Shock is a clinical syndrome characterized by a systemic imbalance between oxygen supply and demand. It progresses through three stages: compensatory shock, progressive shock, and irreversible shock. Types of shock include hypovolemic, cardiogenic, septic, neurogenic, and anaphylactic shock. Treatment focuses on identifying and treating the underlying cause, restoring intravascular volume through fluid resuscitation, and providing supportive care and organ function support. Nursing care involves careful monitoring for signs of deteriorating condition and interventions to increase patient comfort.

1. SHOCK By- Anant Layall
Christian Medical College,
Ludhiana

2. DEFINITION
Shock is a clinical syndrome characterized by a
systemic imbalance between oxygen supply and
demand.

3. PATHOPHYSIOLOGY /STAGES OF
SHOCK
Stage I: Compensatory Shock
Stage II: Progressive Shock
Stage III: Irreversible Shock

4. STAGE I: COMPENSATORY SHOCK
Pressure changes detected by the baroceptors in the aorta.
Activation of compensatory mechanism by
1- activation of sympathetic nervous system to cause
vasoconstriction.
2- secretion of adrenaline and nor adrenaline from adrenal to cause
vasoconstriction
3-activation of renin angiotensin aldosterone system to cause
vasoconstriction and promote reabsorption of water from kidneys.
4- secretion of Anti di uretic hormone for reabsorption of water from
kidneys
To increase the blood pressure.

5. STAGE II: PROGRESSIVE SHOCK
•Sustained drop in blood pressure
•The cell does not get enough oxygen to produce energy, they
shift to anaerobic respiration.
•Production of lactic acid as bi product.
•Lactic acid causes acidosis

6. STAGE III: IRREVERSIBLE SHOCK
•Irreversible stage the tissue anoxia becomes generalized and
wide spread cell death happens.
•Death of vital organs contributes to subsequent death of the
body.

7. CLINICAL MANIFESTATIONS OF
SHOCK
Respiratory
• Increased Respiratory rate
• Respiratory acidosis
Neurologic
• cognition
• consciousness
• Restlessness
• Lethargy
• Coma
Cardiovascular
• Tachycardia
• Thready pulse
• Decreased BP
Integumentary
• Pallor (skin, lips, oral mucosa, nail beds,
conjunctiva)
• Cool, moist skin
Gastrointestinal
• Paralytic ileus

8. TYPES OF SHOCK
1. Hypovolemic Shock
2. Cardiogenic Shock
3. Septic Shock
4. Neurogenic Shock
5. Anaphylactic Shock

9. 1- HYPOVOLEMIC SHOCK
Hypovolemic shock, the most common type of shock, is characterized by a
decreased intravascular volume.
Hypovolemic shock is caused by a decrease in intravascular volume of 15%
or more
Etiology
Trauma
Surgery
Vomiting
Diarrhea
 Diuresis
 Hemorrhage
 Burns
 Ascites
 Peritonitis
 Dehydration

10. MANAGEMENT
TREATMENT OF THE UNDERLYING CAUSE
If the patient is hemorrhaging, efforts are made to stop the bleeding.
This may involve applying pressure to the bleeding site or surgery to
stop internal bleeding.
FLUID AND BLOOD REPLACEMENT
At least two large-gauge intravenous lines are inserted to establish
access for fluid administration.
administration of fluid(isotonic, colloids), medications, and blood
component therapy if required.
the goal of the fluid replacement is to restore intravascular volume

11. 2-CARDIOGENIC SHOCK
Cardiogenic shock occurs when the heart’s ability to contract and to
pump blood is impaired.
Cardiogenic shock is defined as a condition when the heart’s
pumping ability is compromised to the point that it cannot maintain
cardiac output and adequate tissue perfusion.
Etiology
•Myocardial infarction
•Cardiomyopathies
•Valvular damage
•Dysrhythmias
•CCF

12. MANAGEMENT
The treatment include
CORRECTION OF UNDERLYING CAUSES
In coronary cardiogenic shock, the patient may require thrombolytic
therapy, angioplasty, or coronary artery bypass graft surgery.
In the case of noncoronary cardiogenic shock, the patient may require
a cardiac valve replacement or correction of a dysrhythmia.

