Running Head: SHOCK
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Title: Shock
Name
Course
Date
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Table of Contents
Definition. ......................................................................................................................................................3
History of shock. ...........................................................................................................................................3
Types of shock. ..............................................................................................................................................4
Symptoms of shock. ......................................................................................................................................5
Causes of shock .............................................................................................................................................5
Treatment of shock. ......................................................................................................................................6
Prevention of shock.......................................................................................................................................7
Recent research about shock........................................................................................................................7
References.......................................................................................................................................................7
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Definition.
Shock may be defined as a state of the body whereby the output of blood given by the
heart becomes too low to meet the needs of the body to run normal metabolic processes.
Circulatory shock is composed of a variety of entities that do have common
characteristics; although, the characteristic which is evident in all the entities can be stated as
decreased blood supply to tissues with a relatively low or insufficient blood output from the
heart. Therefore, the body parts do not get sufficient oxygen and nutrients to facilitate
functioning of the cells.
History of shock.
The word shock appeared first in the medical literature in the year 1743 in the
translation of a treatise by Henri Francois which was on wounds arising from gun-shots, though
this doesn’t neglect the fact that this condition existed even before the coining of this word.
Hippocrates was credited by Bradford Cannon with the very first usage of the word exemia to
give a description of patients who suffer from hypovolemic type of shock.
W. B Cannon made a recommendation during the first world war that involved delayed
resuscitation of fluid to a point where the cause of a haemorrhagic shock was surgically
repaired. Substances that are used in restoring the blood volumes known as crystalloids were
very much used in the second world war for the purposes of treating patients in conditions that
are not stable.
Major steps have been made since the debut of ways to treat patients suffering from
shock and also more knowledge on the condition has been found through research and
experiments hence providing an even better platform for the treatment of the shock condition
in the present age.
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Types of shock.
The output from the heart might be reduced since the fluid (blood) amount in the
circulation is not enough so as to sufficiently fill it. This is normally referred to as
(hypovolemic shock).
In other cases, it might not be sufficient in a relative sense since the capacity of the
system that circulates blood is elevated by vesicular vasodilation even though the volume of
the circulating blood is normal. This may be referred to as, low-resistance shock, vasogenic
or distributive shock.
Shock may also be as a result of failure in the operation of the pumping mechanism of
the heart. This is majorly brought about by myocardial abnormalities. This type of shock that
arises from that is clinically labelled as (Cardiogenic shock). Shock may also arise from
insufficient cardiac output which might be a disruption of flow of blood into the lungs or even
to the heart.
Figure 1.0 Cardiogenic shock
Another type of shock is one categorised as venous pooling shock. This type arises
more so when one’s body has a volume of blood that is normal, although in the limbs there
might be a lot of it that is accumulated. This may result from long moments of standing or even
taking a sitting position.
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From the venous shock types, a Neurogenic type of shock is one that arises in the case of an
abrupt loss of motor tone of the vessels, hence allowing them to accommodate a lot of fluid.
Brain stem trauma or even shock with regards to emotions may cause the neurogenic shock.
Symptoms of shock.
There are quite a number of things that manifest in the occasion of a shock. Though
most of them are principally determined by the type of shock involved. Amongst them being,
reduced blood pressure, cold and clammy skin; thirst that is very intense; a state of feeling
restless, having a very rapid thread pulse.
With regard to stages, there are symptoms that manifest based on the stage of shock
that one is suffering from. Chest pains may arise as a result of the heart failing to obtain
adequate oxygen supply. This may be attributable to obstruction of the coronary arteries that
give vascular blood supply to the heart.
Causes of shock
There are conditions that would cause cardiogenic shock and among them are; existence
of an embolism or blockage of an artery in the lung; filling up of the pericardial cavity with
fluid such that the heart’s filling capacity is compromised; sudden failure of the valves by way
of them allowing backflow of blood; rapturing of the wall of the heart caused by an increase in
pressure; arrhythmia that is due to the ventricles beating at a rate faster than normal.
