Nursing Management of Shock

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Questions and Answers

What is the primary goal of treatment in hypovolemic shock?

  • Increase inflammation in the body
  • Decrease heart rate
  • Restore intravascular volume (correct)
  • Increase blood viscosity

Which symptom is NOT a typical result of hypovolemic shock?

  • Increased stroke volume (correct)
  • Increased heart rate
  • Progressive tissue hypoxia
  • Decreased cardiac output

What initial step should be taken in the case of hemorrhaging related to hypovolemic shock?

  • Monitor vital signs only
  • Place the patient in a semi-Fowler's position
  • Administer insulin immediately
  • Perform surgical intervention (correct)

Which of the following fluids is typically NOT recommended for non-hemorrhagic shock?

<p>Colloids (A)</p> Signup and view all the answers

How does the body compensate in response to fluid loss in hypovolemic shock?

<p>By increasing heart rate and vasoconstriction (D)</p> Signup and view all the answers

Which treatment is considered to correct the underlying cause of hypovolemic shock due to dehydration?

<p>Administering desmopressin (D)</p> Signup and view all the answers

Which of the following monitoring practices is critical for patients in hypovolemic shock?

<p>Monitoring blood gas values (A)</p> Signup and view all the answers

What should be closely monitored during fluid replacement therapy in hypovolemic shock?

<p>Vital signs and clinical appearance (D)</p> Signup and view all the answers

Flashcards

Hypovolemic Shock

A life-threatening condition where the body's organs and tissues do not receive enough oxygen due to insufficient blood volume.

Compensation Stage

The initial stage of hypovolemic shock where the body tries to compensate for low blood volume by increasing heart rate and constricting blood vessels.

Progressive Stage

The end stage of hypovolemic shock where the body's compensatory mechanisms fail and organs begin to shut down.

Fluid Replacement

The primary treatment goal is to restore blood volume, which is done by administering fluids.

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Crystalloids vs. Colloids

Crystalloids are fluids that stay in the bloodstream for a shorter period of time, while colloids like albumin stay in the bloodstream longer.

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Blood Products

Packed red blood cells are given to increase oxygen-carrying capacity, plasma replaces lost clotting factors, and platelets help with blood clotting.

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Monitoring and Support

Frequent monitoring of vital signs, blood gas values, and clinical appearance is crucial to assess the patient's response to treatment.

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Reverse Inadequate Tissue Perfusion

This involves ensuring the patient receives adequate oxygen, addressing any underlying cause, and providing supportive care.

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Study Notes

Nursing Management of Shock

  • Hypovolemic Shock is the quickest killer
    • Pathophysiology: Fluid loss decreases preload and stroke volume; sympathetic nervous system compensates with increased heart rate and vasoconstriction, activating the RAAS (Renin-Angiotensin-Aldosterone System). Outcome includes decreased cardiac output and progressive tissue hypoxia.
    • Medical Treatment: Restore intravascular volume by reversing inadequate tissue perfusion and addressing the underlying cause (e.g., apply pressure to stop bleeding, treat diarrhea/vomiting, treat dehydration). Fluid replacement involves inserting at least two large-gauge IV lines, administering fluids maintaining intravascular volume (crystalloids for non-hemorrhagic shock, albumin for decreased colloid osmotic pressure), and blood products if hemorrhaging (packed red blood cells, plasma, platelets as needed).
    • Nursing Management: Monitor vital signs, blood gas values, and clinical appearance to determine transfusion needs. Prevent shock by tracking intake and output (I&O) and daily weights, monitoring at-risk patients.
  • Cardiogenic Shock
    • Pathophysiology: Low cardiac output (CO). Heart can't pump enough blood, leading to significantly lowered blood pressure (BP). Signs of poor blood flow include less urine, cool/mottled skin and confusion or anxiety/slow capillary refill. Heart muscle not getting enough blood worsens the CO, causing pulmonary congestion (fluid in lungs due to high pressure in the left atrium).
    • Symptoms: Chest pain (angina).
    • Medical Treatment: Protecting the heart to preserve healthy heart muscle and improve function; improving oxygen management to increase oxygen supply to the heart and reduce its oxygen needs; addressing the cause of shock. Steps include: administering IV fluids, medications to control chest pain, using drugs to support blood pressure, improve heart function and control heart rate, and mechanical support (intra-aortic balloon pump, ventricular assist device [VAD]). Procedures like angioplasty and bypass surgery, and thrombolytic therapy are also considered.
    • Nursing Management: Identifying at-risk patients (advanced age, previous MI, diabetes, hypertension, multivessel [CAD], peripheral and cerebrovascular diseases) is key. Minimizing patient risk factors is also crucial, including conserving energy, relieving angina promptly, and administering supplemental oxygen, aspirin, and beta-blockers.
  • Obstructive Shock
    • Pathophysiology: Air or blood in the pleural space restricts lung expansion, reducing preload; reducing CO. Symptoms include: JVD (jugular venous distension), crepitus, dyspnea, chest pain, tachycardia, tachypnea, tracheal shift, decreased breath sounds.
    • Medical Treatment: Addressing the cause with treatment focusing on restoring cardiac function and preventing progression of shock (tension pneumothorax - chest tube insertion or needle decompression, Cardiac Tamponade - pericardiocentesis).
    • Nursing Management: Collaborative care involving teamwork, monitoring hemodynamic status, anticipating and assisting with medications, IV fluids, and equipment, documenting and reporting hemodynamic, cardiac, pulmonary, and renal changes.
  • Distributive Shock (Septic Shock)
    • Pathophysiology: Immune response to poor tissue perfusion, leading to widespread vasodilation and increased capillary permeability; endothelial injury, coagulation, and inflammatory responses.
    • Medical Management: Infection control (identifying and eliminating infection sources, aseptic techniques), fluid replacement (crystalloids, colloids, blood products to address hypovolemia), oxygen therapy (based on clinical presentation), mechanical ventilation (for ALI/ARDS). Monitoring with CVP, MAP, urinary output, SvO2, and other parameters guides therapy.
    • Nursing Management: Aseptic technique, monitoring IV lines, wounds, catheters, pressure ulcers for infection signs; focusing on vital signs, hemodynamics, mental status, and reports on urine output, etc. Managing hyperthermia, other comfort measures, teamwork, and communication with patients and families.

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