Types of Shock for Nursing | Shock NCLEX Tips Made Easy

now let's review shock shock is a critical condition where the body has decreased tissue perfusion eventually leading to organ failure and death the classic sign to know for your exams and the NCLEX is low blood pressure so the memory trick just think of the double s's s for shock we see severely low blood pressure and so oxygen can't get to the organs leading to organ failure and death now for the four stages of Shock first is the initial stage there's too little oxygen in the blood to feed the organs resulting in anaerobic metabolism meaning metabolism without oxygen but the signs and symptoms are absent in this stage now the second is compensatory stage this is where the body is trying to compensate for that low oxygen so the heart will pump faster going into tachycardia the respiratory rate will increase to get more oxygen so we see tachypnea and the body come sensates with the sympathetic nervous system to speed up the vital signs and the renin Angiotensin activation to maintain blood pressure and oxygenation to keep the organs perfused now as compensatory mechanisms fail clients progress into the progressive stage now a key sign to know for your exams is cold and clammy skin this is priority huge NCLEX tip so write that down this is an early sign that the body is lacking perfusion and getting worse not being able to compensate anymore it's progressing into this Progressive stage here so don't let the NCLEX trick you it's not low oxygen saturation and it's not tachycardia those are compensatory as the body is trying to scramble for oxygen so cold and clammy skin is priority for Progressive stage and the last stage is irreversible basically meaning death is imminent now there are five types of shock the number one most tested is septic shock caused by widespread bloodborne infection think sepsis infection causes septic shock number two is neurogenic shock caused by spinal cord injury T6 or higher number three is hypovolemic shock also called hemorrhagic shock caused by blood loss from a trauma or even a gunshot wound or even from surgery or Burns so just think blood loss for hypovolemic we have low blood volume and number four is cardiogenic shock where the heart fails to pump like an end stage heart failure or heart failure exacerbation and even an MI heart attack where we have weak heart muscles and a failed heart pump so for cardiogenic shock just think the cardiac fails and lastly number five is anaphylactic shock from a severe allergic reaction like from a bee sting or even from eating seafood or something you have an allergy to so for anaphylactic think severe allergic reaction now let's get into these one by one starting with septic shock pathophysiology as mentioned before this is from sepsis that widespread blood-borne infection that overwhelms the body typically caused by a bacterial infection like pneumonia with an infection inside the lung things or even a UTI or kidney infection that progressively gets worse and spreads into the bloodstream whatever the cause a systemic cytokine release inside the bloodstream causes extreme vasodilation and fluid leaking from the capillaries so the signs and symptoms include severely low blood pressure so once again the memory trick just think s for shock is for severely low blood pressure resulting in organ failure from the lack of perfusion that lack of oxygen now the Key signs to know is obviously low blood pressure less than 80 cystolic cool clammy skin or pale and cool extremities with delayed capillary refill write that one down now mental status change huge NCLEX tip the big ones to know is confusion and disorientation these two signs are typically the result of hypoxemia or basically meaning low oxygen perfusion and high WBC count over 10 000 from the infection and a temperature high in the initial stages and then very very low 96 degrees Fahrenheit huge NCLEX tip so write that down many students get tricked on this since the early stages of the infection the body's trying to fight off the infection with High Core body temperatures but the septic shock progresses and very low core body temperature develops as well as the other signs too pale cool extremities difficulty breathing and decreased urinary output with mental confusion and disorientation this develops very quickly in the late stages so you must report this to the hcp immediately emergency treatment is necessary with intravenous fluids antibiotics and other medications but again focus on the signs and symptoms that are bolded here since these are the most tested now for neurogenic shock this is from a spinal cord injury T6 or higher make sure to know that for the NCLEX and your exams in neurogenic shock the autonomic nervous system is damaged resulting in a blockage of sympathetic nervous system which is supposed to speed up the vital signs and cause vasoconstriction so only the parasympathetic nervous system is intact which puts the brakes on the vitals in the parasympathetic nervous system causing widespread vasodilation and hypotension [Applause] so naturally we see low and slow vitals like a low and slow heart rate and blood pressure as vasodilation occurs making it difficult for blood to return back to the heart this decreased blood flow back to the heart leads to decreased blood flow out of the heart basically decrease cardiac output meaning less oxygenated blood out of the heart into the body this results in poor tissue perfusion from the lack of oxygen and impaired cell metabolism resulting in organ failure and ultimately death so the Key signs and symptoms to know for neurogenic shock write this down is bradycardia huge NCLEX tip this is due to the parasympathetic dominance so just think parasympathetic puts the brakes on the vital signs so bradycardia results and this is a very unique sign and symptom unlike other types of shock where the heart rate increases with technical cardia due to compensation in neurogenic shock the sympathetic nervous system is blocked resulting in this bradycardia so Saunders mentions a client is admitted to the hospital with a diagnosis of neurogenic shock after a traumatic motor vehicle collision which manifestation best characterizes this diagnosis bradycardia so the top three signs to know