From research and also the diagnosis of previous shock cases, it has been found that
there are associative risk factors to shock. Some of them being; existence of a past myocardial
infarction, build-up of a plaque in the coronary arteries which give blood supply to the heart
and lastly having a disease of the valves over a long time.
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Figure. 2.The Ogenesis of shock.
Treatment of shock.
Treatment given to shock patients is normally aimed at making a correction on the cause and
ensuring that the body’s normal physiological mechanisms are restored to a sufficient tissue
blood supply.
In case the cause of shock is high blood loss, then the treatment offered must comprise of
timely transfusion of sufficient amounts of fluid (blood) in this case. In cases of shock that
involve burns alongside other conditions whereby hemoconcentration is present; use of plasma
becomes the favourable treatment method to restore the important defect which is the plasma
loss.
Serum albumin which is concentrated and other hypertonic solutions help a lot in expanding
the blood volume by getting fluid to be drawn from the interstitial spaces. These become very
important and come in handy in treatment that is very urgent or is an emergency but there
normally is a disadvantage of further dehydrating the tissues of a patient who is already
dehydrated.
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Prevention of shock
There are recommended practices that prevent by a huge extent the occurrence of shock. This
may involve prescription of drugs that do help in preventing this in the case of patients who
have had a history of a heart attack. Intake of foods which are cholesterol free and also avoiding
habits such as smoking also come in handy.
Other measures that are recommended from research with regards to the prevention of shock
is regular check up for pertaining the circulatory functioning. This ensures that an early
diagnosis on the condition is made and the necessary measures taken to contain the condition
before it gets to far fatal stages.
Recent research about shock.
From the American college of cardiology, a research was done on patients who suffered
cardiogenic shock. This was done with the aim of achieving to associate mortality of these
patients after them being discharged following containing of the condition with them having
an earlier exposure to cardiogenic shock.
References
American College of Cardiology, research on Heart attack patients experiencing cardiogenic
shock; medical Research news; February 16,2016.
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Ganong’s review of medical physiology 24th Ed, Kim E Barret, Susan M. Barman, Scott
Boitano, Heddwen L. Brooks. Section Cardiovascular physiology
Pg 548 (Clinical box 30-2)
Medscape.com, Paul Kolecki, MD, FACEP; Chief Editor; Barry E Brenner, MD, Phd, FACEP.
Hypovolemic Shock. February 27,2014.
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Multiple questions
A patient is admitted to the emergency department after sustaining abdominal injuries and a broken
femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently.
Vital signs upon admission are temperature 98 F (36 C), heart rate 130 beats/minute, respiratory
rate 34 breaths/minute, blood pressure 50/40 mmHg. The healthcare provider suspects which type
of shock?
a.) Hypovolemic
b.) Cardiogenic
c.) Neurogenic
d.) Distributive
a.) Hypovolemic
The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The
patient's central venous pressure (CVP) reading is 2, blood pressure is 90/50 mmHg, lung sounds are
clear, and jugular veins are flat. Which of these actions is most appropriate for the nurse to take?
a.) Slow the IV infusion rate
b.) Administer dopamine
c.) No interventions are needed at this time
d.) Increase the IV infusion rate
d.) Increase the IV infusion rate
A patient who has pericarditis related to radiation therapy, becomes dyspneic, and has a rapid, weak
pulse. Heart sounds are muffled, and a 12 mmHg drop in blood pressure is noted on inspiration. The
healthcare provider's interventions are aimed at preventing which type of shock?
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a.) Distributive
b.) Neurogenic
c.) Obstructive
d.) Cardiogenic
c.) Obstructive
The healthcare provider is caring for a patient who has septic shock. Which of these should the
healthcare provider administer to the patient first?
a.) Antibiotics to treat the underlying infection.
b.) Corticosteroids to reduce inflammation.
c.) IV fluids to increase intravascular volume.
d.) Vasopressors to increase blood pressure.
c.) IV fluids to increase intravascular volume.
