Objective and Management of OT IX

Shock

A lack of blood flow to the body can result in shock, a potentially fatal condition. As a result, many organs may sustain damage. Shock must be treated right away because it can quickly get worse.

Classification

The 5 types of shock are listed below:

1. Hypovolemic shock
   Preload is lost as a result of an absolute lack of intravascular blood volume, which leads to hypovolemic shock. It is the main factor in children's fatalities.
2. Distributive shock
   Vasodilation causes the normal peripheral vascular tone to improperly relax. It doesn't matter if the patient has experienced an acute fluid loss or not—this leads to relative hypovolemia. Vasodilatation and capillary leak, which result in relative and absolute hypovolemia, are typically its defining features.
3. Cardiogenic shock
   Regardless of the initial cause of prolonged shock, cardiogenic shock is a secondary complication of myocardial dysfunction and can affect any form of prolonged shock. It is best described as a pump failure that causes myocardial contractility to decline, which in turn causes symptoms that are attributed to both a decrease in cardiac output and pulmonary congestion. A compensatory rise in systemic vascular resistance is frequently associated with it, and this has a more detrimental impact on the failing heart.
4. Obstructive shock
   Blockage shock In the pediatric population, particular neonates within the first few weeks of life who may have been born with an obstructive congenital heart disease, certain physical causes of shock must be taken into consideration.
5. Septic shock
   Distributive, cardiogenic, and hypovolemic shocks are all combined to create septic shock.

Causes

Shock can be caused by any condition that reduces blood flow, including:

• Heart conditions
• Blood vessels change
• Some drugs that significantly lower blood pressure or heart function
• Shock is frequently accompanied by severe internal or external bleeding from the injury. - Shock can also result from spinal injuries.
• One instance of a shock caused by an infection is toxic shock syndrome.

Signs and symptoms

Blood pressure is incredibly low in someone who is shocked. The following signs may be present depending on the precise cause and kind of shock:

• Anxiety or agitation/restlessness
• Bluish lips and fingernails
• Chest pain
• Confusion
• Dizziness, lightheadedness, or
• Faintness
• Pale, cool, clammy skin
• Low or no urine output
• Profuse sweating, moist skin
• Rapid but weak pulse
• Shallow breathing
• Unconsciousness

Diagnosis

The medical history is most frequently used to determine the diagnosis. The patient's vital signs will be watched as a thorough physical examination is conducted.

1. Patient vital signs
   The patient's vital indicators may be continuously monitored, such as blood pressure, heart rate, and oxygen levels. To assess pressures close to the heart, which may be a better sign of the body's fluid condition, special catheters may be put into the big veins in the neck, chest, arm, or groin and threaded into the pulmonary artery. To take more precise blood pressure readings, more catheters called arterial lines may be placed into the arteries. To assess urine production, tubes (a Foley catheter) can be inserted into the bladder.
2. Blood laboratory tests
   There will be blood tests run in the laboratory (the type dependent on the underlying disease or condition).
3. Radiologic tests
   Depending on the underlying illness, radiologic tests may be performed.

Nursing management

• Airway: Determining whether the patient is alert enough to attempt to breathe on their own and/or whether anything is obstructing their mouth or nose.
• Breathing: Evaluation of the breathing's effectiveness and the possibility that mouth-to-mouth resuscitation, more aggressive interventions like a bag and mask or intubation with an endotracheal tube and a ventilator, or both, may be required.
• Circulation: Determination of whether intravenous lines are required for the supply of fluid or drugs to support the blood pressure and assessment of the blood pressure's suitability.
• The bleeding will be attempted to be controlled with direct pressure if it is obvious that there is bleeding.
• In order to make sure that hypoglycemia (low blood sugar) does not exist, blood sugar will be measured using a fingerstick.
• In the emergency room, both the diagnosis and the treatment will take place simultaneously.
• Patients will get oxygen therapy by a face mask, nasal cannula, or endotracheal intubation. To ensure that there is adequate oxygen accessible for the body to use, the technique and quantity of oxygen will be adjusted. Once more, the objective is to cram every oxygen molecule in a hemoglobin molecule.
• If bleeding (hemorrhage) is the cause of the shock state, blood may be transfused. If there is no bleeding, intravenous fluids will be administered to increase the amount of fluid in the blood vessels.
• Drugs injected intravenously can be used to try to keep blood pressure stable. They function by inducing a stronger heartbeat and constricting blood vessels to increase blood flow.

Hemorrhage

A hemorrhage may be "internal," where there is no external evidence of bleeding, or "external," where it is visible on the outside of the body. An external hemorrhage is when there is bleeding from a facial cut. Internal hemorrhage includes bleeding into the liver or spleen, for instance.

Causes

• Open wounds
• Hemorrhoids
• Menstrual problems
• Low platelets count
• Hemophilia
• Fracture
• Animal bite
• Disseminated intravascular coagulation
• Threatened abortion
• Peptic ulcer
• Dysfunctional uterine bleeding

Signs and symptoms

Mild symptoms can include:

• Headache
• Fatigue, Nausea
• Profuse sweating
• Dizziness

Severe symptoms

The following are severe symptoms that need to be taken seriously and necessitate immediate medical attention:

• Cold or clammy skin
• Pale skin
• Rapid, shallow breathing
• Rapid heart rate
• Little or no urine output
• Confusion, Weakness, Weak pulse
• Blue lips and fingernails
• Lightheadedness
• Loss of consciousness

Diagnosis

Most hemorrhages have clear causes when there is visible bleeding. Tests on the spinal fluid and blood can reveal signs of brain bleeding. An essential imaging test to assess the brain and other tissues for signs of bleeding is computed tomography (CT or CAT) scanning.

Treatment

• To halt the bleeding is the initial step in managing a hemorrhage.
• Clamping or surgically fixing the tears can stop bleeding brought on by trauma or blood vessel ripping.
• With the help of medications that lower blood pressure, prevent vessel spasm, and lessen discomfort, hemorrhage brought on by vessel leakage brought on by high blood pressure can be treated.
• To lower the pressure of accumulated blood in the brain, surgery can be required. Those with bleeding disorders may receive blood factors to aid in blood clotting.

Nursing management

Hemorrhage is an uncommon yet serious complication of surgery that can result in death.

• It may appear slowly or suddenly at any point during the immediate post-operative period or even up to a few days following surgery.
• If hemorrhage is left untreated, cardiac output will decrease, arterial and venous blood pressure will drop quickly, hemoglobin levels will drop, the lips and conjunctivae will become pallid, spots will appear before the patient's eyes, there will be a ringing in their ears, and they will become weaker but will still be conscious until they are close to passing away.
• The first line of treatment involves giving blood or blood products to the patient and figuring out what caused the hemorrhage. Checking for bleeding at the surgical site and incision is always a good idea. If bleeding is present, a pressure dressing and sterile gauze pad should be applied, and if possible, the bleeding site should be raised to the level of the heart.
• Placement of the patient in the shock position
• The patient might be returned to the operating room for an urgent examination of the surgical site if the source of the bleeding is hidden.
• Patients who refuse blood transfusions, such as Jehovah's Witnesses and those who make specific requests in their advance directives or living wills, must be given special consideration.