SHOCK
PREPARED BY:
WILBERT ANTONINO CABANBAN, RN
Definition of Shock
• A condition in which systemic blood pressure is
inadequate to deliver oxygen and nutrients to suppor...
Types of shock
• 68 yo M with hx of HTN and DM presents to the ER with
abrupt onset of diffuse abdominal pain with radiati...
HYPOVOLEMIC SHOCK
Hypovolemic Shock
• A state of physical collapse and prostration caused by
massive blood loss.
• A particular form of shoc...
Causes
• Acute blood loss (common cause)
•
•
•
•

GI bleed
Massive hemoptysis
AAA rupture
Ectopic pregnancy, post-partum b...
Signs & Symptoms
•
•
•
•
•
•
•

Thirst (1st SIGN)
Cold, pale, clammy skin
Decrease sensorium (unconsciousness)
Rapid shall...
Nsg. Diagnosis
• Ineffective tissue perfusion: Cardiopulmonary
• Decrease cardiac output
• Deficient fluid volume
Treatment
A. Blood & fluid replacement
Highest Nursing Priority
• Initiate a least two intravenous lines for fluid
replace...
Treatment
B. Control of bleeding
C. Redistribution of fluid
Priority Nsg. Intervention:
• Proper positioning (modified Tre...
Treatment
Treatment
D. Treatment of Main Cause
Types of Shock
• A 55 yo M with hx of HTN, DM presents with “crushing”
substernal CP, diaphoresis, hypotension, tachycardi...
CARDIOGENIC SHOCK
Cardiogenic Shock
• Occurs when the heart fails to pump adequately, thereby
reducing cardiac output and compromising tissu...
Causes
•
•
•
•
•
•

Advanced heart block
Cardiomyopathy
Heart failure
MI
Myocarditis
Papillary muscle rupture
• Muscles lo...
Signs & Symptoms
•
•
•
•

Cold, clammy skin
Hypotension (systolic pressure below 90 mmHg)
Narrow pulse pressure
Oliguria (...
Nursing Diagnosis
• Decreased cardiac output
• Ineffective tissue perfusion: Cardiopulmonary
• Ineffective tissue perfusio...
Treatment
A. Oxygen administration
B. Activity changes
• Maintaining Bed Rest (w/o Bathroom Priviledges)
C. Dietary change...
Highest Priority Nsg. Intervention
• Monitoring I & O!!!
Types of Shock
• A 34 yo F presents to the ER after dining at a restaurant
where shortly after eating the first few bites ...
ANAPHYLACTIC SHOCK
Anaphylactic Shock
• A severe and sometimes fatal systemic allergic reaction
to a sentisizing substance.
Anaphylactic Shock
Types
• Anaphylaxis
–
a
severe
systemic
hypersensitivity reaction characterized by
multisystem involvem...
Causes
• Systemic exposure to or ingestion of sensitizing drugs or
other substances such as:
• Allergen extracts
• Diagnos...
Signs & Symptoms
• First- Pruritus, flushing, urticaria appear

•Next- Throat fullness, anxiety, chest tightness,
shortnes...
Signs & Symptoms
Note!!!
• A “lump in my throat” and “hoarseness” heralds lifethreatening laryngeal edema.
Nursing Diagnosis
• Risk for suffocation
• Decreased cardiac output
• Anxiety
Treatment
• O2 administration
• CPR in cardiac arrest
• Endotracheal tube insertion (Hospital premises)
Drug Therapy
•

•
•
•

•

Epinephrine
• 0.3 mg IM of 1:1000 (epi-pen)
• Repeat every 5-10 min as needed
Corticosteroids
• ...
Types of Shock
• A 41 yo M presents to the ER after an MVC complaining
of decreased sensation below his waist and is now
h...
NEUROGENIC SHOCK
Neurogenic Shock
• Occurs after acute spinal cord injury
• Sympathetic outflow is disrupted leaving unopposed
vagal tone
•...
“SNAKE BITE”
Snake Bite
Snake venom consists primarily of
proteins with a broad range of physiologic
effects. Multiple organ systems, e...
Common Victims;
Between 1 – 9 y.o
Common Site of Bite;
Upper Extremities
Biting Time;
Daylight hours into evening durin...
Common Venomous Snake

• PIT VIPER (America)
Common Venomous Snake

• COBRA (Philippines)
PERCENTAGE OF ENVENOMATION
 20% to 25% results to envenomation due to snake
bite.
TYPES OF SNAKE BITE
1. DRY BITE – WITHO...
TYPES OF TOXINS FROM A SNAKE BITE
1. Neurotoxins
- Directly affects the brain.
2. Hemotoxins
- Directly affects the blood ...
TYPES OF TOXINS FROM A SNAKE BITE
4. Myotoxins (most common)
- Directly affecting the muscles which leads to
compartment s...
Management
In the site;
 Let the patient lie down
 Instruct the patient to calm down
 Remove all constrictive items
 P...
Management
D.O.C
 ANTIVENIN (ANTITOXIN)
NSG. INTERVENTION:
• Best Time: (the golden time)
Within 12 hours after the inci...
• Skin and eye test to be perform before giving the
antivenin to determine antivenin allergy.
• Diphenhydramine & cimetidi...
• The antivenin should be infused within 4-6 hours.
Note:
It should be on a KVO rate for the first 10 mins. &
regulate @ ...
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Shock

