This document provides a comprehensive overview of shock in medical surgical nursing, defining it as a condition where tissues do not receive enough oxygen and nutrients. It classifies shock into five types: cardiogenic, hypovolemic, obstructive, and distributive (including neurogenic, anaphylactic, and septic), and outlines their causes, pathophysiology, clinical manifestations, diagnostics, and management strategies. Management includes both medical and surgical approaches, along with detailed nursing assessments and interventions.

1. SHOCK
Mr. Abhijeet M. Mahale.
Assistant Professor.

2. DEFINITION OF SHOCK
 Shock is defined as a complex, life threatening condition or syndrome
characterized by inadequate blood flow to the tissues and cells of the body.

3. What happens in shock ?
1.
Inadequate
perfusion
2.
Anaerobic
metabolism
3.
Buildup of
lactic acid
4.
Metabolic
acidosis
5.
Respiratory
rate increases
in response to
metabolic
acidosis.

4. STAGES OF SHOCK
 There are four stages of shock.
a) INITIAL STAGE: The cardiac output is insufficient to supply the
normal nutritional needs of tissues but not low enough to cause serious
symptoms.
b) COMPENSATORY STAGE: The cardiac output is reduced further but
due to compensatory vasoconstriction, the BP tends to remain within the
normal range. Blood flow to the skin and kidney decrease while blood flow
to CNS and myocardium is maintained.

5. C) PROGRESSIVE STAGE: The unfavorable change become more and
more apparent falling BP, increased vasoconstriction, increased heart rate and
oliguria. If compensatory mechanism are unable to cope with the reduce
output shock becomes progressively more severe and passed onto.
d) IRREVERSIBLE STAGE: In this stage of shock no type of therapy can
save the patients life, BP decreases, blood volume can be normal in this
stage. Fluid transfusion may restore BP only temporary BP decline until
DEATH occurs.

6. TYPES OF SHOCK
i. Hypovolemic shock
ii. Cardiogenic shock
iii. Neurogenic shock
iv. Septic shock
v. Anaphylactic shock

7. HYPOVOLEMIC SHOCK
 It occurs when a significant amount of fluid is lost from the intravascular
space, fluid are may be blood, plasma, electrolytes solution.
 It is the most common type of shock.

8. CAUSES
a) Severe bleeding e.g. ; PPH, ectopic pregnancy, uterus rupture, etc.
b) Severe persistent vomiting eg. ; minor and major disorder in pregnancy,
prolong vomiting.
c) Severe diarrhea eg. ; cholera
d) Severe edemas or ascities, peritonitis, pancreatitis
e) Diuresis and rapid remove of amniotic fluid
f) Severe burns
g) Inadequate fluid

9. CLINICAL FEATURE
 BP decrease, hypotension
 Skin cold and clammy
 Pallor
 Tachycardia, Tachypnea
 Restlessness, Anxiety, Weakness
 Oliguria<20 ml/hour; progressive stage
 Irritability
 Nausea and vomiting, thirst
 Pulse rapid, weak and thready

10. Cont…
 Metabolic acidosis;PaCO2 and HCO3 decreased
 Dilated with decrease response to light ; progressive stage
 Respiration rate rapid >20b/min, shallow ; progressive stage
 Cyanosis ; progressive stage
 Increased serum electrolyte, blood glucose, serum creatinine.
 Unconsciousness and unresponsive to pain

11. CARDIOGENIC SHOCK
Introduction
 Cardiogenic shock occurs when the heart’s ability to pump blood is
impaired.
 This is a condition that results from inadequate perfusion of body tissue with
oxygenated blood that is insufficient to sustain life, cardiac output is
decreased.
Causes
1.Acute myocardial infraction resulting in massive damage to myocardium.
2.Pulmonary embolism.
3.Cardiac temponade Cardiomyopathy

12. Clinical features
1. Same as hypovolemic shock
2. Dysrhythmias, chest pain
3. Respiratory distress, multi organ dysfunction syndrome and death are its
complication
4. Left and Right ventricular failure
5. Mechanical complication including ventricular septal rupture

13. NEUROGENIC SHOCK
Introduction
 Inability of nervous system to control dilation of blood vessels.
 Neurogenic shock results from generalized vasodilation and loss of
vasomotor tone due to
a. Massive increase in vascular capacity
b. Pooling of blood in periphery
c. Decreased venous return to Heart.