for neurogenic shock is obviously number one a low heart rate bradycardia less than 60 beats per minute so write that one down number two is a low blood pressure hypotension less than 80 cystolic and number three skin that is warm pink and dry huge NCLEX dip right there so make sure to write that one down as well this is mainly from the vasodilation as blood can't return to the heart and ends up pulling inside the body now interventions for neurogenic shock the priority here is IV normal saline or 0.9 nine percent sodium chloride we have to do this immediately to perfuse the tissues our goal here is to increase the blood pressure and stabilize it in order to perfuse the body now for the complications a little side note here A Deadly complication for any spinal cord injury above T6 is autonomic dysreflexia now we have a full video on this but just to remind you we see severe hypertension that can kill the client typically triggered by a full bladder constipation or tight fitting clothes basically anything with constriction thus placing a Foley in spinal trauma patients to keep the bladder empty and offering laxatives and loose clothes can usually save a client with T6 injury or higher but once again we cover that in the full video for autonomic dysreflexia now Switching gears to hypovolemic shock this is caused by anything that can lower the blood volume so think hypo bow for low blood or low fluid volume typically from excess fluid volume loss through diarrhea vomiting or fluid shifts in burn patients and as mentioned before from bleeding or hemorrhaging from a trauma like a gunshot or knife injury or even from surgery where we get too much blood loss and even GI bleed whatever the cause the signs and symptoms are typically the same so the key point to write down is cold clammy skin this is priority huge NCLEX tip as mentioned before this is seen in the Progressive stage and is indicating that the client is getting worse so you must notify the healthcare provider immediately and get some IV normal saline started quickly so the top three signs to know that are classic indications of hypovolemic shock is number one hypotension just like with any shock we see severely low blood pressure less than 80 cystolic number two is tachycardia due to the compensatory mechanisms to maintain the cardiac output and perfusion and number three is a low central venous pressure normally between two and six so anything less than two typically means your client is through now another classic sign of hypovolemic shock is a low urinary output due to the fluid volume loss so just think 30 ml per hour or less means the body is in distress so Kaplan mentions which Vital sign would alert the nurse to potential Hemorrhage following a nephrectomy or basically kidney removal a heart rate of 110 yes that's tachycardia over 100 beats per minute now as far as the interventions the priority is hemodynamic stability fancy words for getting that blood pressure up so number one we have to lower the head of the bed right away huge NCLEX tip right there so write that down we do this to bring blood flow back to the brain and the core of the body so never place the head of the bed in high Fowler's position or place the head of the bed up don't let the NCLEX trick you here this will worsen the low blood pressure and cause even worse hypotension dropping the blood pressure even more so the memory trick put the head low and hypovolemic or hypotension to prevent further hypotension there and number two is IV normal saline or 0.9 sodium chloride we do this before vasopressor medications this is a huge key point right here as the fluid bolus will increase intravascular volume and increase blood pressure and perfuse tissues then only after then we give the vasopressors like IV norepinephrine and dopamine always use second as these vasopressor drugs mainly press on the vessels to press up the vitals they do this by increasing blood flow back to the heart to increase the blood pressure so again the key point is to give normal saline first so that the vasopressors can press that added fluid back to the heart now initially the vital signs will improve from the normal saline but it won't last so that's why we do nor EPI and dopamine this is definitely needed to maintain the blood pressure for long term now another key Point here this one's really critical do not delay a new bag of norepinephrine when the first bag is almost done huge NCLEX tip even if the client is showing signs of improvement with stabilized blood pressure this is expected initially but it won't last long term so remember do not delay a new bag of norepinephrine when the first one's almost done now the goal here is to maintain map that mean arterial pressure over the key number 65 millimeters of mercury which means that the average blood pressure all over the body is adequate for tissue perfusion or in other words to oxygenate the body and keep the organs Alive Now another thing CVP central venous pressure as mentioned before it should be maintained retained between two to six millimeters of mercury less than two means your client is through basically they need more fluids and over six needs a fix they have too much fluid here so the client needs some diuretics to drain some of that fluid from the body and into the potty so Saunders mentions a client in shock develops a central venous pressure of less than two which prescribed intervention should the nurse Implement first increase the rate of intravenous fluids yes less than two your patient is through so increase those fluids and lastly since vasopressors cause narrowing of blood vessels by pressing on the vessels the pulse oximeter is often not accurate when placed on the finger as blood flow is shunted away from the extremities toward the core of the body so be sure to write this down for the spo2 the sensor should be placed on the forehead instead of the extremities since there will be lack of perfusion there next is cardiogenic shock as mentioned before the heart fails to pump blood out of the heart to the body like in a heart attack where heart muscles die or even heart failure exacerbation where the heart fails to pump so again think cardiogenic shock as the cardiac fails and just like with any shock we see a severe drop in blood