Hypovolemic
What are some EARLY cardinal signs and symptoms of hypovolemic shock?
-tachycardia
-narrowed pulse pressure
-cool, pale, clammy skin
-delayed capillary refill
-thirst
-anxiety, restlessness
-tachypnea
-slight decrease in urine output
-altered mental status
What are some signs and symptoms of septic shock?
-tachypnea
-low oxygen sats (risk for ARDS)
-decreased or absent urine output
-altered mental status
What are some signs and symptoms of cardiogenic shock?
-chest pain
-dyspnea
-faintness
-feelings of impending doom
-tachycardia
-hypotension
-dysrhythmias
-low cardiac output
-positive JVD
-rapid, faint or irregular pulses
-tachypnea
-pulmonary edema
-skin mottling, cool extremities
-cyanosis
-low urine output
What are some signs and symptoms of anaphylactic shock?
-erythema, pruritus, urticaria (hives), angioedema
-rhinorrhea (runny nose), stridor, wheezing, hoarseness, bronchoconstriction, cough, SOB
-N/V/D
-hypotension, tachycardia, diaphoresis
-anxiety, confusion
-oliguria
-fever, hemolysis
What are some signs and symptoms of neurogenic shock?
-Triad (hypotension, bradycardia, hypothermia)
-LOC, fainting
-loss of sensation, flaccid paralysis (below injury level)
-autonomic hyperreflexia (can develop after spinal shock resolves)
-severe hypotension
-bradycardia
-absent peripheral pulses
-anuria
-cyanosis
-unresponsiveness or coma
-organ failure (renal, hepatic, cardiac)
What are some diagnostic tests to confirm septic shock?
-elevated serum creatinine
-elevated lactic acid
-serum lactate high
-hyperglycemia
-WBC may be extremely low
-decreased segmented neutrophils
What are some nursing interventions for cardiogenic shock?
-assess VS, mental status, urine output, skin
-keep oxygen 90-96%
-balance is key (fluid status)
-open blocked arteries (clot busting drugs, balloon angioplasty, stents, bypass, heart transplant)----if MI caused shock
-temporary heart support devices (balloon pump-IABP, ventricular assist device-VAD, ECMO)
-permanent devices (implantable VAD, pacemaker, defibrillator)
What are some life threatening signs and symptoms of anaphylactic shock?
-laryngospasm
-edema
-cyanosis
-hypotensive shock
-vascular collapse
-cardiac arrest
What are some nursing interventions for neurogenic shock?
-fluid resuscitation
-vasopressor (atropine sulfate)
-spinal stabilization (cervial collar)
-jaw thrust maneuver
-log rolling
-assess VS, watch for AD
-thermoregulation
What are nursing interventions for hypovolemic shock?
-oxygen therapy (maintain 90-96%)
-IV fluid resuscitation (normal saline, LR)
-blood products (when shock caused by blood loss)
-drug therapy (increase MAP, venous return and CO)
-assess VS, LOC, skin, capillary refill, urine output
-hemodynamic monitoring for severe patients (CVC for CVP monitoring, arterial lines for BP monitoring)
-obtain blood cultures
-administer broad spectrum antibiotics within 1 hour
-begin fluid resuscitation
-measure lactate levels
-apply vasopressors (if hypotensive)
What are some diagnostics for cardiogenic shock?
-chest xray (enlarged heart-cardiomegaly, signs of pulmonary edema)
-echocardiogram (structural heart disease, cardiac function and contractility)
-ABG's
-cardiac biomarkers (troponin, BNP)
-elevated lactate levels
-stress testing (identifies ischemia)
-coronary angiography (visualizes blocked arteries)
What are some nursing interventions for anaphylactic shock?
-epinephrine (first line treatment)
-maintain airway
-call for help (rapid response)
-oxygen therapy
-IV fluid resuscitation (normal saline, LR)
-assess VS, LOC, cardiac rhythm, skin, urine output
-antihistamines (help with itching)
-corticosteroids (prevents biphasic reactions--can occur hours to days later, reduce inflammation)
What are some causes of neurogenic shock?
-spinal cord injury (most common- above T6)
-brain/brainstem injury
-depressive drugs, anesthetic agents
-severe emotional stress, severe pain
What are some diagnostic tests done for hypovolemic shock?
-ABG's
-hemoglobin and hematocrit
-BUN, creatinine
-serum sodium
-glucose, liver enzymes and serum lactate
-remove infection at its source
-drug therapy (IV fluids, vasopressors, corticosteroids, insulin, sodium bicarbonate, heparin, blood products)
-temperature management for fever or hypothermia
-stress ulcer prevention, DVT/VTE prophylaxis, nutrition within 72 hours
What are some causes of cardiogenic shock?
-decreased contactility and pump failure (AMI, cardiomyopathy, myocarditis, pericarditis, papillary muscle rupture, cardiac contusion, aneurysm)
-systemic conditions (sepsis, metabolic abnormalities)
-dysrhythmias
-obstruction (PE, cardiac tamponade, valvular disorders (stenosis or regurgitation, tumors, wall rupture or septal defects)
What are some causes of anaphylactic shock?
-foods
-medications
-venoms
-latex
-contrast dye
-immunizations
-seminal fluid
-pollens
-blood products
What are some treatments for neurogenic shock?
-IV therapy (fluids, dextran-plasma expander)
-atropine (first line) dopamine, phenylephrine (severe hypotension)
-oxygen therapy
-control room temperature
-trauma (blunt or penetrating, fractures)
-GI bleeding (upper, lower, ulcers)
-clotting disorders (hemophilia, poor clotting factors, use of anticoagulants)
-burns
-vomiting or diarrhea
-DI, diuresis, DM
-third spacing (cirrhosis, ascites, crush injury)
-general surgery, prolonged NPO (dehydration), inadequate fluid intake relative to output
What are some causes of septic shock?
-bacteria (most common)
-viruses
-fungi
(respiratory infection-pneumonia, UTI, abdominal infection, skin/soft tissue infection, infected wounds or surgical sites, indwelling medical devices- foley)
What are some medications used for cardiogenic shock?
-Dobutamine (first line drug of choice for contractility)
-Milrinone (more potent than dobutamine)
-Vasopressors (increase MAP, improves venous return)
-Furosemide (loop diuretic), spironolactone (potassium sparing)
-vasodilators (nitrates, morphine sulfate)
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What are some preventative measures for anaphylactic shock?
-identify and avoid the trigger
-prevent future exposures
-EpiPen
What is the main goal of treatment?
-maintain tissue perfusion
-increase vascular volume
-support compensatory mechanisms to prevent organ damage and death