Shock

cells are not receiving adequate oxygen

Shock occurs when ________.

65 mmHg or more (70-100 mmHg)

A mean arterial pressure (MAP) of ________ indicates adequate tissue perfusion.

Poor Perfusion → Hypoxia → Cell Death → Organ Failure → Death

Poor Perfusion → _______ → _______ → _______ → ________

(1) Compensatory Shock

(2) Progressive Shock

(3) Irreversible (Refractory) Shock

What are the three stages of shock?

the body is trying to save itself by activating the sympathetic nervous system

Compensatory Shock occurs when _______.

BP remains the same because the body is compensating (fixing it).

What happens to blood pressure during the compensatory stage of shock?

• Increased HR + RR

• Peripheral vasoconstriction 

• Cool skin

• Anxiety / restlessness

• Slight decrease in urine output

What are the clinical manifestations observed during compensatory shock?

• Identify and correct the cause (infection, allergic rxn, bleeding, etc)

• Support BP w/ blood + fluids

• Continue assessments (labs, LOC, signs of poor perfusion)

• Reduce oxygen demand (beta blockers, nitrates, decrease activity, treat fever)

• Support family

• Report SBP < 90; MAP < 85; SBP drops > 40; narrowing pulse pressure

What are the nursing interventions for compensatory shocK?

20 — 40 mm/Hg

Normal pulse pressure = ________

compensation fails, blood pressure drops, and organs begin to fail

The progressive stage of shock occurs when ________.

• Hypotension

• Tachycardia

• Confusion

• Cold clammy skin (unless neurogenic shock)

• Oliguria

• Lactic acidosis

• Weak pulses

What are the S/S of progressive shock?

• ICU level care

• Monitor ECG, ABGs, electrolytes, hemodynamics, and mental status

• Aggressive fluids and medications

What are the nursing priorities for progressive shock?

the damage cannot be restored

Refractory shock occurs when _______.

• Severe hypotension

• MODS

• Anuria

• Coma

• Death is likely

What are the S/S of irreversible shock?

• comfort

• injury prevention

• family support

• palliative care

• ethics discussion is appropriate

What are the nursing priorities for refractory shock?

there is not enough blood volume

Hypovolemic shock occurs when ________.

• tachycardia

• hypotension

• cool skin

• weak pulses

• delayed capillary refill

• decreased urine output

Hypovolemic shock causes ________.

IV fluids and blood

How is hypovolemic shock treated?

• administer IV fluids and blood as prescribed

• monitor I&Os

• monitor BP

• Monitor mental status

• administer vasopressors if needed and prescribed

What are the nursing priorities for hypovolemic shock?

the heart cannot pump effectively

Cardiogenic shock occurs when ________.

large MI

Cardiogenic shock is most often caused by ________.

• hypotension

• tachycardia

• pulmonary edema

• crackles

• JVD

• chest pain

• cold clammy skin

What are the S/S of cardiogenic shock?

• monitor ECG

• monitor hemodynamics

• monitor O2 sat and administer as ordered

• monitor cardiac output

• promote rest

• pain control (morphine)

• administer prescribed medications (dobutamine, dopamine, nitroglycerin)

What are the nursing interventions for cardiogenic shock?

the blood vessels become massively dilated, causing blood to pool away from vital organs

Distributive shock occurs when ________.

(1) Septic

(2) Neurogenic

(3) Anaphylactic

What are the three subtypes of distributive shock?

Septic

________ is the most common type of distributive shock.

the immune system overreacts, causing massive inflammation

Septic shock occurs when ________.

• identify infection

• obtain cultures

• broad-spectrum antibiotics

• IV fluids

• vasopressors if fluids don’t restore perfusion

How is septic shock treated?

sympathetic tone

Neurogenic shock occurs when there is a loss of ________.

• bradycardia (only type of shock to cause low HR)

• warm, dry, flushed skin

• hypotension

What are the S/S of neurogenic shock?

severe allergic reaction

Anaphylactic shock = ________.

• Airway swelling

• Wheezing

• Hypotension

• Hives

• GI distress

• Respiratory distress

What are the S/S of anaphylactic shock?

IM epinephrine

The first medication given for a anaphylactic shock is ________.

• oxygen

• fluids

• diphenhydramine

• albuterol

• intubation if necessary

After IM epinephrine is administered, what other treatments are provided for anaphylaxis?

• assess patient allergies

• watch for reactions to new meds

• apply medical alert bracelet

• prepare for CPR if needed

What are the nursing priorities for anaphylactic shock?

Multiple Organ Dysfunction Syndrome

MODS stands for ________.

• Prevention

• Early recognition

• Maintaining organ perfusion

• Nutritional support

• Implement comfort measures

What are the goals of care for a patient experiencing MODS?