MSN-I

1. SHOCK

2. DEFINITION
• Shock is a medical emergency in which the organs
and tissues of the body are not receiving and
adequate blood flow.

3. TYPES
• Cardiogenic shock (associated with heart problem)
• Hypovolemic shock (caused by inadequate blood
volume)
• Anaphylactic shock (caused by allergic reaction)
• Septic shock (associated with infection)
• Neurogenic shock (caused by damage to nervous
system)

4. ETIOLOGY
• Heart failure
• Hemorrhage
• Dehydration
• Severe allergic reaction
• Infections
• Rapid heart rate
• Low blood pressure

5. PATHOPHYSIOLOGY
• Inadequate perfusion
• Hypoxia
• Decreased energy level
• Lactic acid accumulation and PH decreases
• Metabolic acidosis
• Dysfunction of cell membrane
• Destruction, dysfunction and cell death

6. CLINICAL MANIFESTATION
• Chest pain
• Shallow breathing
• Bluish lip and nails
• Unconsciousness
• Distended jugular vein
• Cool and clammy
extremities
• Thirst and dry mouth
• Confusion
• Weak and absent pulse
• nausea and vomiting
• Anxiety
• Low blood pressure

7. DIAGNOSTIC EVALUATION
Lab investigation:
• Hb,WBC,Plateletes
• PT/PTT
• Electrolytes
• Arterial blood gases
• Ca, Mg
• Serum lactate
• ECG

8. • CXR
• CT scan abdomen or chest
• Echocardiogram
• Venous oximetry- measuring
oxyhemoglobin saturation of central or
mixed venous blood
• Pulmonary artery catheter-assess
intracardiac and intrapulmonary
pressure

9. MANAGEMENT
• Provide Oxygen therapy (100% O2)
• IV infusion for reduced hopovolemia, e.g. dextran,
plasma, blood.
• Vasoconstrictors agents for maintaining blood
pressure e.g., epinephrine, nor epinephrine.

10. NURSING MANAGEMENT
• Assess airway, breathing and circulation, if necessary give CPR.
• If the person is conscious and does not have an injury to the
head, leg, spine, place person in position.
• Give appropriate first aid for any wound, injuries or illness
• Keep the person warm and comfortable, loosen tight clothes.
• If patient is having vomiting, turn the head to one side.