Here are the answers to the assignment questions: 1) CIRCULATORY SHOCK 2) COMPENSATED STAGE 3) NORMAL SALINE AND RINGER'S LACTATE SOLUTION 4) DECREASED TISSUE PERFUSION

1. KAILASH , 25- YEAR OLD MAN ,
WAS NOT WEARING HIS SEAT BELT
WHEN HE WAS THE DRIVER
INVOLVED IN A MOTOR VEHICLE
COLLISION. THE WIND SHIELD WAS
BROKEN AND KAILASH WAS FOUND
15 FEET FROM HIS CAR. HIS FACE
WAS DOWN , CONSCIOUS ,
BLEEDING AND MOANING. ALL
PASSENGERS WERE TAKEN TO THE
EMERGENCY DEPARTMENT

2. HYPOVOLEMI
C SHOCK
PRESENTED TO ,
MRS. PRIYADARSHINI
JOHN
ASSOC . PROFESSOR
DYPSON
PRESENTED BY,
MISS. JAYS GEORGE
1ST YEAR MSC(N)
DYPSON

3. INTRODUCTION
CIRCULATORY SHOCK , COMMONLY KNOWN AS SHOCK ,
IS A LIFE THREATENING MEDICAL CONDITION OF LOW
BLOOD PERFUSION TO TISSUES RESULTING IN CELLULAR
INJURY AND INADEQUATE TISSUE FUNCTION.
IT IS A MEDICAL EMERGENCY AND THE MOST COMMON
CAUSE OF DEATH FOR CRITICALLY ILL PEOPLE.

4. DEFINITION
Shock can be defined as condition in which
systemic blood pressure is inadequate to
deliver oxygen and nutrient supply to vital
organs for cellular functions.

5. CLASSIFICATION
• LOW BLOOD FLOW
1. CARDIOGENIC SHOCK
2. HYPOVOLEMIC SHOCK
3. RELATIVE
HYPOVOLEMIA/DISTRIBUTIVE
SHOCK
• MALDISTRIBUTION OF
BLOOD FLOW.
1. NEUROGENIC SHOCK
2. ANAPHYLACTIC SHOCK
3. SEPTIC SHOCK

6. HYPOVOLEMIC SHOCK
This is the most common type of shock due
to insufficient circulatory volume.
In hypovolemic shock , there is decrease in
circulatory volume to level that is
inadequate to meet body’s need for tissue
oxygenation.

7. CONTD……
THIS OCCUR WHEN THERE IS LOSS IN THE
INTRAVASCULAR FLUID UP TO 15% TO 25%.
THIS WOULD REPRESENT A LOSS OF 750 TO 1300 ML
OF BLOOD IN A 70 KG PERSON.
E.G. : BLEEDING , BURNS, AND BLOOD LOSS FROM
GASTROINTESTINAL OR SEVERE DIARRHOEA.

8. ETIOLOGY
1. Sudden malfunction of heart
Coronary artery occlusion with acute
myocardial ischemia
Trauma with structural damage to heart
Toxaemia – viral or bacterial
Effects of drugs

9. CONTD…
2. Deficient oxygenation of blood in
lungs.
 Post operative atelectasis
 thoracic injuries particularly of chest, i.e.
pneumothorax , crushing and laceration of
lung.
Disturbances of lung function following

10. 3. Reduction in blood volume
 Haemorrhage (internal or external)
Burns
Peritonitis
Intestinal obstruction
Paralytic ileus
Diarrhoea
vomiting

11. 4. MISCELLANEOUS
 Acute anaphylaxis
Acute adrenal deficiency(Addison’s disease)
Over dosage of drugs e.g. : analgesics like
pethidine.
Following therapy with beta blocking agents.
Noxious stimuli such as pain

12. PATHOPHYSIOLOGY

13. STAGES OF SHOCK

14. CLINICAL MANIFESTATIONS
CARDIOVASCULAR
Decreased capillary refill time.
Chest pain
Decreased ejection fraction
Bradycardia

15. PULMONARY SYSTEM
Tachypnoea
Cyanosis
Crackles
Rhonchi

16. Shortness of breath
Wheezing
Rhinitis
Stridor

17. RENAL SYSTEM
 Bladder dysfunction
 Decreased urine output
Decreased renal blood flow

18. INTEGUMENTARY SYSTEM
 Pallor
 Cool and clammy skin
 Decreased skin perfusion
 Flushing

19. NEUROLOGICAL SYSTEM
Decreased cerebral perfusion
Anxiety
Confusion
Late coma

20. GASTROINTESTINAL SYSTEM
Decreased bowel sounds
Bowel dysfunction

21. DIAGNOSTIC EVALUATION

22. FIRST AID IN SHOCK
•Reassure the casualty.
•Lay him down on his back comfortably with
head low and turned to one side except in
care of head injury.
•Loosen the clothing around the neck ,chest ,
and waist.
•Keep the casualty warm.
•Give him sips of water if he is thirsty , never

