Types of Shock
Which type of shock can be caused by dehydration?
Hypovolemic shock
What happens to the urine output during shock?
Decreases
What is a priority intervention for a patient in shock?
Administering oxygen
(Remember your A, B, C's)
What medication is used in treating anaphylaxis and what is its action?
Epinephrine
Causes vasoconstriction
What is the result of untreated shock?
Inadequate tissue perfusion > decreased oxygen delivery to organs > organ failure > DEATH
What is a local infection that gets out of control?
Septic shock
What are the two main cardiac-related vital signs that change with shock?
Increased HR (Tachycardia)
Decreased BP (Hypotension)
Once the patient is stable, what is the nurse's main responsibility?
Monitoring the patient's progress.
What two specific types of IV fluids would be given during shock?
Isotonic crystalloid fluids (Normal Saline, Lactated Ringers)
Colloid fluids (Albumin, Fresh Frozen Plasma)
Name three common allergens that can cause anaphylaxis?
Peanuts
Bee stings
Shellfish
Eggs
Mold
Latex
This type of shock can happen instantaneously.
Anaphylactic shock
What central nervous system changes occur with shock?
Thirst
LOC (from cerebral hypoxia)
Anxiety
Restlessness
Name three things the nurse would assess that are related to the patient's cardiac function?
Heart rhythm
Heart rate
Blood pressure
Skin Color
Skin temperature
Capillary refill
What nursing intervention is critical prior to initial administration of antibiotics in a patient with septic shock?
Drawing blood cultures (to determine which antibiotic is sensitive to the cultured organism).
Name two lab values that you would expect to be elevated in a septic patient.
Increased Lactic Acid
Increased Blood Glucose
Increased PaCO2
Fluid volume is not affected by this type of shock
Cardiogenic shock
In hypovolemic shock, what changes would a nurse expect to see in Hematocrit and Hemoglobin?
Decrease from blood loss
(Different from a volume shift in dehydration where Hgb and HCT are elevated from concentration)
Name two things would the nurse monitor related to respiratory function?
Respiratory rate
Respiratory depth
Oxygen saturation
What medication would help to enhance myocardial perfusion in cardiogenic shock?
Sodium nitroprusside:
1. Causes direct dilation of veins and arteries (through relaxation of vascular smooth muscle)
2. Reduces preload
3. Reduces afterload
What are two pieces of education should a nurse provide to patients with severe allergies?
Always wear a medical Alert band
Always carrying an EpiPen
What type of shock causes loss of sympathetic tone resulting in wide-spread vasodilation?
Neurogenic Shock (a distributive shock)
What are notable blood gas changes that occur with shock?
Decreased pH
Decreased PaO2
Increased PaCO2
What is the priority nursing intervention for a patient with Septic Shock?
Administering antibiotic effective against gram-negative bacteria within one hour of Shock diagnosis.
What is the action and purpose of a vasoconstrictor?
Constriction of the blood vessels to maintain blood pressure and venous return to the heart.
What are the 4 stages of shock?
1. Initial
2. Non-progressive (Compensatory)
3. Progressive
4. Refractory
Replacement of volume is critical before using a vasopressor in what type of shock?
Hypovolemic Shock
What two metabolic lab changes may be seen in shock?
Increased blood sugar (hypermetabolic state)
increased lactic acid (anaerobic metabolism)
What are three things that the nurse might monitor in a critical care setting?
Intra-arterial pressure
Mixed venous oxygen saturation
Pulmonary arterial pressure
Pulmonary capillary wedge pressure
What medication should be given through a central line, if possible, because of its high potential for causing tissue necrosis when given in peripheral IV sites?
vasopressin
Which population is most prone to hypovolemic shock and why?
The elderly population;
1. Consume less fluid and proteins
2. Take more medications