This document discusses different types of shock, their causes, signs and symptoms, and treatment. It defines shock as inadequate delivery of oxygen to tissues. The main types discussed are hypovolemic, cardiogenic, distributive (neurogenic, anaphylactic, septic), and obstructive shock. For each type, the causes, pathophysiology, clinical manifestations, diagnosis and management are explained. Nursing interventions for shock include monitoring vitals, airway, circulation, providing fluids and vasoactive drugs, and addressing nutritional and comfort needs. Immediate steps for someone in shock include laying them down, calling for emergency help, and beginning CPR if needed.

2. PRESENTED BY
SUCHISMITA SETHI

3. INTRODUCTION TO SHOCK
• Shock is a physiologic event which may have
different causes but if it is not treated at
proper time it has the single clinical outcome.
• Mortality rate 20% .

4. DEFINITION
• Shock is defined as inadequate delivery of
oxygen and nutrient to maintain the normal
tissue & cellular function.
• ( Schwartz’s)

5. CAUSES:-
• Drug reaction.
• Poisoning.
• Heart failure.
• Vomiting and diarrhoea.
• Burns.
• Spinal injury.
• Allergy .
• Infection.
• Dehydration.
• Heavy bleeding

6. • SHOCK
• CARDIOGENIC HYPOVOLEMIC DISTRIBUTIVE OBSTRUCTIVE
• ABSOLUTE NEUROGENIC
• HYPOVOLEMIA
• ANAPHYLATIC
• RELATIVE
• HYPOVOLEMIA SEPTIC

7. CARDIOGENIC
• It results from inadequate pumping action of
heart due to cardiac muscle dysfunction.
• Hear heart damaged so much that it is unable
to supply blood to the organs of body.
• CAUSES:-
• MI
• Ventricular hypertrophy.
• Systemic or pulmonary hypertension.
• Cardiac injury.
• Blunt cardiac injury.

8. • PRIMARY VENTRICULAR STRUCTURAL DYSRHYTHMIA
• ISCHEMIA PROBLEM
• SYSTOLIC DYSFUNCTION DIASTOLIC DYSFUNCTION
• (Ineffective forward movement of blood) ( Infective filling)
• Stroke volume Pulmonary pressure
• cardiac output Pulmonary edema.
• Oxygenation
• Cellular o2 supply
• Tissue perfusion
• Impaired cellular metabolism
• Shock

9. CLINICAL MANIFESTATION
• Cyanosis.
• Pallor.
• Weak peripheral pulse.
• Cool and camy skin.

10. HYPOVOLEMIC SHOCK
• It is an emergency condition in which there is
severe blood and fluid loss so the heart not
able to pump sufficient amount of blood to
the body.
• A. Absolute Hypovolemia:- It occur due to
external loss of blood and body fluid.
• EX:- Haemorrhage, surgery, GI Bleeding,
vomiting.
• B. Relative Hypovolemia:- It occur due to
pulling of body fluid from intracellular to
extracellular space.
• Ex- Burn, ascites.

11. • RELATIVE HYPOVOLEMIA ABSOLUTE HYPOVOLEMIA
• CIRCULATORY VOLUME
• VENOUS RETURN
• STROKE VOLUME
• CARDIAC OUTPUT
• CELLULAR O2 SUPPLY
• TISSUE PERFUSION
• SHOCK

12. CLINICAL MANIFESTATION
• Tachycardia.
• Bradycardia(late)
• Decrease urine output.
• Pallor, cool and cammy skin.
• Anxiety.
• Confusion.
• Agitation.
• Decrease haemotocrit.
• Decrease haemoglobin.

13. DISTRIBUTIVE SHOCK
• A. NEUROGENIC SHOCK:-
• It occur due to damage to the spinal
cord above the level of 6th thoracic vertebra.
• It can cause extremely dangerous because blood
pressure drop drastically & suddenly.
• CAUSES:-
• Accident which damage to nervous system.
• Gun shout wound to the spine.
• Medication that affect autonomic nervous
system.
• Improper administration of spinal anasthesia.

14. • DYSRUPTION OF SYMPATHETIC NERVOUS SYSTEM
• LOSS OF SYMPATHETIC TONES
• VENOUS DIALATION ARTERIAL DIALATION
• VENOUS RETURN DECREASE PERIPHERAL
• VASCULAR RESISTANCE
• STROKE VOLUME
• CARDIAC OUTPUT
• TISSUE PERFUSION.

