Shocked Patient Flashcards
What is shock?
An acute circulatory failure resulting in adequate tissue perfusion and energy production
What does normal tissue perfusion rely on?
Cardiac output
Circulating volume
Peripheral vascular resilience
What does a reduction in tissue perfusion parameters result in?
Inadequate perfusion
Triggers compensatory mechanisms
Altered efficacy of all systems
What are baroreceptors?
They detect reduced cardiac output, stimulating adrenaline and noradrenaline release
This causes increased heart rate and contractility
What is hypoxia?
Occurs in tissues
Results in metabolic acidosis
Ventilation increases to address acid
What is hypoperfusion?
Occurs in kidney
Activates the RAA system
Aldosterone acts on the collecting ducts to retain Na and H2O
Also causes peripheral vasoconstriction
What happens during decompensation?
Fluid and proteins leak from circulation into the tissues
Viscosity of blood increases
Acidosis increases
Why does hypovolaemic shock occur?
Due to loss of blood, fluid or plasma
Decreased or inadequate circulating volume
What does hypovolaemic shock result in?
A severe tissue hypoperfusion
What are examples which could lead to hypovolaemic shock?
Trauma
Ruptured abdominal organs
Surgery
Hepatitis
What occurs in septic shock?
Gram -ve bacterial infection
Endotoxins released from ruptured bacterial cells
Toxins in the circulation increase capillary permeability causing uneven fluid distribution
What are examples which could lead to septic shock?
Pyometra
Intestinal strangulation
Peritonitis
What does cardiogenic shock cause?
Reduction in cardiac efficacy
Heart loses its ability to pump effectively leading to a reduction in cardiac output
What does cardiogenic shock result in?
Congestion in the liver and lungs
Oedema
What are examples which can lead to cardiogenic shock?
Cardiomyopathies
Pericarditis
Congenital heart defects
What occurs during obstructive shock?
Obstruction of normal blood flow
Due to pericardial effusion, blood in unable to fill the ventricles and hence cardiac output is reduced
What are causes of obstructive shock?
Pericardial effusion
Pulmonary thromboembolism
What are clinical signs of shock?
Tachycardia
Hypotension
Tachypnoea
Pale mucous membrane
Prolonged capillary refill time
Hypothermia
Weakness
Reduced urine output
How should shock patients be evaluated?
History
Physical examination
(MM, CRR, HR, PR, RR, temp, hydration)
Blood tests
(Hb, PCV, glucose, total protein)
How should shock patient be managed?
Identify and rectify cause
Establish adequate ventilation and oxygenation
Restore optimum intravascular volume
What should be maintained in shock patient?
Adequate cardiac output and renal perfusion
Optimum internal metabolic environment
How should shock patients be treated?
-Oxygenate
-Provide analgesia
-Control haemorrhage
-IVFT
-Antibiotics
-Maintain body temperature
What nursing care can be provided to shock patients?
-carry out first aid
-select method of oxygen delivery
-organise fluid administration
-analgesia (under VS direction)
-dressings
-warming patient
-stress reduction measures
-constant monitoring vital signs and records
What should be monitored in shock patient?
Mucous membrane
Capillary refill time
Temperature
Heart rate
Respiratory rate
Sp02 levels
