Shock

Subject: Medical and Surgical Nursing I (Theory)

Overview

Shock is an abnormal and potentially fatal condition in which the brain receives insufficient blood, the cardiac output is inadequately maintained, and sudden reduction of vital functions or abrupt collapse of blood circulation may take place. Its causes include excessive body fluid loss, which can be brought on by continuous vomiting and diarrhea, serious accidents that result in blood loss, severe burns that produce fluid loss, or both. Its varieties include anaphylactic shock, hypovolemic shock, cardiogenic shock, septic shock, and neurogenic shock. Its symptoms include profuse perspiration, headaches and vertigo, blurred vision, breathing difficulties, etc. If the shock is caused by circulatory volume failure, such as hemorrhage, elevate the client's legs high enough to provide adequate blood circulation to the essential organs. Make sure there's enough ventilation, open door and windows and keep crowd away of the patient.

Shock is an abnormal and potentially fatal condition in which the brain receives insufficient blood, cardiac output is not adequately maintained, and sudden depression of vital functions may take place. Shock is also characterized by a sudden collapse of blood circulation.

Causes

  • Substantial or severe trauma
  • Severe agony or a heart attack
  • Excessive body fluid loss, which may be brought on by prolonged diarrhea and vomiting, extensive burns, or blood loss following a serious accident
  • Acute allergy
  • Poisons
  • Specific illnesses

Types of Shock

  • Shock from hypovolemia
  • Cardiovascular shock
  • Stomach shock
  • A neurological shock
  • Hypersensitivity shock

Sign and Symptoms

  • A cold, clammy complexion that is gray or pale
  • Weak and rapid heartbeat
  • Heavy perspiration
  • Dizziness and headaches
  • Distorted vision
  • Uncertainty and fear
  • Having trouble breathing
  • Consciousness loss

Nursing Management of Shock

  • If the shock is caused by circulatory volume failure, such as hemorrhage, elevate the client's legs high enough to provide adequate blood circulation to the essential organs.
  • If the reasons of the shock are unknown, place the patient in the recovery position, which is left lateral.
  • So as to avoid oral secretions being aspirated, tilt the client's head to one side.
  • Review the vital signs
  • Manage the oxygen supply
  • Immediately open an IV line and administer fast-acting fluids if vital signs are altered.
  • Manage appropriately if dysrhythmia is suspected and it is cardiogenic shock.
  • Maintain patient's warmth and comfort.
  • Make sure the environment is safe by getting rid of dangerous materials and substances.
  • Ensure a quiet and peaceful environment
  • Make sure there is enough ventilation, keep the doors and windows open, and keep people away from the patient.

Overall Nursing Management

  • Fluid replacement

To restore intravascular volume. following are the list of fluids can be used to treat shock.

  • Crystalloids: sodium chloride at 0.9%
  • Lactate from Ringer
  • (5%, 25%) Hypertonic Saline B Colloids Albumin
  • Dextras (40, 70) (40, 70)
  • Restore
  • Hetastarch (high glucose) (high glucose)
  • Medicines
  • Vasoactive drugs to improve heart function and vasomotor tone
  • The following is a list of vasoactive medications used to treat shock.

Sympathomimetics (improve contractility, increase stroke volume, increase cardiac output)

  • Amrinone
  • Dobutamine
  • Dopamine
  • Epinephrine
  • Milrinone

Vasodilators (reduce preload and afterload, reduce oxygen demand of heart)

  • Nitroglycerine
  • Nitroprusside

Vasoconstrictors (increase BP by vasoconstriction)

  • Norepinephrine
  • Phenylephrine
  • Vasopressin
  • Nutritional support is needed to meet the metabolic needs that are frequently drastically increased by shock.

 References

  • dictionary.cambridge.org/dictionary/english/shock
  • healthline.com › Symptom Checker
  • mayoclinic.org/first-aid/first-aid-shock/basics/art-20056620
  • Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 20
  • medlineplus.gov › Medical Encyclopedia
Things to remember
  • Shock, inadequate blood flow to the brain, abrupt decrease of essential processes, or abrupt collapse of blood circulation are all possible outcomes.
  • A heart attack or excruciating pain
  • A cold, clammy complexion that is gray or pale
  • Headaches, lightheadedness, distorted vision
  • Manage the oxygen supply.
  • So as to avoid oral secretions being aspirated, tilt the client's head to one side.
  • Elevate the client's legs high enough to allow for adequate blood flow to their internal organs.
  • Make sure there is enough ventilation, keep windows and doors open, and keep people away from the patient.
Questions and Answers

When the brain does not receive enough blood, cardiac output is not kept at a healthy level, and sudden depression of vital functions may occur. Shock is also known as a sudden collapse of blood circulation.

Nursing Management of Shock

  • If the shock is caused by circulatory volume failure, such as hemorrhage, elevate the client's legs high enough to provide adequate blood circulation to the essential organs.
  • If the reasons of the shock are unknown, place the patient in the recovery position, which is left lateral.
  • So as to avoid oral secretions being aspirated, tilt the client's head to one side.
  • Review the vital signs
  • Manage the oxygen supply
  • Immediately open an IV line and administer fast-acting fluids if vital signs are altered.
  • Manage the situation appropriately if disarythmia is suspected and there is cardiogenic shock.
  • Keep the patient cozy and warm.
  • Make sure the environment is safe by getting rid of dangerous materials and substances.
  • Ensure a quiet and peaceful environment
  • Make sure there is enough ventilation, keep windows and doors open, and keep people away from the patient.

Overall nursing management

  • Fluid substitution

To refill the intravascular space. The list of fluids that can be used to treat shock is provided below.

  • Crystalloids: sodium chloride at 0.9%
  • Lactate from Ringer
  • (5%, 25%) Hypertonic Saline B Colloids Albumin
  • Dextras (40, 70) (40, 70)
  • Restore
  • Hetastarch (high glucose) (high glucose)
  • Medicines
  • Vasoactive drugs to improve heart function and vasomotor tone

The following is a list of vasoactive medications used to treat shock.

  • Sympathomimetics (Improve Contractility, Increase Stroke Volume, Increase Cardiac Output)
    • Amrinone
    • Dobutamine
    • Dopamine
    • Epinephrine
    • Milrinone
  • Vasodilators (Reduce Preload and After Load, Reduce Oxygen Demand of Heart)
    • Nitroglycerine
    • Nitroprusside
  • Vasoconstictors (Increase BP by Vasoconstriction)
    • Norepinephrine
    • Phenylephrine
    • Vasopressin

Nutritional supplementation is needed to meet the metabolic needs of those who are frequently in shock.

 

 

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