15. CLINICAL MANIFESTATION OF
NEUROGENIC SHOCK
• Difficulties in breathing
• Decrease BP
• Bradycardia.
• Decrease body temperature.
• Cyanosis.
• Chest pain.

16. ANAPHYLATIC SHOCK
• It is an hypersensitive reaction to an sensitizing
substance like drugs, chemicals, vaccines, food,
insect venom. (hear fluid leak from vascular
space to the interstitial space).
• CAUSES:-
• Certain medication such as penicillin.
• Insects stings.
• Food such as-
• Tree nuts.
• Shellfish
• Milk.
• Egg.

17. • EXPOSURE TO ANTIGEN
• ACTIVATION OF SENSITISE ANTIBODIES
• ANTIGEN ANTIBODY REACTION
• RELEASE OF VASOACTIVE MEDICATIONS
• MASSIVE VASODIALATION CAPILARY PERMIABILITY
VENOUS AND ARTERIAL DIALATION INTERSTICIAL EDIMA
RELATIVE HYPOVOLEMIA
SHOCK

18. CLINICAL MANIFESTATION
• Chest pain
• Third spacing of fluid.
• Skin reaction
• Suddenly feeling too warm
• Difficulty in swallowing(laryngeal edema)
• Abdominal pain.
• Tingling sensation
• Confusion.
• Loss of consciousness.

19. SEPTIC SHOCK
• Septic shock is a medical condition results from
severe infection and sepsis. It can cause multiple
organ dysfunction and death.
• CAUSE:-
• Ecoli
• Proteus species.
• Klebsiella pneumonia.
• PREDISPOSING FACTOR:-
• Trauma
• DM
• Steroid therapy
• Immunocompromise.

20. • INFECTION
• RELEASE MICROBEAL TOXINS
• ACTIVATED HOST DEFENCE SYSTEM
• ADIQUATE INFLAMATORY RESPONSE INADIQUATE
(controlled infection Excessive (uncontrolled infection
Microbial toxins ongoing release of
Cleared) microbial toxins)
Tissue injury
shock & multiorgan failure
death

21. Clinical manifestation
• Fever
• Hypovolemia
• Increase heart rate
• Rapid breathing
• Low amount of urine
• Confusion
• cyanosis.

22. OBSTRUCTIVE SHOCK
• It is a form of shock associated with physical
obstruction of the great vessels or the heart
itself.
• Ex- pulmonary embolism, cardiac tamponade
• Aortic stenosis,

23. STAGES OF SHOCK
• There are 4 basic stages of shock for each type
of shock
• Initial
• Compensatory
• Progressive
• Irreversible or refractory.

24. Cont...
• A.INNITIAL STAGE:-
• Hypo perfusion causes hypoxia.
• Due to lack of oxygen cell membrane become damaged and leaky to
extracellular fluid.
• Also due to lack of oxygen cell perform anaerobic respiration & build
up of lactic and pyruvic acid which causes metabolic acidosis.
• B.COMPENSATORY STAGE:-
• Hear body attempt several measures to correct the metabolic
acidosis.
• Compensatory mechanism attempt to perfuse heart and brain.
• Due to hyperventilation cause respiratory alkalosis.
• Epinephrine and non epinephrine increase bp & contractility of heart.
• Ranin angiotensin system increase the blood volume & venous return
by retention of sodium and water. It increase CO & tissue perfussion.

25. • c. PROGRESSIVE STAGE:-
• It begin when compensatory mechanism fail to
maintain CO.
• Due to poor perfusion there is sodium ion build up
and potassium ion leak out.
• Increase metabolic acidosis, arteriolar smooth
muscle, precapilary sphincter relax leads to keep
blood remain in capillary.
• D. Irreversible stage:-
• Compensatory mechanism no longer maintain CO.
• Perfusion to coronary artery reduce causes
myocardial depression, cell death occure

26. DIAGNOSTIC STUDY
• History taking & physical exam.
• Chest X-Ray
• ABG analysis.
• Urine analysis
• HB level
• CBC
• Blood, Urine, sputum culture
• Cardiac enzyme
• Cardiac catheterization & coronary
angiography.

