Med-Surg - Cardiovascular System, part 21: Shock

Hi. I'm Cathy with Level Up RN. In this video, we are going to talk about shock. And if you wait till the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key facts I'll be covering in this video. So definitely stay tuned for that. And if you have our Level Up RN medical-surgical nursing flashcards, definitely pull those out so you can follow along with me.

With shock, we have insufficient blood flow, such that we have lack of perfusion to the body's organs. So our organs are not getting the oxygen and nutrients that they need.

So this circulatory failure is caused by one of several different types of shock.

First of all, we have hypovolemic shock.

This can be caused due to blood loss associated with a trauma or with surgery. Hypovolemic shock can also be caused by GI losses, such as excess vomiting or diarrhea. It can also be caused by excess fluid loss, for example, with diuresis.

Then we have cardiogenic shock.

So this is where we have heart pump failure that can occur from an MI, from heart failure, from a valve or structural problem in the heart, as well as dysrhythmias.

Then we have obstructive shock.

This is where we have blockage of the great vessels or the heart itself. So examples of causes that can lead to obstructive shock include a PE, a tension pneumothorax, as well as a cardiac tamponade.

And then we have distributed shock, which leads to extreme systemic vasodilation, which causes the patient's blood pressure to plummet. 

And there are three different types of distributive shock.

We have septic shock, which is where we have endotoxins that end up in the bloodstream from an infection.

We have neurogenic shock, which is where we have dysfunction of the sympathetic nervous system that happens based on a trauma such as a spinal cord injury.

And then we have anaphylactic shock, which is where the patient has a reaction based on exposure to an allergen, which can lead to closure of the airway and the systemic vasodilation as well.

Signs and symptoms that are common across all these different types of shock include hypotension, tachycardia, tachypnea, weak pulses, as well as a decrease in urine output. So under 30 milliliters an hour. If the patient has anaphylactic shock, they may also have wheezing as well as angioedema.

In terms of labs, we will likely see an increase in serum lactate as well as abnormal ABGs. If the patient has cardiogenic shock, then we will also see an increase in cardiac enzymes. If the patient has hypovolemic shock, we will see a decrease in hemoglobin and hematocrit. And if we're talking about septic shock, then we will have positive blood cultures, because of the presence of endotoxins in the bloodstream.

In terms of treatment, we're going to want to treat the underlying condition. We're going to administer IV fluids as well as blood products and colloids to help maintain that intravascular volume. We're likely going to need to administer vasopressors such as epinephrine or norepinephrine. One thing that's important to note is that we need to correct the patient's hypovolemia first before administering vasopressors. In addition, we would need to give antibiotics for the case of septic shock.

In terms of nursing care, we're going to administer oxygen as ordered. Help maintain the patient's airway, and prepare for intubation if necessary. We want to place our patient in shock position, so that means they'll be supine with their legs elevated. So this is like modified Trendelenburg position. Or to closely monitor their vital signs, their level of consciousness, as well as their urine output.

And we're going to monitor for complications such as multiple organ dysfunction syndrome and something called DIC, which is disseminated intravascular coagulation. With DIC, the body forms all these micro clots all over the body, which can lead to ischemia. But it also places the patient at high risk for bleeding because all of those clotting factors are used up.

All right, time for Quiz. I have three questions for you. First question, a urine output under 30 milliliters an hour may be indicative of shock, true or false? The answer is true. Second question, what type of shock is caused by heart pump failure? The answer is cardiogenic shock. Question number three, hypotension is a key symptom with which type of shock? The answer is all of them. So that was a little tricky question. Hopefully, you don't hate me for that. But really hypotension is a key symptom for shock in general, no matter which type we're talking about. Okay, that's it for this video. I hope you have found it helpful. Take care and good luck with studying.