13. INITIATION OF FIRST-LINE
TREATMENT
• Supplying supplemental oxygen
• Controlling chest pain
• Providing selected fluid support
• Administering vasoactive medications(eg. Nitroglycerin, Dopamine,
adrenaline)
• Controlling heart rate with medication or by implementation of a
transthoracic or intravenous pacemaker
• Implementing mechanical cardiac support (intra-aortic balloon
therapy, ventricular assist systems, or cardiopulmonary bypass)
• Hemodynamic monitoring

14. 3- SEPTIC SHOCK
Septic shock is a serious medical condition that occurs when sepsis,
leads to dangerously low blood pressure and abnormalities in cellular
metabolism due to vasodilation.
Risk Factors
•Immunosuppression
•Extremes of age (<1 yr and >65 yr)
•Malnourishment
•Chronic illness
•Invasive procedures

15. MANAGEMENT
Current treatment of septic shock involves identifying and
eliminating the cause of infection.
Specimens of blood, sputum, urine, wound drainage, and invasive
catheter tips are collected for culture using aseptic technique.
If the infecting organism is unknown, broad-spectrum antibiotic
agents are started until culture and sensitivity reports are
received.(Eg. Ceftriaxone, Cefotaxime,meropenem )
After the reports the antibiotic sensitive for the organism is started

16. 4- NEUROGENIC SHOCK
Neurogenic shock is a condition in which massive vasodilation occurs
as a result of a loss of sympathetic tone. This can be caused by spinal
cord injury, spinal anesthesia, or nervous system damage.

17. MANAGEMENT
•Dopamine is often used either alone or in combination with
other inotropic agents.
•Certain vasopressors (ephedrine, norepinephrine).
•Phenylephrine may be used as a first line treatment, or secondarily in
people who do not respond adequately to dopamine.

18. 5- ANAPHYLACTIC SHOCK
Anaphylactic shock is the result of a widespread humorally mediated
hypersensitivity reaction (anaphylaxis) resulting in vasodilatation,
pooling of blood in the periphery.
Etiology
•Penicillin (Drug) sensitivity
•Transfusion reaction
•Bee sting allergy
•Latex sensitivity

19. MANAGEMENT
•Treatment of anaphylactic shock requires removing the
causative antigen (eg, discontinuing an antibiotic agent).
•Epinephrine is given for its vasoconstrictive action.
Diphenhydramine (Benadryl) is administered to reverse the
effects of histamine, thereby reducing capillary permeability.

20. EMERGENCY MANAGEMENT OF
SHOCKAssess & Maintain patent airway (suction and intubation) and assess
breathing.
Put the patient on High flow oxygen
Stabilize cervical spine
Start 2 Large IV bore and administer crystalloids
Control and manage the underlying cause
Insert Catheter and Ng tube
Monitor vitals, consciousness, ECG saturation and urinary output

21. NURSING MANAGEMENT
1- Decreased Cardiac Output
•Assess and monitor cardiovascular function via the following:
■ Blood pressure
■ Heart rate and rhythm
■ Pulse oximetry
■ Peripheral pulses
■ Hemodynamic monitoring
•Measure and record intake and output
•Monitor bowel sounds, abdominal distention, and abdominal pain.
•Monitor for sudden sharp chest pain, dyspnea, cyanosis, anxiety,and
restlessness.

22. 2- Altered Tissue Perfusion
■ Monitor skin color, temperature, turgor, and moisture.
■ Monitor cardiopulmonary function
■ Monitor body temperature.
■ Monitor urinary output per Foley catheter hourly, using a urimeter.
■ Assess mental status and level of consciousness.

23. 3- Anxiety
1. Assess the cause(s) of the anxiety
2. Administer prescribed pain medications on a regular basis
3. Provide interventions to increase comfort and reduce restlessness:
■ Maintain a clean environment.
■ Provide skin and oral care.
■ Monitor the effectiveness of ventilation or oxygen therapy.
■ Eliminate all nonessential activities.
■ Remain with the patient during procedures.
■ Speak slowly and calmly, using short sentences.
■ Use touch to provide support.