Nursing Shocked Patient

Question 1

Define Shock

Answer 1

An acute circulatory failure resulting in inadequate tissue perfusion and energy production

Question 2

Why is shock so serious?

Answer 2

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

Question 3

What does normal tissue perfusion rely on?

Answer 3

good Cardiac output, good circulating volume, good peripheral vascular resistance

Question 4

What is the formula for calculating cardiac output?

Answer 4

CO= Stroke volume (amount of blood in each pump) x HR (pumps per minute)

Question 5

What is the role of baroreceptors?

Answer 5

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

Question 6

What will hypoxia of the tissues result in?

Answer 6

Acidosis - respiration will increase to try and counteract this and get rid of excess acid

Question 7

What system is activated if the kidneys aren’t getting enough perfusion?

Answer 7

RAA system

Question 8

What happens once compensatory mechanisms start to fail?

Answer 8

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)

Question 9

What is hypovolaemic shock?

Answer 9

• decreased/ inadequate blood volume

- due to loss of blood, fluid or plasma

Question 10

What is endotoxic/septic shock?

Answer 10

• a distributive shock
• gram neg bacterial infection
• toxins in circulation cause uneven fluid distribution

Question 11

What is cardiogenic shock?

Answer 11

• reduced cardiac efficiency and therefore output

- causes congestion in lungs and liver and oedema

Question 12

What is neurogenic shock?

Answer 12

• shock to CNS
• causes loss of sympathetic tone and acute vasodilation => drop in BP (essentially it affects the ability of the vessels to vasoconstrict)

Question 13

Give examples of causes of hypovolaemic shock?

Answer 13

• Trauma e.g. RTA
• Ruptured abdominal organs
• Surgery
• Burns

Question 14

Give examples of causes of septic shock?

Answer 14

• Peritonitis
• Pyometra e.g. recent season and vomiting
• Gastric haemorrhage

Question 15

Give examples of causes of Cardiogenic shock?

Answer 15

• Cardiomyopathy
• Pericarditis
• Congenital Defects
• Arrhythmias
• Endocarditis

Question 16

Give examples of causes of Neurogenic shock?

Answer 16

• Brain or spinal trauma
• Deep anaesthesia
• Epidural anaesthesia

Question 17

Name some clinical signs of shock?

Answer 17

• Tachycardia
• Hypotension
• Tachypnoea
• Pale MM
• Prolonged CRT
• Hypothermia
• Reduced urine output

Question 18

What should you do to manage a shocked patient?

Answer 18

• identify and rectify cause of shock
• establish adequate ventilation and oxygenation
• restore intravascular volume

Question 19

What is the treatment of a shocked patient

Answer 19

• 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

Question 20

What can be done to help quickly increase fluid volume ?

Answer 20

• 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

Question 21

What dressing can be applied for any haemorrhagic shock?

Answer 21

Pressure bandages