  1. 1. SHOCK PREPARED BY: WILBERT ANTONINO CABANBAN, RN
  2. 2. Definition of Shock • A condition in which systemic blood pressure is inadequate to deliver oxygen and nutrients to support vital organs and cellular function (Mikhail, 1999). • Inadequate oxygen delivery to meet metabolic demands. • Shock is a physiologic state characterized by systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery. In short there is a DECREASE TISSUE PERFUSION!!!
  3. 3. Types of shock • 68 yo M with hx of HTN and DM presents to the ER with abrupt onset of diffuse abdominal pain with radiation to his low back. The pt is hypotensive, tachycardic, afebrile, with cool but dry skin. WHAT TYPE OF SHOCK IS THIS? HYPOVOLEMIC SHOCK!!!
  4. 4. HYPOVOLEMIC SHOCK
  5. 5. Hypovolemic Shock • A state of physical collapse and prostration caused by massive blood loss. • A particular form of shock in which the heart is unable to supply enough blood to the body.
  6. 6. Causes • Acute blood loss (common cause) • • • • GI bleed Massive hemoptysis AAA rupture Ectopic pregnancy, post-partum bleeding • Non-hemorrhagic • • • • Vomiting Diarrhea Burns Environmental (dehydration)
  7. 7. Signs & Symptoms • • • • • • • Thirst (1st SIGN) Cold, pale, clammy skin Decrease sensorium (unconsciousness) Rapid shallow respiration Tachycardia (Early stage) Bradycardia (Late stage) Anuria (< 25 mL/ hour)
  8. 8. Nsg. Diagnosis • Ineffective tissue perfusion: Cardiopulmonary • Decrease cardiac output • Deficient fluid volume
  9. 9. Treatment A. Blood & fluid replacement Highest Nursing Priority • Initiate a least two intravenous lines for fluid replacement. Note: It should be a LARGE BORE/GAUGE!!!
  10. 10. Treatment B. Control of bleeding C. Redistribution of fluid Priority Nsg. Intervention: • Proper positioning (modified Trendelenburg) for the patient who shows signs of shock. The lower extremities are elevated to an angle of about 20 degrees; the knees are straight, the trunk is horizontal, and the head is slightly elevated.
  11. 11. Treatment
  12. 12. Treatment D. Treatment of Main Cause
  13. 13. Types of Shock • A 55 yo M with hx of HTN, DM presents with “crushing” substernal CP, diaphoresis, hypotension, tachycardia and cool, clammy extremities WHAT TYPE OF SHOCK IS THIS? CARDIOGENIC SHOCK!!!
  14. 14. CARDIOGENIC SHOCK
  15. 15. Cardiogenic Shock • Occurs when the heart fails to pump adequately, thereby reducing cardiac output and compromising tissue perfusion.
  16. 16. Causes • • • • • • Advanced heart block Cardiomyopathy Heart failure MI Myocarditis Papillary muscle rupture • Muscles located in the ventricles of the heart. They attach to the cusps of the atrioventricular valves (a.k.a. the mitral and tricuspid valves) via the chorda tendinae and contract to prevent inversion or prolapse of these valves.
  17. 17. Signs & Symptoms • • • • Cold, clammy skin Hypotension (systolic pressure below 90 mmHg) Narrow pulse pressure Oliguria (urine output of less than 30 mL/hour)
  18. 18. Nursing Diagnosis • Decreased cardiac output • Ineffective tissue perfusion: Cardiopulmonary • Ineffective tissue perfusion: Renal
  19. 19. Treatment A. Oxygen administration B. Activity changes • Maintaining Bed Rest (w/o Bathroom Priviledges) C. Dietary changes • Withholding fluids • Withholding Na D. Drug therapy • Adrenergic agents (epinephrine) • Cardiac glycoside (digoxin) • Cardiac inotropes (dopamine & dobutamine)
  20. 20. Highest Priority Nsg. Intervention • Monitoring I & O!!!
  21. 21. Types of Shock • A 34 yo F presents to the ER after dining at a restaurant where shortly after eating the first few bites of her meal, became anxious, diaphoretic, began wheezing, noted diffuse pruritic rash, nausea, and a sensation of her “throat closing off”. She is currently hypotensive, tachycardic and ill appearing. WHAT TYPE OF SHOCK IS THIS? ANAPHYLACTIC SHOCK!!!
  22. 22. ANAPHYLACTIC SHOCK
  23. 23. Anaphylactic Shock • A severe and sometimes fatal systemic allergic reaction to a sentisizing substance.
  24. 24. Anaphylactic Shock Types • Anaphylaxis – a severe systemic hypersensitivity reaction characterized by multisystem involvement • IgE mediated • Anaphylactoid reaction – clinically indistinguishable from anaphylaxis, do not require a sensitizing exposure • Not IgE mediated
