CHAPTER Care of Clients

Experiencing Biological
Crisis: Shock

10

LEARNING OUTCOMES

Identify the nurses role in the prevention of shock.

Discuss the pathophysiology of shock and its clinical manifestations.
Apply nursing process to identify care of the client in the diagnosis and treatment of
shock.
Value the nurses role in providing quality, comprehensive, individualized, ethical and
humane care of clients with shock.

THE CLIENT EXPERIENCING SHOCK

SHOCK is
A condition of profound hemodynamic and metabolic disturbance due to:
(1) __________________ and (2) __________________ to the capillaries and tissues
of
the body (Udan, 2009)
A clinical syndrome characterized by a systemic imbalance between oxygen
(1) ____________ and (2) ___________. This imbalance results in a state of inadequate
blood flow to body organs and tissues, causing life-threatening cellular dysfunction.
(LeMone, Burke, 2007)

PATHOPHYSIOLOGY

CARL EDRIENNE C. MADRID | MAN I

Page | 1

There are four stages of shock. As it is a complex and continuous condition, there is no
sudden transition from one stage to the next.
Initial

HYPOPERFUSION __________________
Cells begin to change
_________________ Metabolism

REVERSIBLE
Compensatory

ACIDOSIS ____________________
BARORECEPTORS (ARTERIES) __________________________
causing the release of EPINEPHRINE AND NOREPINEPHRINE
ACTIVATION OF RAAS ___________________ Hormone release
Progressive

Decreased Perfusion _______ ions build up & ________ ions leak out
HYDROSTATIC PRESSURE increases ______________________________
PROLONGED VASOCONSTRICTION Damage of vital organs
Refractory

VITAL ORGANS have ___________________________

Brain Damage
Cell Death

IRREVERSIBLE
CARL EDRIENNE C. MADRID | MAN I

Page | 2

CARDIOGENIC SHOCK

Cardiogenic shock is based upon an inadequate circulation of blood due

_________________________________________.
Cardiogenic shock is defined by sustained ___________________________ with tissue
hypoperfusion.

Cause: _______________________________________
Diagnosis:
1. Electrocardiogram
2. Ultrasound
3. _________________ catheter
4. Biopsy
Treatment and drugs:
Focus: Repairing the damage of heart muscle and other organs caused by lack of oxygen

EMERGENCY LIFE SUPPORT

MEDICATIONS
1.
2.
3.
4.
5.

Aspirin.
Thrombolytics.
Super aspirins.
Blood-thinning medications.
Inotropic agents.

MEDICAL PROCEDURES

1. Angioplasty and stenting.

2. Balloon pump.
SURGERY
1. Coronary artery bypass surgery. Bypass surgery involves sewing veins or arteries in
place at a site beyond a blocked or narrowed coronary artery.
2. Heart transplant.

HYPOVOLEMIC SHOCK

CARL EDRIENNE C. MADRID | MAN I

Page | 3

Also called hemorrhagic shock, is a life-threatening condition that results when you lose
more than __________% of your bodys blood or fluid supply.

Cause:
Blood loss of this magnitude can occur because of:
bleeding
ruptured ectopic pregnancy
The loss of body fluids can cause a decrease in blood volume. This can occur in cases of:
excessive diarrhea
severe burns
protracted and excessive vomiting

excessive sweating

Diagnosis:
Blood chemistry
Complete blood count
Radiologic examinations
Echocardiogram
Endoscopy and/or colonoscopy
Right heart catheterization
Urinary catheterization
Treatment and Drugs:
Focus: Replace fluid and blood loss

FIRST AID
FIELD CARE
HOSPITAL TREATMENT

DISTRIBUTIVE SHOCK

Distributive shock results from excessive __________________ and the impaired

distribution of blood flow.

Cause:
The most common etiology of distributive shock is _____________. Other causes include
the following:
SIRS
TSS
CARL EDRIENNE C. MADRID | MAN I

Page | 4

Anaphylaxis
Adrenal insufficiency
Reactions to drugs or toxins
Heavy metal poisoning
Hepatic insufficiency
Neurogenic shock

Diagnosis:
All patients with evidence of distributive shock should undergo the following studies:
Complete blood count (CBC) with differential
Urinalysis
Electrolytes
Blood urea nitrogen (BUN)
Creatinine
Glucose
Urine cultures
Blood cultures
Arterial blood gas
Serum lactate
Lumbar puncture
Arterial catheter placement
Treatment and Drugs:
Focus: Reverse the underlying cause of shock and hemodynamic stabilization of the patient

MONITORING
RESUSCITATION
ANTIMICROBIAL DRUGS
PREVENTING MICROVASCULAR THROMBOSIS
TREATMENT OF ANAPHYLAXIS
SURGICAL CONTROL OF SHOCK SOURCES
MEDICAL THERAPY
1. Antimicrobial drugs
2. Corticosteroids
3. Vasopressors

CARL EDRIENNE C. MADRID | MAN I

Page | 5