changes

NURSING CARE OF PATIENT ON
SHOCK
• Supplemental Oxygen by Nasal cannula @ 2-6 l/mt ( SPO2>90%)

• Monitor ABG and Spo2

• Hemodynamic Monitoring- BP, Intra Arterial BP, ECG

• Fluid Therapy- RL, NS, Dextran

• Dobutamine :
• Increase the strength of myocardial contraction and improves CO
NURSING CARE OF PATIENT ON
SHOCK
• Monitor Vital signs frequently

• Watch for changes in skin color & report if cyanosis and administer O2

• Provide psychological support to patient

• Be gentle, kind and loving even when hurried in emergency situation

• Administer analgesics & sedatives as ordered to reduce pain and anxiety

• Prevent complications