Care of Patients in Shock

Care of Patients in Shock

Definition and Types of Shock

• Shock: inadequate tissue perfusion leading to cellular hypoxia and organ dysfunction
• Types of shock:
  • Hypovolemic shock: decreased blood volume
  • Cardiogenic shock: impaired cardiac function
  • Distributive shock: abnormal distribution of blood flow
  • Obstructive shock: obstruction of blood flow
  • Septic shock: infection-induced inflammation

Stages of Shock

• Compensatory stage: body compensates for decreased perfusion
• Decompensatory stage: body's compensatory mechanisms fail
• Irreversible stage: organ damage and death

Assessment and Diagnosis

• Vital signs: tachycardia, tachypnea, hypotension, decreased urine output
• Physical examination: altered mental status, cool and clammy skin, delayed capillary refill
• Laboratory tests: complete blood count, electrolyte panel, blood urea nitrogen, creatinine

Management and Interventions

• Fluid resuscitation: crystalloids, colloids, and blood products
• Vasopressors: dopamine, norepinephrine, and vasopressin
• Inotropic agents: dobutamine and milrinone
• Cardiac support: invasive hemodynamic monitoring, mechanical ventilation
• Pain management: analgesics and sedatives

Care of Patients with Burn Injury

Classification of Burns

• First-degree burns: epidermal damage
• Second-degree burns: epidermal and dermal damage
• Third-degree burns: full-thickness skin damage
• Fourth-degree burns: damage to muscle, bone, and organs

Assessment and Diagnosis

• Burn size and depth estimation: rule of nines, Lund-Browder chart
• Burn severity assessment: American Burn Association (ABA) criteria
• Wound inspection: eschar, discharge, and signs of infection

Management and Interventions

• Fluid resuscitation: Parkland formula, colloid solutions
• Wound care: debridement, topical antibiotics, and dressing changes
• Pain management: analgesics, sedatives, and anxiolytics
• Infection prevention: antibiotics, wound cleaning, and isolation precautions
• Nutrition and hydration: high-calorie, high-protein diet, and hydration therapy

Care of Patients in Shock

Definition and Types of Shock

• Inadequate tissue perfusion leads to cellular hypoxia and organ dysfunction
• Four main types of shock: hypovolemic (decreased blood volume), cardiogenic (impaired cardiac function), distributive (abnormal blood flow distribution), and obstructive (obstruction of blood flow)
• Septic shock is a type of distributive shock caused by infection-induced inflammation

Stages of Shock

• Compensatory stage: body tries to compensate for decreased perfusion
• Decompensatory stage: body's compensatory mechanisms fail, leading to organ dysfunction
• Irreversible stage: organ damage and death occur

Assessment and Diagnosis

• Vital sign changes: tachycardia, tachypnea, hypotension, and decreased urine output
• Physical examination findings: altered mental status, cool and clammy skin, delayed capillary refill
• Laboratory tests: complete blood count, electrolyte panel, blood urea nitrogen, and creatinine

Management and Interventions

• Fluid resuscitation with crystalloids, colloids, and blood products
• Vasopressors (dopamine, norepinephrine, vasopressin) and inotropic agents (dobutamine, milrinone) to support blood pressure
• Cardiac support: invasive hemodynamic monitoring and mechanical ventilation
• Pain management: analgesics and sedatives

Care of Patients with Burn Injury

Classification of Burns

• First-degree burns affect only the epidermis
• Second-degree burns affect both epidermis and dermis
• Third-degree burns affect the full thickness of the skin
• Fourth-degree burns extend to muscle, bone, and organs

Assessment and Diagnosis

• Estimating burn size and depth: rule of nines and Lund-Browder chart
• Burn severity assessment using American Burn Association (ABA) criteria
• Wound inspection: eschar, discharge, and signs of infection

Management and Interventions

• Fluid resuscitation with Parkland formula and colloid solutions
• Wound care: debridement, topical antibiotics, and dressing changes
• Pain management: analgesics, sedatives, and anxiolytics
• Infection prevention: antibiotics, wound cleaning, and isolation precautions
• Nutrition and hydration: high-calorie, high-protein diet, and hydration therapy

Care of Patients in Shock

Definition and Types of Shock

• Inadequate tissue perfusion leads to cellular hypoxia and organ dysfunction
• Types of shock include:
  • Hypovolemic shock: decreased blood volume due to hemorrhage or dehydration
  • Cardiogenic shock: heart failure caused by myocardial infarction (MI) or cardiomyopathy
  • Distributive shock: abnormal blood vessel tone resulting from sepsis or anaphylaxis
  • Obstructive shock: mechanical obstruction caused by pulmonary embolism or cardiac tamponade

Assessment and Interventions

• Assess vital signs, including blood pressure, heart rate, respiratory rate, and temperature
• Evaluate level of consciousness, skin condition, and urine output
• Interventions include:
  • Fluid resuscitation using IV fluids and blood products
  • Vasopressors, such as dopamine and norepinephrine, to increase blood pressure
  • Inotropes, such as dobutamine, to increase cardiac contractility
  • Oxygen therapy to improve oxygen delivery
  • Cardiac monitoring to track cardiac rhythm and function

Care of Patients with Burn Injury

Burn Classification

• First-degree burns: epidermal damage, redness, and pain
• Second-degree burns: partial-thickness burns, blisters, and pain
• Third-degree burns: full-thickness burns, charring, and no pain
• Fourth-degree burns: burns extending to muscle, bone, or organs

Assessment and Interventions

• Assess burn size and depth, as well as airway, breathing, and circulation (ABCs)
• Evaluate pain level and fluid status
• Interventions include:
  • Wound care, including debridement and dressing changes
  • Pain management using opioids and non-pharmacological methods
  • Fluid resuscitation using the Parkland formula
  • Infection prevention using antibiotics and wound cleaning

NCLEX Style Questions

Shock

• In hypovolemic shock, the priority intervention is initiating fluid resuscitation
• In cardiogenic shock, the next action is inserting an intra-aortic balloon pump

Burn Care

• In second-degree burns, the priority intervention is initiating fluid resuscitation
• Patients with third-degree burns are at risk for infection, hypovolemia, and respiratory distress