A 4.5 kg infant is admitted to the pediatric intensive care unit after 33 days of watery diarrhea. The
infant is diagnosed with severe dehydration. The infant's skin is mottled and turgor is poor. Capillary
refill is delayed, and there is an absence of tears with crying. Which intervention should be the
priority action by the healthcare provider?
a.) Calculate the mean arterial pressure
b.) Draw blood for a complete blood count
c.) Establish vascular access
d.) Take a complete set of vital signs
c.) Establish vascular access
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Rationale:
Vascular access should be established quickly in order to replace lost volume before shock
progresses.
Which of the following assessment findings is an early indication of hypovolemic shock?
a.) Diminished bowel sounds
b.) Increased urinary output
c.) Tachycardia
d.) Hypertension
c.) Tachycardia
When compensatory mechanisms for hypovolemic shock are activated, the nurse would expect
which two patient findings to normalize?
a.) Intensity of peripheral pulses and body temperature.
b.) Peripheral pulses and heart rate (HR).
c.) Metabolic alkalosis and oxygen saturation.
d.) Cardiac output (CO) and blood pressure (BP).
d.) Cardiac output (CO) and blood pressure (BP).
Which type of fluid is most appropriate for volume replacement for a patient with non-hemorrhagic
hypovolemic shock?
a.) Lactated Ringers (LR)
b.) 10% Dextrose in Water (D 10 W)
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c.) One-half Normal Saline (1/2% NS)
d.) Packed Red Blood Cells (PRBC)
a.) Lactated Ringers (LR)
A client is progressing into the third stage of shock. The nurse will expect this client to demonstrate:
Choose all that apply:
a.) Intractable circulatory failure.
b.) Neuroendocrine responses.
c.) Demonstrating MODS.
d.) Buildup of metabolic wastes.
e.) Profound hypotension.
f.) Increase in lactic acidosis.
c.) Demonstrating MODS.
d.) Buildup of metabolic wastes.
A client has been diagnosed with sepsis. The nurse will most likely find which of the following when
assessing this client:
Select all that apply:
a.) Rapid shallow respirations.
b.) Severe hypotension.
c.) Mental status changes.
d.) Elevated temperature.
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e.) Lactic acidosis.
f.) Oliguria.
a.) Rapid shallow respirations.
d.) Elevated temperature.
A client in shock is prescribed an inotropic drug to act on alpha and beta receptors. The nurse will
most likely be administering:
a.) Dopamine.
b.) Dobutamine.
c.) Pavulon.
d.) Milrinone.
a.) Dopamine.
The client experiences shock following a spinal cord injury. This type of shock is classified as:
a.) Hypovolemic.
b.) Neurogenic.
c.) Cardiogenic.
d.) Anaphylactic.
a.) Neurogenic.
The client in shock is prescribed an infusion of lactated Ringer's solution. The nurse recognizes that
the function of this fluid in the treatment of shock is to:
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a.) Replace fluid, and promote urine output.
b.) Draw water into cells.
c.) Draw water from cells to blood vessels.
d.) Maintain vascular volume.
a.) Replace fluid, and promote urine output.
Nursing assessment of a client receiving serum albumin for treatment of shock should include:
a.) Assessing lung sounds.
b.) Monitoring glucose.
c.) Monitoring the potassium level.
d.) Monitoring hemoglobin and hematocrit.
a.) Assessing lung sounds.
Dobutamine (Dobutrex) is used to treat a client experiencing cardiogenic shock. Nursing intervention
includes:
a.) Monitoring for fluid overload.
b.) Monitoring for cardiac dysrhythmias.
c.) Monitoring respiratory status.
d.) Monitoring for hypotension.
b.) Monitoring for cardiac dysrhythmias.
