Nursing Management of Shock

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.