Chapter 6 Shock 107

Name Cause Signs & Symptoms Diagnosis Treatment

Hypovolemic
Shock

(Acute blood
loss from
trauma, fluid
shifts, loss from
surgery or
burns, vomiting
or diarrhea.
Severe
electrolyte
imbalance.)
Decrease in clients circulating
blood volume that leads to
inadequate tissue perfusion.
This can lead to organ damage
& death. Most Common cause
is acute blood loss from
trauma. Burned (massive
evaporation of water from
skin). Vomiting & diarrhea
(fluid loss & electrolyte
imbalance).
**Shock occurs when less than
20% of circulating blood
volume is lost & Severe shock
occurs when the patient has
lost more than 40% of the
blood volume. Most Adults
have a total blood volume of 5
liters, and do not show
symptoms of shock until at
least 500mL is lost. ** Small
children are more susceptible
than adults. ** Teens & Young
adults are high risk because
trauma main death in MVAs.
Early Signs: mild
tachycardia, mild
hypotension (B/P falls
below 90/40).
Anxiety, restlessness,
delayed cap refill,
increased Res Rate.
Kidney function
decreases. Skin cool
clammy & may appear
mottled. If
Hypovolemic is not
corrected patient may
experience
tachycardia,
arrhythmias, & chest
pain. Changes in LOC
with possible
unconsciousness.
** Weak thread pulse.
Diminished urine
output.
ABG, BUN (protein
of metabolism),
Creatine (renal
function),
Osmolality (fluid
status), WBC
(indicator of
immune status and
infection). Blood &
urine specimens.
Treatment based on
correcting circulation
volume & the cause. O2
Administered immediately.
Blood products & IV fluids
may be ordered. **LR is the
common fluid Rx. Diet &
fluids are administer as
tolerated. *Epinephrine &
dopamine. (Tissue damage,
even death, can occur if
these medications esp.
dopamine leak into the
tissue. monitor IV site for
signs of infiltration. Activity
as tolerated. Reposition Q
1-2 hours. Monitor I&O q1-
2 hours (Foley). Monitor
EKG. Signs of fluid
overload. Adequate sleep.
*Monitor changes in mental
status.
Cardiogenic
Shock

(MI, Ventricular
Hypotension, cellular hypoxia
& inadequate tissue perfusion
resulting from decreased
cardiac output.
Cool & clammy skin,
weak thread pulses,
tachycardia, increased
res rate, decreased
ABG, Cardiac
catheterization
(inserted into
femoral artery &
Treatment centered at
restoring pump function &
easing workload of the
heart. ** Cardiac output will
Chapter 6 Shock 107

Rupture,
Cardiac
tamponade.)
**Usually from MI.
Cardiogenic shock occurs in 5-
10% of clients with MIs. Risk
factors: Female, CAD, and
previous MI.

urinary output, lower
extremity edema, EKG
changes, decreased
B/P, anxiety, feelings of
impending doom, chest
pain, shortness of
breathe, hypotension.
threaded into
heart), Chest X-ray,
Echocardiogram
(ejection fraction
50-75%),
Osmolality (fluid
status), Troponin
(indicates MI),
WBC.
be less than 2.2L/min
(normal 4-8L/min). Diet as
tolerated (if critically ill
NPO or TPN). May be on a
ventilator, may need tube
feedings. **Medication is
the First Line of treatment
Dopamine & primacor.
Placed in supine
Trendelenburg position or
passive leg elevation
UNLESS patient is having
respiratory distress and
lower EXR edema.
Reposition q1-2h. Bed rest.
O2 if ordered. Urinary
output q1-2h.
Septic Shock

(Infection from
sources
including bone,
blood, invasive
lines, GI tract,
GU tract,
pulmonary,
cardiac, skin &
CNS.)
Bacteria releases endotoxins
into the bloodstream and
inflammatory cascade if
triggered that causes
inflammation in the entire
body, edema, hypotension,
hypoxia, decreased cellular
perfusion.
*Sepsis has a 40-50%
mortality rate.
Warm flushed skin,
fever above (100.4F),
tachycardia; elevated
res rate above 20/min,
WBC count to low or to
high. Anxiety,
hypotension, hypoxia,
mental status change.
*Tachycardia worsens
metabolic acidosis can
occur. Septic shock can
lead to organ damage
to the brain, heart,
*Risk increases
with age.
ABG, Blood
culture, BUN, CBC,
Creatine, EKG,
LDH, PTT, PT,
urinalysis with
culture.
Finding & treating cause is
essential. 1
st
line of
treatment is IV antibiotics,
fluid resuscitation,
vasopressors & O2. Usually
a central line is used for
multiple line access.
Monitor B/P,
Glucocorticoids used as
anti-inflammatory, Solu-
medrol is the steroid of
choice administered IV Q6-
8H. Bed REST. *Proper
Chapter 6 Shock 107

lungs, liver, and
kidneys. DEATH.
Foley cath care.
Neurogenic
Shock

(Spinal cord
injury, or
permanent
paralysis.)

Interruption of the
sympathetic Nervous System
response. NS is more severe
form of spinal shock
(sympathetic innervation of
the spinal cord is lost but the
parasympathetic function
continues).
Flaccidity & paralysis
can result in loss of
motor & sensory
function. Hypotension,
bradycardia, low B/P,
Weak thread pulse,
cool clammy skin,
decreased urinary
output, cyanosis,
increased Res Rate.
Symptoms can last 4-6
weeks. Complication:
Organ failure, MI,
stress ulcers.
ABG, BUN, CBC,
Creatine, EKG,
LDH, Urine specific
gravity.
Correction of hypotension,
IV fluid, vasopressors, O2,
Respiratory support PRN.
No dietary restrictions.
Vasopressors are the first
line of treatment. Maintain
flat position. Monitor EKG.
Monitor BS. Asses level of
anxiety.
Anaphylactic
Shock

(Type 1
hypersensitivity
reaction caused
when allergen
comes in
contact with
body)
Body reacts to foreign
substance with a misdirected
immune response. IGE
antibodies.
**Common allergies: milk &
eggs (esp. infants), peanuts,
chocolate, strawberries,
tomatoes & seafood (common
in adults. **Physiological
changes within the body in
response to anaphylactic
reactions include
bronchoconstriction,
hypotension, tachycardia,
Can occur within
minutes-hours. Itching,
hives, nasal congestion,
headache, nausea,
vomiting, or diarrhea.
Hypotension,
tachycardia, wheezing,
tachypnea, cyanosis,
chest pain,
arrhythmias, seizures,
and Rare symptoms:
pelvic pain, vaginal
bleeding, and urinary
incontinence.
ABG. BUN, CBC,
Creatine (renal
function), EKG
(electrical activity
of the heart), LDH
(tissue ischemia,
necrosis, or
acidosis), Urine
specific gravity
(fluid status).
No dietary restrictions,
except avoid food allergens.
Epinephrine. Epi-Pen Rx.
(do NOT inject Epi-pen IV
or into buttocks). Benadryl
(antihistamine),
Corticosteroids
(inflammatory mediators).
Trendelenburg position or
supine position. O2 prn. IV
NS or LR.
**Most severe complication
is DEATH.
Chapter 6 Shock 107

hypovolemic & febrile
response.

******************************************************************************************************************************
Blood: Bacteremia Pulmonary: Pneumonia Surgical wounds
Bone: Osteomyelitis Invasive Lines: Caths, IVs UTIS
Cardiovascular: endocarditis, pericarditis Soft tissue: Cellulitis & Wound
CNS: meningitis Intra-abdominal: diverticulitis, Appendicitis