Types of Shock
What are the four main categories of shock?
Cardiogenic, hypovolemic, distributive, obstructive
What is the goal of drug therapy for shock?
To correct the decreased tissue perfusion resulting in
tissue hypoxia. Vasopressor or vasodilator therapy is used according to patient needs to maintain the mean arterial pressure at the appropriate level after adequate volume resuscitation.
The initial assessment should focus on ABC's. What does ABC stand for?
Airway, Breathing, Circulation
Occurs when either systolic or diastolic dysfunction of the pumping action of the heart results in reduced cardiac output (CO).
Cardiogenic shock
Interventions for cardiogenic shock?
Hemodynamic monitoring, drug therapy (e.g., diuretics to reduce preload), and use of circulatory assist devices (e.g., intraaortic balloon pump, ventricular assist device).
After assessing ABC's, what should our assessment focus on?
tissue perfusion and includes evaluation of trends in vital signs, peripheral pulses, level of consciousness, capillary refill, skin (e.g., temperature, color, moisture), and urine output.
Occurs from inadequate fluid volume in the intravascular space to support adequate perfusion
Hypovolemic shock
Septic shock interventions?
large amounts of fluid replacement. The goal is to achieve a targeted response based on CVP, ScvO2, cardiac ultrasound, a focused physical assessment, fluid responsiveness, or other measures. Vasopressor if not responsive to fluids. (need to have an adequate MAP) for perfusion.
What is one overall goal for shock?
(1) evidence of adequate tissue perfusion,
(2) restoration of normal or baseline BP, (3) recovery of organ function, and (4)
avoiding complications from prolonged states of hypoperfusion, and (5) preventing
health care–associated complications of disease management and care.
Develops when a physical obstruction to blood flow occurs with a decreased CO.
Obstructive Shock
What is the most critical piece of managing anaphylactic shock?
Maintaining the airway.
What is the nurse's role in managing shock?
1) monitoring the patient’s ongoing physical and emotional status, (2) identifying trends to detect changes in the patient’s condition, (3) planning
and implementing nursing interventions and therapy, (4) evaluating the patient’s response to therapy, (5) providing emotional support to the patient and caregiver, and (6) collaborating with other members of the health team to coordinate care.
An acute and life-threatening hypersensitivity (allergic) reaction. The reaction is caused by a sensitizing substance (e.g., drug, chemical, vaccine, food, insect venom).
Anaphylactic shock
What is the most common drug used to treat anaphylactic shock?
Epinephrine
What is one key assessment piece of monitoring shock?
requent assessment of heart rate/rhythm, BP, CVP, SvO2, and pulmonary artery (PA) pressures or arterial pressure wave-form analysis for cardiac
output (APCO); neurologic status; respiratory status, urine output, and temperature; capillary refill; skin for temperature, pallor, flushing, cyanosis, diaphoresis; and bowel sounds and abdominal distention, as well as prevention of health care-associated infections.