14. Causes:
 Brain traumatic injury
 Brain damage, vasomotor depression
 Spinal cord injury
 Deep spinal anaesthesia
 Severe pain, hypoglycemia, emotional stress
 Drugs causing vasomotor centre depression
 Anti snake venom

15. Clinical features
 Nervousness
 LOC
 Confusion
 Skin warm but dry
 Respiration depress
 Hypotension

16. ANAPHYLACTIC SHOCK
Anaphylaxis is a life threatening systemic hypersensitivity reaction
contact with an allergen.
Causes
 Drugs: penicillin, radio contrast, lignocaine, anaesthetic drugs, iron
injectable. etc.
 Blood transfusion
 Stings and snake bite
 New clothes
 Dusting smokes
 Suddenly climate change

17. Clinical features
 Cough, wheezing, laryngeal oedema, bronchospasm
 Hypotension, tachycardia, palpitation
 Syncope
 Angeodema, pruritus
 Nausea, vomiting
 Seizures
 Respiratory depression, cardiovascular collapse
 Coma

18. SEPTIC SHOCK
Introduction
It is the most common type of shock and caused by widespread infection due
to gram positive and negative bacteria and viruses.
Causes
 UTI, abortion
 RTA
 Severe burn
 CSOM (Chronic Suppurative Otitis Media)
 Due to chronic disesases : diabetes, AIDS
 lines and catheter
 Improper wound care and management

19. Clinical features
 Hyperthermia
 Severe headache
 Respiration distress
 Decreased cardiac output
 Hypotension
 Skin cold and pale
 Multiple organ failure
 Anuria(complete absence of urine production)

20. Prevention of Shock
 Primary prevention of shock is an essential focus on nursing intervention;
hypovolemic shock can be prevented in some instances by closely monitoring
patients who is at risk for fluid deficit and assisting with fluid replacement before
Intravascular volume is depleted.
 General nursing measures include safe administration of prescribed fluids and
medication and proper documentation, monitoring sign of complication and side
effects and early reporting
 Safe blood administration
- Blood sample should be obtained for CBC, cross match grouping before BT
- Patient receiving BT must be closely monitored for adverse effect.
 Proper care of wound and using aseptic technique in any invasive procedures.
 Proper pain management.
 Skin test should be done before giving antibiotics as anaphylaxis reaction may
occur.
 Early detection and management of cardiac diseases.

21. NURSING ASSESSMENT
 CABs: Circulation, Airway, breathing, and Focused assessment of tissue
perfusion;
 Vital signs
 Peripheral pulses
 Level of consciousness
 Capillary refill
 Skin (e.g., temperature, color, moisture)
 Urine output
 Brief history Taking
 Events leading to shock
 Onset and duration of symptoms
 Allergies

22. Immediate Nursing care of patient on SHOCK
Check for a response. Give Rescue Breaths or CPR as needed.
1. Lay the person flat, face-up, but do not move him or her if you suspect a head,
back, or neck injury.
2. Raise the person's feet about 12 inches. Use a box, etc. If raising the legs will
cause pain or further injury, keep him or her flat. Keep the person still.
3. Do not raise the feet or move the legs if hip or leg bones are broken. Keep the
person lying flat.
4. Check for signs of circulation. If absent, begin CPR
5. Turn the person on his or her side to prevent choking if the person vomits or
bleeds from the mouth.

23. Cont.
6. Keep the person warm and comfortable. Loosen belt (s) and tight clothing and
cover the person with a blanket.
7. NPO: Even if the person complains of thirst, give nothing by mouth. If the
person wants water, moisten the lips.
8. Reassure the person. Make him or her as comfortable as you can.
9. Fluid and blood replacement: Open IV line on both hands with two wide bore
cannula and start fluid rapidly as advised.
10. Administer oxygen via face mask.
11. Identify the cause and treat accordingly.
12. Vasoactive medications to improve cardiac contractility, i.e. Dopamine,
Dobutamine, Noradrenaline.
13. Other care are same as the care of unconscious patient.

24. Thank You