Shock -Introduction & Management

1. SHOCK
A N A M I K A R A M AWAT
M . S C . N U R S I N G P R E V.
B ATC H 2 0 1 7 - 1 8
G CO N , J O D H P U R

2. INTRODUCTION
• Shock is a condition in which tissue perfusion is inadequate to
deliver oxygen and nutrients to support vital organ and cellular
function.
• Shock is a state of inadequate tissue perfusion of vital organ. It
results in decreased oxygenation at the cellular level and cellular
metabolism is inadequate, metabolic waste accumulate in the cell,
if condition is not treated
• cell and organ death occur.
• Shock is a state of inadequate perfusion of vital organ like brain,
kidney, liver due to the reduction in the cardiac output.
• Shock is a state of peripheral circulatory failure

3. DEFINITION
• “Shock is defined as a complex, life threatening
condition or syndrome characterized by inadequate
blood flow to the tissues and cells of the body.”
• “Shock may be defined as inability of circulatory
system to supply blood oxygen and nutrients
adequately.”

4. TYPES

9. ETIOLOGY

10. HYPOVOLAEMIC ETIOLOGY Blood loss-hemorrhage
Electrolytes imbalance-Vomiting, Diarrhea, Dehydration.
CARDIOGENIC ETIOLOGY Valvular heart disease
Myocardial infarction.
Cardiac arrhythmias.
Cardiomyopathy
Cardiac Tamponade
Pulmonary Embolism
Tension Pneumothorax
Air embolism
NEUROGENIC ETIOLOGY Paraplegia.
Quadriplegia.
Trauma to spinal cord.
Spinal anesthesia
ANAPHYLACTIC ETIOLOGY Injections - Penicillin’s.
Anesthetics
Stings
SEPTIC ETIOLOGY Gram +
Gram –
Fungi / Virus
Protozoa

11. PATHOPHYSIOLOGY

13. STAGES OF SHOCK
NON-
PROGRESSIVE
STAGE
PROGRESSIVE
STAGE
IRREVERSIBLE
STAGE

14. CLINICAL MANIFESTATIONS
Hypotension
Tachycardia
Tachypnea
Diaphoresis
Thirst
Cyanosis

15. Pallor face
Hypothermia
Oliguria
Nausea and vomiting
Decrease level of consciousness

16. Cold and clammy skin
Dilated pupil
Anxiety and restlessness
Irritability
Metabolic acidosis

17. ASSESSMENT AND DIAGNOSTIC
FINDINGS-
CBC and electrolyte balance
Lactate dehydrogenase (LDH), creatine phosphokinase
myocardial and muscle (CPK-MB) increased.
Urinary output usually decreases to less than 0.5ml/kg/hour or
less than 30ml/ hour.
liver enzymes aspartate aminotransferase (AST) alanine
aminotransferase (ALT) lactate dehydrogenase (LDH) and
bilirubin level are elevated and the patient appears jaundiced.

18. MANAGEMENT
MEDICAL
1. Broad spectrum antibiotic therapy begins immediately.
2. Vasopressor drugs administered as prescribed e.g.,
Dopamine, dobutamine.
3. Nor adrenaline may be administered as prescribed in
case of cerebral edema increase.
4. In anaphylactic shock corticosteroid administered as
prescribed.
5. Heparin used in condition of intra vascular coagulation.

19. NURSING MANAGEMENT
ASSESSMENT: -
1. History collection
2. Physical examination
General look, pulse, respiration, temperature, B.P, skin,
urine output, level of consciousness, and cyanosis,
pallor in shock patient.

20. DIAGNOSIS1.Ineffective airway clearance related to
disease process as evidenced by difficulty in
breathing.1.Ineffective breathing pattern related to inadequate
tissue perfusion as evidenced by forceful respiration.
1.Fluid volume deficit related to fluid loss as
evidenced by blood loss.1.Altered nutrition less than body requirement
related to decreased blood flow to body cells as
evidenced by poor skin turgor, patient seems weak
and dull.
Ineffective cell perfusion related to decreased blood
pressure as evidenced by cyanosis, and shock
condition.

21. INTERVENTION

22. HEALTH EDUCATION
Health education is given regarding to oral and personal hygiene.
Encourage the for regular checkup.
Educate the patient for taking small and frequent diet.
Educate the patient for regular exercise.
Health education is given regarding to prevention from cross infection.

23. SUMMARY…