Shock Types and Interventions

Overview

This lecture covers the essential types of shock for nursing exams, including their stages, symptoms, key differences, and interventions for each type.

General Concepts of Shock

• Shock is a critical state with decreased tissue perfusion, leading to organ failure and death.
• The hallmark sign of shock is severely low blood pressure (hypotension).
• Low oxygen delivery to tissues is central in all forms of shock.

Stages of Shock

• Initial Stage: Low oxygen leads to anaerobic metabolism; no observable symptoms.
• Compensatory Stage: The body increases heart rate (tachycardia) and respiratory rate (tachypnea) to compensate.
• Progressive Stage: Cold, clammy skin is a priority sign indicating worsening perfusion.
• Irreversible Stage: Organ failure and death are imminent.

Septic Shock

• Caused by widespread infection (sepsis) with systemic cytokine release, leading to vasodilation and fluid leakage.
• Key symptoms: hypotension (<80 systolic), cool/clammy skin, delayed cap refill, confusion/disorientation, high WBC, initial fever then dropping to hypothermia (<96°F), low urine output.
• Treatment: Immediate IV fluids, antibiotics, and medications.

Neurogenic Shock

• Results from spinal cord injury at T6 or higher, causing loss of sympathetic nervous system function.
• Key symptoms: bradycardia (<60 bpm), hypotension (<80 systolic), warm/pink/dry skin due to vasodilation.
• Treatment: Immediate IV normal saline (.9% sodium chloride).

Hypovolemic Shock

• Caused by loss of blood or fluid (hemorrhage, burns, vomiting, diarrhea).
• Key symptoms: hypotension, tachycardia (>100 bpm), cold clammy skin, low central venous pressure (CVP <2), urine output <30 mL/hr.
• Interventions: Lay head low, give IV normal saline first, then vasopressors (norepinephrine, dopamine); maintain MAP >65 mmHg and CVP between 2-6.

Cardiogenic Shock

• Caused by heart failure to pump blood (e.g., MI, heart failure exacerbation).
• Key symptoms: severe hypotension, signs of poor perfusion.
• Interventions: Inotropes (dopamine, digoxin) to increase contractility; monitor for tachycardia and arrhythmias.

Anaphylactic Shock

• Caused by severe allergic reaction (e.g., bee sting, food allergy).
• Key symptoms: hypotension, bronchoconstriction, hives, respiratory distress.
• Priority treatment: Inject epinephrine IM immediately, repeat every 5–15 min as needed; seek emergency care.

Key Terms & Definitions

• Shock — State of poor tissue perfusion leading to organ dysfunction.
• Hypotension — Abnormally low blood pressure.
• Tachycardia — Abnormally high heart rate.
• Bradycardia — Abnormally low heart rate.
• MAP (Mean Arterial Pressure) — Average pressure in arteries; target >65 mmHg in shock.
• CVP (Central Venous Pressure) — Pressure in the thoracic vena cava; normal is 2–6 mmHg.
• Inotropes — Medications that increase cardiac contractility (e.g., dopamine, digoxin).
• Vasopressors — Medications that constrict blood vessels, increasing blood pressure.

Action Items / Next Steps

• Memorize key symptoms and treatments for each type of shock.
• Practice identifying shock stages and priority interventions on sample questions.
• Review mean arterial pressure and central venous pressure targets.
• Review proper EpiPen administration steps and patient teaching points.