SHOCK : FOR NURSING & MEDICAL STUDENTS

1. MEDICAL SURGICAL
NURSING
SHOCK
PRESENTED BY
ABHISHEK K THOMAS

2. INTRODUCTION
• SHOCK IS A LIFE-THREATENING
CONDITION WITH A VARIETY OF
UNDERLYING CAUSES. IT IS
CHARACTERIZED BY INADEQUATE
TISSUE PERFUSION,IF UNTREATED
RESULTS CELL DEATH. THE NURSE
CARING FOR THE PATIENT WITH
SHOCK OR AT RISK FOR THE
SHOCK.
• RAPID ASSESSMENT AND RESPONSE
ARE ESSENTIAL FOR THE PATIENT
RECOVERY.

3. DEFINITION
ACCORDING TO MIKHAIL
1999
SHOCK CAN BE DEFINED AS A
CONDITION IN WHICH
SYSTEMIC BLOOD PRESSURE
IS INADEQUATE TO DELIVER
OXYGEN AND NUTRIENTS TO
SUPPORT THE VITAL ORGANS
AND CELLULAR FUNCTIONS.

4. INCIDENCE
• SHOCK IS COMMON IN BOTH
GENDERS
• CHILDREN AND OLD AGE PEOPLES
ARE MORE PRONE TO SHOCK
• 80% OF MORTALITY RATE CAUSE
BY SHOCK
• OF THESE CARDIOGENIC SHOCK
ACCOUNTS APPROX. 20%,
HYPOVOLEMIC ABOUT 20% AND
SEPTIC SHOCK ABOUT 60% OF
CASES.

5. ANATOMY & PHYSIOLOGY
CIRCULATORY SYSTEM:
THE CIRCULATORY SYSTEM
ALSO KNOWN AS
CARDIOVASCULAR SYSTEM
MAJOR WORK IS TO PUMP
BLOOD FROM HEART TO LUNGS
TO GET THE OXYGEN.
THE HEART SEND OXYGENATED
BLOOD THROUGH ARTERIES TO
THE REST OF THE BODY.
THE VEINS CARRY
DEOXYGENATED BLOOD BACK TO
THE HEART TO START THE
CIRCULATION PROCESS OVER

7. CONT…
WHAT IS CIRCULATORY SYSTEM?
•THE HEART AND VESSELS MAKEUP THE
CIRCULATORY SYSTEM THE MAIN FUNCTION
IS TO PROVIDE O2 , NUTRIENTS AND
HORMONE TO MUSCLE TISSUE AND ORGAN
THROUGHOUT YOUR BODY
•IT PROVIDE BLOOD SUPPLY TO ALL THE
BODY TISSUE SO IT CAN BE FUNCTION
PROPERLY.

8. CONT… • THIS ALSO HELPS OUR BODY TO
GET RID OF WASTE PRODUCTS
INCLUDES:
CO2 FROM RESPIRATION
(BREATHING) OTHER CHEMICAL
BY PRODUCT FROM OUR ORGANS
WASTE FROM THINGS WE EAT AND
DRINK
PARTS OF CIRCULATORY SYSTEM:
• HEART: IS A MUSCULAR ORGAN
THAT PUMPS BLOOD THROUGHOUT
OUR BODY
• BLOOD VESSELS: WHICH
INCLUDES ARTERIES VEINS AND
CAPILLARIES.
• BLOODS: MADEUP OF RBC, WBC,
PLASMA & PLATELETS

9. PATHOPHYSIOLOGY
CELL SWITCH TO FORM AEROBIC TO ANAEROBIC METABOLISM LACTIC & PRODUCTION
CELL FUNCTION CAUSES & SWELLS
MEMBRANE BECOME MORE PERMEABLE
ELECTROLYTES & FLUIDS SEEPIN & OUT OF CELLS
Na+,K+1 PUMP IMPAIRED
MITOCHONDRIA DAMAGES CELLS DEATHS
SHOCK

10. CLASSIFICATION
OF SHOCK
HYPOVOLEMIC SHOCK
CARDIOGENIC SHOCK
OBSTRUCTIVE SHOCK
DISTRIBUTIVE SHOCK
ANAPHYLATIC SHOCK
SEPTIC SHOCK
NEUROGENIC SHOCK

11. HYPOVOLEMIC SHOCK:
• HYPOVOLEMIC SHOCK IS A LIFE-
THREATENING CONDITION THAT
RESULTS WHEN YOU LOSE MORE THAN
20% OF YOUR BODY’S BLOOD OR FLUID
SUPPLY
• THE SEVERE FLUID LOSS MAKE IT
IMPOSSIBLE FOR THE HEART TO PUMP
A SUFFICIENT AMOUNT OF BLOOD TO
OUR BODY.
• IT OCCURS USUALLY IN CHILDREN'S
AND OLD AGE GROUP PEOPLES.
• THIS CONDITION REQUIRES
IMMEDIATE EMERGENCY MEDICAL
ATTENTION.

12. CARDIOGENIC SHOCK
• CARDIOGENIC SHOCK IS A STATE OF
SYSTEMIC HYPOTENSION PERSISTING
<30 MINUTES WITH REDUCED END
ORGAN PERFUSION DUE TO LOW
CARDIAC OUTPUT DESPITE
ADEQUATE FILLING PRESSURE.
• CARDIOGENIC SHOCK OCCUR WHEN
THE HEART HAS BEEN DAMAGED SO
MUCH, THAT IT IS UNABLE TO SUPPLY
ENOUGH BLOOD TO THE VITAL
ORGANS OF THE BODY. AS A RESULT
OF THE FAILURE OF THE HEART TO
PUMP ENOUGH NUTRIENTS IN THE
BODY.

