IVF, Sepsis & Shock Flashcards
Shock definition
When tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function.
Shock is characterized by decreased tissue perfusion and impaired cellular metabolism. This results in an imbalance between the supply of and demand for oxygen and nutrients.
What are the Types of shock
- Hypovolemic (External or internal fluid loss)
- Cardiogenic (Impaired cardiac function)
- Obstructive (Obstructive to circulation)
- Distributive (Maldistribution of blood flow/loss of vascular tone)
Signs and symptom of shock
Altered level of consciousness
* Cold and clammy skin
* Decreased skin turgor
* Dizziness
* Dry mucous membranes
* Increased thirst
* Prolonged capillary refill time (>3 seconds)
* Cardiac dysrhythmias
* Orthostatic hypotension
* Tachycardia
* Variable urine output ranging from normal
(>30 ml/hr) to as low as 20 ml/hr
* Abnormal arterial blood gases
(ABGs) indicating hypoxemia and acidosis
What are the four stages of shock?
- Initial
- Compensatory
- Progressive
- Refractory
What is Hypovolemic Shock
Hypovolemic shock occurs when there is a reduction in intravascular volume by 15% to 30%, representing a loss
of approximately 750 to 1,500 mL of blood in a 70-kg person. I
It can be caused by external fluid losses, such as traumatic blood loss, or internal fluid shifts, like severe dehydration or edema.
Symptoms vary based on the severity of fluid or blood loss, but all symptoms of shock require immediate medical treatment.
This reduction in intravascular volume leads to decreased venous return, decreased ventricular filling, decreased stroke volume, decreased cardiac output, and ultimately, inadequate tissue perfusion.
Nursing management of Hypovolemic Shock
Nursing care management for patients with hypovolemic shock involves:
- rapid assessment to determine the cause and severity of hypovolemia - (Airway, Breathing, Circulation, Disability, Exposure)
- administering intravenous fluids for volume resuscitation
- closely monitoring vital signs and perfusion parameters
- using invasive hemodynamic monitoring when needed
- providing oxygen therapy and respiratory support
- addressing the underlying cause of hypovolemia – wound management/surgical intervention/
Fluids/blood/Transexcemic acid - collaborating with the healthcare team for timely interventions and adjustments.
Whats Cardiogenic shock
- This is caused by impaired cardiac function. Even if fluid volumes are adequate, poor cardiac output can result in tissue hypoxia in situations where the heart fails to pump blood effectively throughout the systemic circulation.
- This type of shock can occur because of cardiac arrhythmias, necrosis and heart valve dysfunction following myocardial ischaemia or infarction as a result of heart failure
Nursing Management of Cardiogenic shock
Assess vital signs, including blood pressure, heart rate, respiratory
rate, and oxygen saturation, and report any changes immediately (Airway, Breathing, Circulation, Disability, Exposure). ECG/Echocardiogram.
- Administer medications as prescribed, such as inotropic agents to improve cardiac function, vasopressors to increase blood pressure, and diuretics to reduce fluid overload.
- Assist with invasive monitoring, such as arterial lines, central venous lines, and pulmonary artery catheters, to continuously monitor hemodynamic status.
- Position the patient in a semi-Fowler’s position to reduce venous congestion and improve oxygenation.
- Collaborate with the healthcare team to develop a plan of care that addresses the patient’s specific needs and goals, and adjust the plan as needed based on the patient’s response to treatment.
What is Obstructive Shock
This is caused by obstruction to the circulating blood flow.
Decreased cardiac output can have a physically obstructive cause that impedes blood flow and affects both the preload and afterload of the cardiac cycle.
Such obstructions can be caused by numerous conditions, including;
* cardiac tamponade
* tension pneumothorax
* pulmonary embolus
* heart valve stenosis and certain anatomical defects that are more regularly observed in paediatric patients.
Nursing management of Obstructive shock
The goal with obstructive shock is to remove the thing causing the obstruction;
* Monitor vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, and report any
changes immediately. X ray/ultrasound/echocardiogram.
- Administer medications as prescribed. Pulmonary embolism needs heparin, thrombolytic therapy
- Assist with invasive monitoring, such as arterial lines, central venous lines, and pulmonary artery catheters, to
continuously monitor hemodynamic status. Tension pneumothorax requires a needle decompression and/or chest tube Cardiac tamponade needs a pericardiocentesis - Position the patient in a semi-Fowler’s position to reduce venous congestion and improve oxygenation.
- Collaborate with the healthcare team to develop a plan of care that addresses the patient’s specific needs and goals, and adjust the plan as needed based on the patient’s response to treatment.
What is Distributive shock
Distributive shock one of the four broad classifications of disorders that cause inadequate tissue perfusion.
Systemic vasodilation leads to decreased blood flow to the brain,
heart, and kidneys causing
damage to vital organs.
Distributive shock also leads to leakage of fluid from capillaries into the surrounding tissues.
Types of distributive shock include;
* Neurogenic shock
* Anaphylactic shock
* Septic shock
Whats Neurogenic shock
The loss of sympathetic nervous system activity (motor and sensory nerve impulses) because of:
- Sport injuries leading to trauma to the
spine - Inaccurate administration of anesthesia to the spinal cord
- Car accidents leading to spinal cord injury or damage to the central nervous system
- Medicines that impact the autonomic
nervous system - Gunshot wounds affecting the spine
Whats Anaphylactic shock
Anaphylactic shock is a severe,
systemic hypersensitivity reaction
to an allergen. Such allergic
reactions can be caused by foods
such as nuts, fish and dairy; drugs,
including antibiotics and
anaesthetics; and insect bites and
stings.
What is Septic Shock
Sepsis arises when the body’s
response to an infection injures its
own tissues and organs. It may lead
to shock, multi-organ failure, and
death – especially if not recognized
early and treated promptly. Sepsis is
the final common pathway to death
from most infectious diseases
worldwide, including viral infections
such as SARS-CoV-2 / COVID-19.
What is Nursing management
of disruptive shock
Sepsis: treat infection—use Sepsis
6 or Surviving Sepsis Campaign guidelines
- Neurogenic: CT scan; treat underlying cause and provide pain relief
- Anaphylactic: treat effects of antigen with adrenaline, antihistamines, steroids; follow local anaphylaxis algorithms and guidelines