23. •Never use hot water bag or massage the
limbs.
•Arrest haemorrhage by adequate
measures.
•Check pulse , respiration and level of
consciousness.
•Transport the casualty to the hospital

24. MANAGEMENT OF SHOCK
Administration of intravenous fluids ,
blood products and medication. They are
helpful in treating shock , these includes
;
 CRYSTALLOIDS : these are used for
intravenous fluid replacement in early
stages of shock .e.g. normal saline and
ringer’s lactate solution are most
commonly used.

26. BLOOD
IT IS GIVEN AS PACKED RBCS, WHICH
SHOULD BE CROSS-MATCHED, BUT IN AN
URGENT SITUATION, 1 TO 2 UNITS OF TYPE
O RH-NEGATIVE BLOOD ARE AN
ACCEPTABLE ALTERNATIVE.
WHEN > 1 TO 2 UNITS ARE TRANSFUSED
(E.G., IN MAJOR TRAUMA), BLOOD IS
WARMED TO 37° C.

27.  IONOTROPIC AGENTS : like
dopamine , dobutamine
and epinephrine to improve
myocardial contractility,
adequate cardiac output
and improve tissue
perfusion

28. VASODILATORS : Nitro-glycerine , sodium
nitroprusside used to dilate the coronary
arteries.
DIURECTICS : These are used to treat oliguria
and increase urine output.
ANTIBIOTICS: used to treat septic shock
because they are bactericidal.
ANTIHISTAMINES: epinephrine used in

29.  STEROIDS : Used to decrease fluid shift
out of vasculature by stabilizing capillary
walls.
SODIUM BICARBONATE : It is used to treat
metabolic acidosis that occurs as shock
progress.
BRONCHODILATORS : Like atropine ,

30. NURSING DIAGNOSIS
1. Ineffective tissue perfusion related to
hypovolemia secondary to haemorrhage as
evidenced by urinary output < 0.5
mg/kg/hr , increased BUN , decreased
blood pressure , tachycardia, increased
peripheral pulse , cool and clammy skin,
decreased capillary refill , pallor or
cyanosis.

31. 2. Ineffective breathing pattern related to
hypovolemia secondary to rapid
respiration , decreased energy or fatigue
as evidenced by increased rate and
decreased depth of respirations
associated with fear and anxiety , chest
pain .

32. 3. Fluid volume deficit related to bleeding and
vomiting evidenced by Decreased urine output,
increased urine concentration, sudden weight
loss, decreased venous filling, increased body
temperature, decreased pulse volume or pressure,
elevated haematocrit, decreased skin or tongue
turgor; dry skin/mucous membranes, thirst,
decreased blood pressure.

33. 4. Imbalanced nutritional pattern less
than body requirement related to
decreased oral intake as evidenced by
reluctance to eat due to pain or injury,
weakness , sudden weight loss .

34. 5.Anxiety related to severity of condition and
unknown outcome as evidenced by
verbalisation about condition and fear of
death or withdrawal with no communication;
restlessness ; sleeplessness ; increase in
heart and respiratory rate.

35. COMPLICATIONS OF SHOCK
KIDNEY DAMAGE
BRAIN DAMAGE
GANGRENE OF ARMS OR LEGS, SOMETIMES LEADING
TO AMPUTATION
HEART ATTACK
OTHER ORGAN DAMAGE
DEATH

36. CONCLUSION
• HYPOVOLEMIC SHOCK IS AN EMERGENCY
CONDITION IN WHICH SEVERE BLOOD AND FLUID
LOSS MAKE THE HEART UNABLE TO PUMP
ENOUGH BLOOD TO THE BODY. THIS TYPE OF
SHOCK CAN CAUSE MANY ORGANS TO STOP
WORKING.

37. ASSIGNMENT
1) SHOCK IS COMMONLY KNOWN AS
______________?
2) _____________IS THE FIRST STAGE IN SHOCK ?
3) GIVE AN EXAMPLES FOR CRYSTALLOIDS
____________?
4) AN EARLY EFFECT THAT SHOCK HAS ON THE
BODY IS____________?