pressure remember this one is always the most tested Saunders mentions a client having a myocardial infarction based on the elevated troponin levels the nurse should alert the hcp because the Vital sign changes are most consistent with which complication refer to the exhibit so cardiogenic shock we have a cardiac problem and the question mentions a heart attack an MI or myocardial infarction so mi think heart tissues die the heart fails to pump adequately so just look at the blood pressure here when clicking on the exhibit the lower and lower it goes indicates that we have a cardiogenic shock problem severely low blood pressure with any type of shock so the key treatment to help help out art failed heart pump is the Double D's here dopamine and digoxin which both have inotropic properties meaning it helps the heart to pump more forcefully so just think I know Tropic is very forceful kind of like when you know the answer to something you're like I know the answer it's very very forceful so inotropic means a forceful contraction now D for dopamine is also a vasopressor which presses down the vessels in vasoconstriction to press up the heart rate and blood pressure but a big caution here are vasopressors can work too well and may cause adverse effects like tachycardia a heart rate over 100 beats per minute which is a huge NCLEX tip so write that one down as well as arrhythmias but really the most tested here was tachycardia typically means that the dose may need to be lowered and the next D is for digoxin just think digoxin digs for a deeper contraction here especially for our clients and heart failure who have a failed heart pump with a weaker contraction and Saunders mentions a client with heart failure exacerbation and suspected State of Shock the nurse knows which intervention is priority for this client administration of digoxin yes we need a dig for that deeper contraction and lastly here anaphylactic shock are severe allergic reaction like from a bee sting or even a peanut allergy again anaphylactic shock we have that severe allergic reaction the key treatment to know for the NCLEX and write this down epinephrine or Epi auto injector we have to know this and the key points so let's play a segment from our pharmacology Master course for this lecture we're talking about anaphylaxis that's severe allergic reaction we give an EpiPen or AKA auto injector to inject straight into the outer thigh for an IM injection typically after severe allergic reactions for example a bee sting or food allergies say we're eating shellfish with an allergy the client goes into an anaphylactic shock resulting in deadly hypotension and bronchoconstriction which inevitably leads to death via cardiac and respiratory arrest so the key points to know Hesse mentions Epi is the first drug used for anaphylaxis and ATI backs this up by saying first signs of anaphylaxis reaction those hives dyspnea and hypotension we use an EpiPen so the key term here to know is it's the first drug for the first sign of anaphylactic reaction we always use epi first now two big NCLEX tips we repeat every 5 to 15 minutes if the signs and symptoms continue and we repeat Epi until the signs and symptoms resolve so we keep on repeating Epi until those signs and symptoms go away then we give the other medications and in the NCLEX world we just keep on giving this drug Forever Until those symptoms resolve now how do you know if it's a super-sized anaphylactic reaction and not just a mild allergic reaction well any allergy that affects the ABCs the airway breathing and circulation or even induces hives this is deadly anaphylaxis the supersized allergy reaction so again don't delay Epi injection we inject immediately upon these signs and symptoms and no skin prep is necessary just stab that outer thigh straight through the pants and hold it there for about 10 seconds so the correct medication sequence is Epi first then diphenhydramine or basically Benadryl and lastly Albuterol and steroids but out of all these most question Banks only stress about Epi being that first drug during anaphylaxis and the rest only after the acute signs and symptoms have resolved remember we repeat Epi as a priority until fill those signs and symptoms resolve now Kaplan mentions a patient scenario administration of ampicillin and the client reports itchiness and difficulty breathing the priority actions is number one stop the infusion that's causing the problem number two you assess by auscultate in the lungs or listening to the lungs and number three you prepare to administer epinephrine first so again not steroids not albuterol it's always Epi first and secondly the captain mentions effective management of shock you have a BP that's a little bit High apical pulse that is 99 and a cap refill that's less than two seconds guys this indicates good perfusion meaning Epi is doing its job to press on the veins as a vasopressor so it's pressing those vital signs up and speaking of normal expected side effects to know after giving this medication tachycardia that heart rate over 100 palpitations and dizziness again these side effects means that Epi is doing its job to prevent that shock or basically that death from low blood pressure now for patient education how to use the EpiPen the three big key points here number one we inject into the outer thigh at a 90 degree angle on the onset of symptoms so Hesse mentions we stab the pen into the outer thigh and we hold it in place for about 10 seconds so not five seconds not three seconds but a full 10 seconds here now number two is we seek immediate medical attention after use so go to the hospital don't wait since Epi wears off in about 10 to 20 minutes and signs and symptoms May return lastly number three this is a big one here store Epi pens in a dark place at room temperature so not too cold not too hot so not in the refrigerator and not in a car since this medication can be deactivated by heat and light alright that wraps it up thank you so much for watching don't forget to take the quiz and download the study guides and also please consider sharing with the classmate

Channel: Simple Nursing

Views: 320,570

Keywords: #shock, #hypovolemicshock, #intravascularshock

Id: e2bUU3C8sO4

Length: 22min 49sec (1369 seconds)

Published: Wed Aug 17 2022