Nursing Shocked Patient Flashcards
Define Shock
An acute circulatory failure resulting in inadequate tissue perfusion and energy production
Why is shock so serious?
Any circulatory failure will lead to inability of nutrient transport and inability to clear waste products which then build up and become toxic. If its left, the body will try and correct it, making it worse
What does normal tissue perfusion rely on?
good Cardiac output, good circulating volume, good peripheral vascular resistance
What is the formula for calculating cardiac output?
CO= Stroke volume (amount of blood in each pump) x HR (pumps per minute)
What is the role of baroreceptors?
Measure the force of blood coming out of the heart. If they detect a fall in CO, stimulates the release of adrenaline & noradrenaline which increases HR and contractility
What will hypoxia of the tissues result in?
Acidosis - respiration will increase to try and counteract this and get rid of excess acid
What system is activated if the kidneys aren’t getting enough perfusion?
RAA system
What happens once compensatory mechanisms start to fail?
Blood vessels become leaky
Blood becomes more viscous and causes clots etc
Acidosis
Gut lacks a blood supply so allows bacteria into bloodstream and causes sepsis
Eventually, causes disseminated intravascular coagulation (DIC)(Death is coming)
What is hypovolaemic shock?
- decreased/ inadequate blood volume
- due to loss of blood, fluid or plasma
What is endotoxic/septic shock?
- a distributive shock
- gram neg bacterial infection
- toxins in circulation cause uneven fluid distribution
What is cardiogenic shock?
- reduced cardiac efficiency and therefore output
- causes congestion in lungs and liver and oedema
What is neurogenic shock?
- shock to CNS
- causes loss of sympathetic tone and acute vasodilation => drop in BP (essentially it affects the ability of the vessels to vasoconstrict)
Give examples of causes of hypovolaemic shock?
- Trauma e.g. RTA
- Ruptured abdominal organs
- Surgery
- Burns
Give examples of causes of septic shock?
- Peritonitis
- Pyometra e.g. recent season and vomiting
- Gastric haemorrhage
Give examples of causes of Cardiogenic shock?
- Cardiomyopathy
- Pericarditis
- Congenital Defects
- Arrhythmias
- Endocarditis
Give examples of causes of Neurogenic shock?
- Brain or spinal trauma
- Deep anaesthesia
- Epidural anaesthesia
Name some clinical signs of shock?
- Tachycardia
- Hypotension
- Tachypnoea
- Pale MM
- Prolonged CRT
- Hypothermia
- Reduced urine output
What should you do to manage a shocked patient?
- identify and rectify cause of shock
- establish adequate ventilation and oxygenation
- restore intravascular volume
What is the treatment of a shocked patient
- oxygenate
- resuscitation if required
- control any haemorrhage
- Increase the blood volume FAST - IVFT (type of fluid depends on what is lost)
- Bicarbonate to address metabolic acidosis / antibiotics if toxic
- Maintain body temp
What can be done to help quickly increase fluid volume ?
- Bollus
- 2 cannulas
- Jugular less likely to collapse
- central line or IO
- Can put a pressure cuff around the bag
- Lactated ringers to offset acidosis
- May need blood products
What dressing can be applied for any haemorrhagic shock?
Pressure bandages