27. MANAGEMENT
• 1. Management of airway, breathing,
circulation.
• 2.Fluid replacement to restore intravascular
volume.
• 3. Vasoactive medication to restore the vaso
active tone & improve cardiac function.
• 4. Nutritional support to address metabolic
requirement.

28. 1. Management of airway, breathing,
circulation.
• Check consciousness & breathing pattern
• If not breathing properly check any blockage
in mouth or in nose.
• Assess adequacy of blood circulation
• Provide o2 therapy by nasal cannula , face
mask or endotracheal intubation.
• Provide appropriate position.

29. 2.Fluid replacement to restore
intravascular volume.
• get an access for fluid administration
• 2 iv cannula or 1 central line catheter inset to
maintain the fluid need.
• Use 0.9 ns & RL crystalloid solution which move
freely from intravascular compartment &
interstitial space. first choice of fluid id rl then ns
to prevent acidosis
• Provide colloids such as 5% albumin, 6 % beta
starch, 6 % dextran hetastarch solution to
maintain intravenous fluid volume.
• Blood transfusion if there is huge blood loss.

30. 3. Vasoactive medication to restore
the vaso active tone & improve cardiac
function.• Vasoactive agents are a group of bioactive chemicals which change
vasomotor tone through there influence various peripheral
receptors.
• They stimulate the heart beat stronger by squizing blood vessel to
increase the flow within them.
• A. Vasoconstrictors:- it contract the smooth muscle of blood vessels
which cause the vessels to constrict which increase systemic
vascular resistance & increase co.
• i. Dopamine:- to increase cardiac contractility & CO.
• Ii. Dobutamin:- It improve blood flow by vasodilatation &
strengthening the heart muscle.
• Iii. Norepinephrine:-It is a alpha agonist which cause
vasoconstriction & also have beta activity which cause increase
contractility.
• Iv. Epinephrine:- it also have alpha agonist and beta agonist activity
which cause vasoconstriction , increase contractility.

31. • B. vasodilators:- to relax the smooth muscle in
blood vessels which cause the vessels to dilate
which leads to reduction of vascular resistance
which case decrease bp.
• i,. Nitroglycerine- it is a coronary artery dialator.
• Ii. Sodium nitropruside:- it break down in the
blood & release chemical nitric oxide when it
enter muscle cell in the wall of the blood vessels
& cause them to relax.
• Iii. Hydralazine:- It relax the blood vessel so that
blood can flow more easily through the body.

32. 4. Nutritional support to address
metabolic requirement.
• Provide enteral or parenteral nutrition to
meet the calories, proteins, slectrolytes,
vitamins, minerals, trace elements & fluids.

33. Nursing management.
• 1. nursing assessment:- Assess ABCDE
• Monitor cardiovascular status, abg cvp, &
pulmonary artery pressure.
• Monitor saturation, ECG rhythm , skin
condition dehydration etc.

34. Nursing diagnosis
• 1. ineffective breathing pattern related to rapid
respiration & progression of septic shock
• Ineffective tissue perfusion related to
hypovolemia & inadiquate CO as evidenced by
cyanosis.
• Deficit fluid volume related to bleeding or
vomiting as evidenced by decrease urine output.
• Fear related to severity of condition as evidenced
by verbalization.

35. Nursing interventions
• Monitor vital sign.
• Monitor respiratory status
• Check patient airway & circulation.
• Check ABG to monitor acid base balance.
• Insert central venous line & pulmonary artery cath for
hemodynamic monitoring.
• Insert indwelling catheter to know i/o
• Provide adequate fluid intake
• Encourage chest physiotherapy & deep breathing exercise
• Provide skin care & mouth care to provide tissuse perfusion
& comfOrt.

36. • Seek emergency medical care
• If you suspect a person is in shock, call 911 or your local emergency
number. Then immediately take the following steps:
• Lay the person down and elevate the legs and feet slightly, unless
you think this may cause pain or further injury.
• Keep the person still and don't move him or her unless necessary.
• Begin CPR if the person shows no signs of life, such as not
breathing, coughing or moving.
• Loosen tight clothing and, if needed, cover the person with a
blanket to prevent chilling.
• Don't let the person eat or drink anything.
• If the person vomits or begins bleeding from the mouth, and no
spinal injury is suspected, turn him or her onto a side to prevent
choking.