  25. 25. Causes • Systemic exposure to or ingestion of sensitizing drugs or other substances such as: • Allergen extracts • Diagnostic chemicals • Insect venoms (honeybees, fire ants, mosquitoes, etc..) • Vaccines
  26. 26. Signs & Symptoms • First- Pruritus, flushing, urticaria appear •Next- Throat fullness, anxiety, chest tightness, shortness of breath and lightheadedness •Finally- Altered mental status, respiratory and circulatory collapse distress
  27. 27. Signs & Symptoms Note!!! • A “lump in my throat” and “hoarseness” heralds lifethreatening laryngeal edema.
  28. 28. Nursing Diagnosis • Risk for suffocation • Decreased cardiac output • Anxiety
  29. 29. Treatment • O2 administration • CPR in cardiac arrest • Endotracheal tube insertion (Hospital premises)
  30. 30. Drug Therapy • • • • • Epinephrine • 0.3 mg IM of 1:1000 (epi-pen) • Repeat every 5-10 min as needed Corticosteroids • Methylprednisolone 125 mg IV • Prednisone 60 mg PO Antihistamines • H1 blocker- Diphenhydramine 25-50 mg IV • H2 blocker- Ranitidine 50 mg IV Bronchodilators • Albuterol nebulizer • Atrovent nebulizer • Magnesium sulfate 2 g IV over 20 minutes Glucagon • For patients taking beta blockers and with refractory hypotension • 1 mg IV q5 minutes until hypotension resolves
  31. 31. Types of Shock • A 41 yo M presents to the ER after an MVC complaining of decreased sensation below his waist and is now hypotensive, bradycardic, with warm extremities WHAT TYPE OF SHOCK IS THIS? NUEROGENIC SHOCK!!!
  32. 32. NEUROGENIC SHOCK
  33. 33. Neurogenic Shock • Occurs after acute spinal cord injury • Sympathetic outflow is disrupted leaving unopposed vagal tone • Results in hypotension and bradycardia • Spinal shock- temporary loss of spinal reflex activity below a total or near total spinal cord injury (not the same as neurogenic shock, the terms are not interchangeable)
  34. 34. “SNAKE BITE”
  35. 35. Snake Bite Snake venom consists primarily of proteins with a broad range of physiologic effects. Multiple organ systems, especially the neurologic, cardiovascular, and respiratory systems, may be affected.
  36. 36. Common Victims; Between 1 – 9 y.o Common Site of Bite; Upper Extremities Biting Time; Daylight hours into evening during summer months. WHY???
  37. 37. Common Venomous Snake • PIT VIPER (America)
  38. 38. Common Venomous Snake • COBRA (Philippines)
  39. 39. PERCENTAGE OF ENVENOMATION  20% to 25% results to envenomation due to snake bite. TYPES OF SNAKE BITE 1. DRY BITE – WITHOUT VENOM 2. WET BITE – WITH VENOM
  40. 40. TYPES OF TOXINS FROM A SNAKE BITE 1. Neurotoxins - Directly affects the brain. 2. Hemotoxins - Directly affects the blood thereby causing heart attack. 3. Cytotoxins - Directly affects the nearby living cells from the bite site.
  41. 41. TYPES OF TOXINS FROM A SNAKE BITE 4. Myotoxins (most common) - Directly affecting the muscles which leads to compartment syndrome. NSG. INTERVENTION: W.O.F – 4 P’s with S 1. PALLOR 2. PULSELESSNESS 3. PAIN 4. PARESTHESIA 5. SWELLING TREATMENT: FASCIOTOMY - To relieve the pressure!!!
  42. 42. Management In the site;  Let the patient lie down  Instruct the patient to calm down  Remove all constrictive items  Providing warmth  Cleansing the wound (use soap if available) Note: Do not suck the site of snake bite!!!  Immobilize the injured body part below the level of the heart  “Ice or a tourniquet is not applied in the acute stage”
  43. 43. Management D.O.C  ANTIVENIN (ANTITOXIN) NSG. INTERVENTION: • Best Time: (the golden time) Within 12 hours after the incidence • Dosage: Depending on the type of snake & severity of bite Note: Children needs more antivenin
  44. 44. • Skin and eye test to be perform before giving the antivenin to determine antivenin allergy. • Diphenhydramine & cimetidine are given prior to antivenin administration. • Best Route: Intravenous IM (can be used) Note: Antivenin should be diluted to 500 to 1000 mL of PNSS.
  45. 45. • The antivenin should be infused within 4-6 hours. Note: It should be on a KVO rate for the first 10 mins. & regulate @ desired flow rate after. When symptoms is decreased the affected site should be checked every 30 to 60 mins. for 2 days!!!

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