SHOCK AND ITS NURSING MANAGEMENT CN 2011 BATCH, BPKIHSLeadership and management NAME OF STUDENTSSonali Koiri(514)Soni Shrestha(515)Srijana Neupane(516)Sujata Devkota(517)Sushila Ku. Hamal(518)Tashi Dolma Lama(519)Triza Napit(520)

Objectives:General objectives:All the participants will be able to explain about shock.Specific Objectives:1.Define Shock2.Stages of shock3.Types of shock4.Prevention of Shock5.Nursing Care of patients with shock

Pre test1 Which is not the stage of shock?•Progressive•Compensatory•Initial•Reversible2 which is not the type of shock?•Cardiogenic•Hypovolemic•Anaphylactic•Aseptic3 most common type of shock?•Cardiogenic •Hypovolemic•Anaphylactic•neurogenic

contd4 Shock results from:Decreased blood flow to tissuesIncrease blood flow to tissuesAdequate perfusionBoth 2nd and 3rd

5 which is not the cause of cardiogenic shock?•CHF•Pulmonary embolism•Spinal cord injury•cardiomyopathy

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

perfusion

2. Anaerobic metabolism

3. Buildup of lactic acid

4. Metabolic acidosis

5. Respiratory rate increases in

response to metabolic acidosis.

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STAGES OF SHOCKThere 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.

contdC)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 reduce 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 can be normal in this stage. Fluid transfusion may restore BP Only temporary BP decline 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 e.g. ; PPH , ectopic pregnancy ,uterus rupture , severe polytrauma , haemonumothorax , UGI bleeding , hematemesis , haemoptysis.b)Severe persistent vomiting eg ;DVA ,minor and major disorder in pregnancy , prolong vomiting.c)Severe diarrhea eg ; cholerad)Severe edemas or ascities ,peritonitis , pancreatitis

contd…….e)Diuresis and rapid remove of amniotic fluidf)Severe burnsg)Inadequate fluid

CLINICAL FEATURE;a)BP decrease , hypotensionb)Skin cold and clammyc)Pallord)Tachycardia , Tachypneae)Restlessness , Anxiety , Weaknessf)Altered sensoriumg)Oliguria<20 ml/hour ; progressive stage

contd…..Metabolic acidosis ;PaCO2 and HCO3 decreasedNausea and vomiting , thirstPulse rapid , weak and threadyIrritabilityDilated with decrease response to light ; progressive stageRespiration rate rapid >20b/min, shallow ; progressive

stageCyanosis ; progressive stageIncreased serum electrolyte ,blood glucose , serum

creatinine , odium, potassiumUnconsciousness and unresponsive to painAnuria , renal failure

CARDIOGENIC SHOCKIntroduction

Cardiogenic shock occurs when the heart’s ability to pump blood is impaired.This is a condition that results from inadequate perfusion of body tissue with oxygenated blood that is insufficient to sustain life ,cardiac output is decreased.

Causes1.Acute myocardial infraction resulting in massive damage to myocardium.2.CHF ,Pulmonary embolism3.Cardiac temponade Cardiomyopathy4.Hypovolemia,Septicemia5.Drug overdose ; anesthesia

Clinical features1.Same as hypovolemic shock2.Dysrythmias,chest pain3.Respiratory distress , multi organ

dysfunction syndrome and death are its complication

4.Left and Right ventricular failure5.Mechanical complication including

ventricular septal rupture

NEUROGENIC SHOCKIntroductionInability of nervous system to control dilation

of blood vessels.Neurogenic shock results from generalized

vasodilation and loss of vasomotor tone due toa.Massive increase in vascular capacityb. Pooling of blood in periphery c. Decreased venous return to Heart.