13. OBSTRUCTIVE
SHOCK
• OBSTRUCTION TO THE OUTFLOW
DUE TO IMPAIRED CARDIAC
FILING AND EXCESSIVE AFTER
LOAD.
• OBSTRUCTIVE SHOCK CAN BE
CAUSED BY A NUMBER OF
DIFFERENT ETIOLOGIES THAT
RESULTS IN MECHANISM.
OBSTRUCTION OF VENOUS
RETURN TO THE HEART IN
TRAUMA PATIENT THIS IS MOST
COMMONLY DUE TO THE
PRESENCE OF TENSION

14. DISTRIBUTIVE SHOCK
ABNORMAL DISTRIBUTION OF BLOOD
FLOW IN THE SMALL BLOOD VESSELS
RESULT INADEQUATE SUPPLY OF
BLOOD TO THE BODY’S TISSUES AND
ORGANS.
MOST COMMON FORMS OF
DISTRIBUTIVE SHOCK ARE:
• ANAPHYLACTIC SHOCK:
ANAPHYLACTIC SHOCK IS CAUSED BY
A SEVERE ALLERGIC REACTION WHEN
A PATIENT WHO HAS ALREADY
PRODUCED ANTIBODIES TO THE
FOREIGN SUBSTANCE (ANTIGEN)
DEVELOP A SYSTEMIC ANTIGEN-
ANTIBODIES REACTION.

15. • SEPTIC SHOCK:
REFERS TO SEVERE SEPSIS WHICH IS
NOT RESPONSIVE TO INTRAVENOUS
FLUID INFUSION FOR
RESUSCITATION AND REQUIRES
INOTROPIC OR VASOPRESSOR AGENT
TO MAINTAIN SYSTOLIC BLOOD
PRESSURE.
IT IS CONSIDERED AS PART OF A
SPECTRUM AND A PROGRESSION OF
SIRS (SYSTEMIC INFLAMMATORY
RESPONSE SYNDROME).
• NEUROGENIC SHOCK:
NEUROGENIC SHOCK IS A LIFE-
THREATENING CONDITION CAUSED
BY IRREGULAR BLOOD CIRCULATION
IN THE BODY. TRAUMA OR INJURY TO
THE SPINE CAN CAUSE THIS
DISRUPTION. IT CAN OCCUR AFTER
DAMAGE TO THE CENTRAL NERVOUS
SYSTEM SUCH AS SPINAL CORD
INJURY.

16. ETIOLOGY
• SEVER ALLERGIC
REACTIONS
• SIGNIFICANT BLOOD
LOSS
• HEART FAILURE
• BLOOD INFECTION
• DEHYDRATION
• POISONING
• BURN

17. CLINICAL
MANIFESTATION

18. DIAGNOSTIC EVALUATION
• HISTORY COLLECTION
• PHYSICAL
EXAMINATION
• BLOOD CULTURE &
SENSITIVE TEST
• CBC TEST
• ECG
• ECHOCARDIOGRAM
• IMAGINE TEST LIKE X-
RAY AND CT- SCAN
• CARDIAC MONITORING

19. MEDICAL
MANAGEMENT

20. NON-
PHARMACOLOGICAL
MANAGEMENT
MODIFY TRENDELENBURG
POSITION
ASSESSMENT OF VITAL
SIGNS
OXYGEN
ADMINISTRATION
PARENTERAL
NUTRITIONAL SUPPORT.

21. PHARMACOGICAL
MANAGEMENT
CRYSTALLOID: RINGER SOLUTION AND
NORMAL SALINE SOLUTION.
INOTROPIC AGENTS: LIKE DOPAMINE,
DOBUTAMINE AND EPINEPHRINE.
VASODILATORS: NITROGLYCERIN
DIURETICS: FRUSEMIDE, LASIX
ANTIBIOTICS: EPINEPHRINE USED IN
ANAPHYLACTIC SHOCK
CORTICOSTEROIDS: DEXAMETHASONE
SODIUM BICARBONATE: TO TREAT
METABOLIC ACIDOSIS
BRONCHODILATORS: ATROPINE

22. SURGICAL
MANAGEMENT
• WOUND DEBRIDEMENT: IN THE
CASE OF CHRONIC INFECTED
WOUND, BURNS WOUND
DEBRIDEMENT DONE FOR THE
FAST HEALING
• ANGIOPLASTY: IN THE CASE OF
MYOCARDIAL INFARCTION
ANGIOPLASTY CAN BE
PERFORMED.

23. COMPLICATIONS

24. PREVENTION OF
SHOCK
PRE-OPERATIVE
• Patients blood should be in adequate
quantity and volume
• Patient’s tissue should be adequately
hydrated
• Patients should be kept warm on his
journey from ward to theatre.
POST OPERATIVE
• Fluid and electrolyte replacement
saline, dextrose 5%,plasma
• Gently handling the nursing staff
will help in prevention of shock
• Administer diuretic like mannitol.

25. NURSING RESPONSIBILITY
• Check the vital signs
continuously of the patient
• Maintain the input and
output chart of the patient
• To administer oxygen to the
patient if having breathing
problem
• Check for response give
rescues of breaths and CPR
as needed
• To change the position of
the patient if patient in
every 2 hour
• To administer adequate fluid

26. THANK YOU