Hey guys, it's nurse Mike here from simple nursing.com. Today we're breaking down the types of shock that you need to know for your nursing exams from hypoalmic to cardiogenic and more. We'll make it super simple, memorable, and easy to stick. Plus, if you're a Simple Nursing member, be sure to grab your shock study guides to follow along. Trust me, this is high yield, top tested stuff. So, let's get started. Shock is a critical condition where the body has decreased tissue profusion eventually leading to organ failure and death. The classic sign to know for your exams and the enclelex 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 anorobic 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 tacocardia. The respiratory rate will increase to get more oxygen. So we see tacopenia and the body compensates with the sympathetic nervous system to speed up the vital signs and the renin angotensin activation to maintain blood pressure and oxygenation to keep the organs perused. 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 enclelex 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 anklelex trick you. It's not low oxygen saturation and it's not tacocardia. 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. For this part of the video, keep these study guides close by to help you make this knowledge actually stick. 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 hypoalmic 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 hypoalmic. We have low blood volume. And number four is cardiogenic shock where the heart fails to pump like an endstage 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 beasting 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 bloodborne infection that overwhelms the body, typically caused by a bacterial infection like pneumonia with an infection inside the lungs or even a UTI or kidney infection that progressively gets worse and spreads into the bloodstream. Whatever the cause, a systemic cytoin release inside the bloodstream causes extreme vasoddilation 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 profusion that lack of oxygen. Now the key signs to know is obviously low blood pressure less than 80 systolic cool clammy skin or pale and cool extremities with delayed capillary refill. Write that one down. Now, mental status change. Huge ENLEX tip. The big ones to know is confusion and disorientation. These two signs are typically the result of hypoxmia 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° F. Huge Anklex 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 introvenous 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 enlex 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 vasoc constriction. So only the parasympathetic nervous system is intact which puts the brakes on the vitals in the parasympathetic nervous system causing widespread vasoddilation and hypotension. So naturally we see low and slow vitals like a low and slow heart rate and blood pressure as vasoddilation 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 decreased cardiac output meaning less oxygenated blood out of the heart and to 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 and write this down is brada cardia huge enclelex tip. This is due to the parasympathetic dominance. So just think parasympathetic puts the brakes on the vital signs. So brada cardia results and this is a very unique sign and symptom. Unlike other types of shock where the heart rate increases with teacardia due to compensation in neurogenic shock the sympathetic nervous system is blocked resulting in this brada cardia. 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? Brada cardia. So the top three signs to know for neurogenic shock is obviously number one a low heart rate breda cardia less than 60 beats per minute. So write that one down. Number two is a low blood pressure hypotension less than 80 systolic. And number three skin that is warm pink and dry. Huge enclelex tip right there. So make sure to write that one down as well. This is mainly from the vasoddilation 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.9% sodium chloride. We have to do this immediately to peruse the tissues. Our goal here is to increase the blood pressure and stabilize it in order to peruse the body. Now for the complications, a little side note here. A deadly complication for any spinal cord injury above T6 is autonomic dysflexia. 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 dysflexia. Now, switching gears to hypoalmic shock. This is caused by anything that can lower the blood volume. So think hypo 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 enclelex 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 hypoalmic shock is number one, hypotension. Just like with any shock we see severely low blood pressure, less than 80 systolic. Number two is tacocardia 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 hypoalmic shock is a low urinary output due to the fluid volume loss. So just think 30 mls 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 tacoc cardia over 100 beats per minute. Now, as far as the interventions, the priority is hemodnamic stability. Fancy words for getting that blood pressure up. So, number one, we have to lower the head of the bed right away. Huge enlex 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 fer position or place the head of the bed up. Don't let the enclelex 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 in hypoalmic or hypovension to prevent further hypotension there. And number two is IV normal saline or.9% sodium chloride. We do this before vasopressor medications. This is a huge key point right here as the fluid bololis will increase intravascular volume and increase blood pressure and profuse 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 vasop pressors 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 norepi 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 enclelex 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 mm of mercury which means that the average blood pressure all over the body is adequate for tissue profusion or in other words to oxygenate the body and keep the organs alive. Now another thing CVP central venus pressure as mentioned before it should be maintained between 2 to 6 mm 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 body. So Saunders mentions a client in shock develops a central pressure of less than two. Which prescribed intervention should the nurse implement first? Increase the rate of introvenous 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 oximter 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 SPBO2, the sensor should be placed on the forehead instead of the extremities since there will be lack of profusion 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 mioardial inffection based on the elevated tropponent 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 and MI or myocardial inffection. 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 out our failed heart pump is the double D's here. dopamine and digin 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 vasoc constriction to press up the heart rate and blood pressure. But a big caution here. Our vasop pressors can work too well and may cause adverse effects like tacocardia a heart rate over 100 beats per minute which is a huge anklex tip. So write that one down as well as arrhythmias but really the most tested here was tacocardia typically means that the dose may need to be lowered. And the next D is for digin. Just think digoxin digs for a deeper contraction here, especially for our clients in 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 or severe allergic reaction like from a beasting or even a peanut allergy. Again, anaphylactic shock, we have that severe allergic reaction. The key treatment to know for the enlex 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 anaphilaxis. That 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 bronco constriction which inevitably leads to death via cardiac and respiratory arrest. So the key points to know Hessie mentions EPI is the first drug used for anaphilaxis and ATI backs this up by saying first signs of anaphilaxis reaction those hives dysnia and hypotension we use an epi pen. 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 Enclelex 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 Enclelex world, we just keep on giving this drug forever until those symptoms resolve. Now, how do you know if it's a superersized 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 superersized 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 dyenhydramine or basically benadryil and lastly albuterol and steroids. But out of all these, most question banks only stress about epi being that first drug during anaphilaxis and the rest only after the acute signs and symptoms have resolved. Remember we repeat epi as a priority until those signs and symptoms resolve. Now Kaplan mentions a patient scenario administration of ampeillin 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 oscultating 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 2 seconds. Guys, this indicates good perfusion, meaning epi is doing its job to press on the veins as a phasopressor. So, it's pressing those vital signs up. And speaking of normal expected side effects to know after giving this medication, tacocardia, 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° angle on the onset of symptoms. So, Hessie mentions we stab the pen into the outer thigh and we hold it in place for about 10 seconds. So not 5 seconds, not 3 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 EpiPens in a dark place at room temperature. So not too cold, not too hot. So, not in a refrigerator and not in a car since this medication can be deactivated by heat and light. Thanks for watching. Did you know you can unlock beautifully handcrafted study guides packed with key points and memory tricks from all our videos? Plus, you'll get access to over 1,200 exclusive videos not on YouTube, all neatly organized by nursing school topic. to make that complex nursing knowledge actually stick. You'll also gain thousands of practice questions written by current professors and actual ENLEX writers. So, for access to all this and more, click right up here or visit simple nursing.com. And don't forget to subscribe to our YouTube channel. Happy studying and we'll see you in the next videos.