Types of shock

Mrs. Almusalhi

Hypovolemic Shock

• Causes: most common type, caused by reduction of fluid 15% to 30% of blood (750-1500ml of blood in 70kg person).

• Loss of blood externally by blooding or shifts of internal fluids by dehydration AND severe edema,

•Effects: decreased IV fluid, decreased blood ejected from heart, decreased cardiaac output then BP drops and less tissue perfusion.

Hypovolemic Shock• Medical management:

1. Treating underlying cause (stop bleeding by pressure or surgery for internal organs), medication to treat diarrhea and vomiting.

2. Fluid and blood replacement: use large vein and two IV lines, use crystaloid solution as NS and RL or albumen, blood products (packed RBCs for hemoglubin to carry O2 to tissues). use 3:1 rule ( 3ml of crystaloid to 1 ml of blood loss)

Hypovolemic Shock• Medical management:

1. Redistribution of fluid: (modified tendlemberge position for returning of blood to heart.

2. Pharmacological therapy: use of vasoactive medication, insulin is given if dehydration is secondary to diabetes, medication of diabetes insipidus, anti-diarrhoeal mediation for diarrhoea and anti emetic medication.

• Nursing management:• Administring blood and fluids safely• O2• Comfort and explanation of patient is

needed.

Cardiogenic shock

• Occurs when heart not able to pump blood• Causes: unknown• Seen in patient with MI• Patho: when heart not able to pump

blood, HR decrease then BP decrease. Resulting in low tissue perfusion.

• Clinical manifestation: angina pain, dysrthemia, fatigue and hemdynimically not stable.

• Medical managment: • Correction of underlying cause: O2,

thrompolitic therapy in MI, CABAG, correction of acidosis, and dysrrhethmia.

• Initiation of first line management: O2, pain

control (Morphin), hemodynimically monitoring (ICU care, arterial line insertion for BP monotoring, laboratory marker monitoring (cardiac enzymes (CK mb and cTn-1), ECG for ST segment monitoring and fluid therapy and pharmacological therapy (Doputamine,,,,,p 326

• Nursing management: • Preventing cardiogenic shock: O2, • Monitoring hemodynamic status: V/s

checking, ECG, IV fluids• Administering medication: record

medication and response, neurological assessment, monitor (BUN, creatinine, urine output ,,,,,

• Reduce anxiety and ensure comfort.

Septic shock• Most common by widespread infection.• Causes: invasive procedurs, older

population and resistance to antibiotic• Virus, fungus, gram negtive bacteria are

causes• When it invade body immune system and

inflammation is activated, leads to increase permiability and poor tissue perfusion.

• S&S: normal BP, high HR, normal to low urine

output, nausea, vomitting, confusion, then acidosis and organ dysfuntion (low BP, ,,,,,,,,

• Medical management: fluid replacement therapy, pharmacologic therapy (anti inflammatory,,,,,,,), nutrition therapy: to prevent resistance to infection, started within first 24hrs of ICU admission, enteral feeding in perfered to prevent IV infections,

• Nursing management: use aseptic technique, monitor injection sties for infection, sample for C/s from any sties, administer antibiotic and assess S&S of infection.

Neurogenic shock

• Vasodilatation occurs when loss of balance between parasmpathetic and sympathatic stimulation

• Sympathatic stimulation cause vasoconstriction

• Blood volume is normal but parasympathatic cause vasodilatation so there fluid shifts.

• Causes: spinal cord injury, spinal anesthesia, nervous system damage.

• S&S: low BP, dry and warm skin, bradycardia

• Medical management: control spinal cord injury, position patient carefully in spinal anasethesia,

• Nursing management: elevate the head of bed when using spinal anesthesia to prevent agent spread to brain, carefully mobilize the patient, support cardiovascular function, apply anti-embolism stocking and check for lower extremity pain or tenderness or redness.

Anaphylactic shock• Occurs for person who develops antigen and

antibody reaction (patient with allergy)

• Causes: severe allergic reaction, leading to systematic antigen-antibody reaction, it requires the individual to be exposed to antigen before

• Medical management: stop antibiotic or the agent, epinephrine (vasoconstrictive agent), antihistamine, nebulization, CPR if it happens, IV lines for fluids,

• Nursing management : 1.close monitoring for allergens

( medication, blood products, latex, contrast agent, foods,,,,,),

2.assess previous reaction, 3.new antibiotic IV 4.then document it carefully and report it.