Causes:Brain traumatic injuryBrain damage, vasomotor depressionSpinal cord injury Deep spinal anesthesiaDuring LPSevere pain, hypoglycemia, emotional stressDrugs causing vasomotor center depressionAnti snake venom

Clinical featuresNervousnessLOCConfusionSkin warm but dryRespiration depressHypotension

ANAPHYLACTIC SHOCKAnaphylaxis is a life threatening systemic hypersensitivity reaction contact with an allergen.CausesDrugs: penicillin , radio contrast, lignocaine , anesthetic drugs, iron injectable . . etc.Blood transfusionStings and snake biteNew clothes Dusting smokesSuddenly climate change

Clinical featuresCough, wheezing, laryngeal

edema, bronchospasmHypotension, tachycardia,

palpitationSyncopeUrticaria, angeodema , pruritusNausea ,vomitingSeizuresRespiratory depression,

cardiovascular collapse coma

SEPTIC SHOCKIntroductionIt is the most common type of shock and caused by widespread infection due to gram positive and negative bacteria and viruses.CausesUTI , abortionRTASevere burnCSOMDue to chronic disesases : diabetes, AIDSIndwelling lines and catheterImproper wound care and management

Clinical features• Hyperthermia• Severe headache• Respiration distress• Decreased cardiac output• Hypotension • Skin cold and pale• Multiple organ failure• Anuria

Prevention of Shock • Primary prevention of shock is an

essential focus on nursing intervention; hypovolemic shock 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.

• General nursing measures include safe administration of prescribed fluids and medication and proper documentation, monitoring sign of complication and side effects and early reporting

• Safe blood administration Blood sample should be obtained foe CBC,

cross match grouping before BTPatient 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 on SHOCK

Check for a response. Give Rescue Breaths or CPR as needed.

1.Lay the person flat, face-up, but do not move him or her if you suspect a head,

back, or neck injury.

2.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.

Keep the person still.

3.Do not raise the feet or move the legs if hip or leg bones are broken. Keep the

person lying flat.

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

6. Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth.

7. Keep the person warm and comfortable. Loosen belt (s) and tight clothing and cover the person with a blanket.

8. NPO: Even if the person complains of thirst, give nothing by mouth. If the person wants water, moisten the lips.

9. Reassure the person. Make him or her as comfortable as you can.

Contd…6. Fluid and blood replacement:

Open IV line on both hands with two wide bore cannula and start fluid rapidly as advised.

7. Administer oxygen via face mask.8. Identify the cause and treat

accordingly. 9. Vasoactive medications to improve

cardiac contractility, i.e. Dopamine, Dobutamine, Noradrenaline.

10. Other care are same as the care of unconscious patient.

Post test1)Which is the best position for hypovolemic shock?Dorsal recumbentProne positionSemi fowlersLeft lateral

2) Which of following happens in compensatory stage?•Hypotension•Hypertension•Normal BP•Both 2nd and 3rd

contd………3) Which is not the sign and symptoms of neurogenic shock?•LOC•Nervousness•Confusion•Dehydration4)Which is not the cause of septic shock?UTIAbortionMassive infected wounds Smokes and dust

Answers Pre test1) Reversible2) Aseptic3) Hypovolemic4) Decreased blood flow to tissues5) Spinal cord InjuryPost test1) Dorsal recumbent2) Normal BP3) Dehydration4) Smokes and dust5) Metabolic acidosis

ReferencesSandra M. Nettine , The Lippincott Manuals of Nursing practice, 7th edition, Jaypee brothers medical publisher Pvt.Ltd page no:1076-1078Suzzanne C . Smeltzer, Brunner and Suddharth Medical Surgical nursing 8th editionSharma Asha, Lewis medical surgical nursing, Elsevier publication, page no 1722-1750

contd…….Joycee M. Black, Medical Surgical Nursing, 6th edition, volume 2, page no 2231-2258Sharon Mantik Lewis Medical Surgical Nursing, Mosby's year book publication 3rd

Edition page no 740-757Wilma Plipps , Shafers Medical Surgical Nursing, 7th edition, page no 35-37

contd……5) What happens in shock?•Adequate perfusion•Aerobic perfusion•Metabolic acidosis•Metabolic alkalosis

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