SHOCK
An intensive care nurse, is assessing a patient with suspected sepsis. Which predisposing factors
would expect to be found in the patient with septic shock?
a.) A 45 year old client with a history of renal insufficiency.
b.) A client age 65, with a history of cancer who is recovering from an abdominal peritoneal
resection.
c.) A 27 year old with pyelonephritis responding to treatment with an antibiotic.
d.) A 50 year old with community acquired tuberculosis.
b.) A client age 65, with a history of cancer who is recovering from an abdominal peritoneal
resection.
The acute care nurse is planning an inservice to present evidence based practices to address the
increasing incidence in ventilator associated pneumonia. Interventions included in this protocol
include:
a.) Avoid the use of agents that increase the pH of the stomach as these blocks their antibacterial
properties.
b.) Maintaining the head of the bed at 30 degrees and strict hand washing before and after any
patient contact.
c.) Changing the ventilator circuit at least every 24 hours.
d.) Provide routine oral care with a combination of alcohol based products.
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b.) Maintaining the head of the bed at 30 degrees and strict hand washing before and after any
patient contact.
When performing a physical assessment of a patient with severe sepsis, what abnormal assessment
would the nurse expect to find?
a.) A WBC of 8,100 despite the presence of chills.
b.) A blood pressure of 100/72 with a capillary refill of <3 seconds.
c.) Leucocytosis in a patient with absent bowel sounds.
d.) Renal output that fluctuates according to intravenous intake.
c.) Leucocytosis in a patient with absent bowel sounds.
Rationale:
Leucocytosis in a patient with absent bowel sounds A white count > 12,000/mm3 and a left shift is
one of the diagnostic criteria. Absent bowel sounds indicate a possible ileus. This would allow
translocation of the intestinal flora into the bloodstream.
Multiple organ dysfunction syndrome (MODS) develops in severe sepsis as a result of systemic
inflammatory response syndrome (SIRS), disseminated intravascular coagulation and damage to the
endothelium. Which of the following statements best describes the management of MODS?
a.) The use of proton pump inhibitors and H2 agents to increase the pH of the stomach inhibit the
development of stress ulcers, an ileus and malabsorption issues.
b.) Maintaining ventilator settings that ensure a tidal volume of at least 6 mL/kg of body weight will
keep the lungs from being injured by endothelial damage.
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c.) There is no specific therapies for MODS other than supportive care and the early recognition of
dysfunctional organ(s).
d.) Much of the organ damage that occurs with MODS in the setting of severe sepsis is associated
with pre-existing conditions.
c.) There is no specific therapies for MODS other than supportive care and the early recognition of
dysfunctional organ(s).
Sepsis is the most common cause of disseminated intravascular coagulation (DIC). All of the
following statements concerning this life threatening complications are true except:
a.) The rapidity of onset is determined by the intensity of the trigger and is related to the condition
of the patient's liver, bone marrow and endothelium.
b.) In the early phase, the patient may demonstrate manifestations of thrombosis and microemboli.
c.) Though a coagulopathy is present, excessive blood loss rarely results in hemorrhagic shock.
d.) The most critical intervention for DIC is the early identification and treatment of the underlying
disorder.
c.) Though a coagulopathy is present, excessive blood loss rarely results in hemorrhagic shock.
A patient is treated in the emergency department (ED) for shock of unknown etiology. The first
action by the nurse should be to
a.) check the blood pressure.
b.) obtain an oxygen saturation.
c.) attach a cardiac monitor.
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d.) check level of consciousness.
b.) obtain an oxygen saturation.
A patient with hypovolemic shock has a urinary output of 15 ml/hr. The nurse understands that the
compensatory physiologic mechanism that leads to altered urinary output is
a.) activation of the sympathetic nervous system (SNS), causing vasodilation of the renal arteries.
b.) stimulation of cardiac -adrenergic receptors, leading to increased cardiac output.
c.) release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention.
d.) movement of interstitial fluid to the intravascular space, increasing renal blood flow.
c.) release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water
retention.
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