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Wednesday, March 28, 2012

Shock

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Shock


The content of this topic paper is “Shock”. Shock has several different classifications, and is a progressive widespread reduction in tissue perfusion that results from a decrease in effective circulating blood volume causing a decrease in oxygen delivery and/or exchange in capillary circulation. Each type of shock involves numerous clinical manifestations that may also represent other conditions, making diagnosis difficult. So, let us take a look at the different classifications of shock Anaphylactic, Cardiogenic, Hypovolemic, and Septic. (Silvestri 00) missing comma between Silvestri and 00; period follows references.


Anaphylactic shock begins as anaphylaxis, an immune and inflammatory reaction to an allergen. If this reaction is not treated the client goes into anaphylactic shock. Most common symptoms are, but not limited to, hives and swelling of the throat, lips, tongue, and around the eyes with difficulty breathing or swallowing. It only takes one or two minutes for a mild allergic reaction to escalate to anaphylaxis. Death may occur if emergency treatment is not provided. The first nursing consideration is to establish an airway and the administration of vasopressor agents, especially epinephrine and antihistamines. Oxygen should be initiated and I.V. fluids given rapidly, if indicated, along with any other emergency drugs according to facility protocol. Once the client is stable he or she should be instructed on avoiding common allergies, and how to recognize an allergic reaction. (Guyton, 16) see above


Cardiogenic shock results from any cause of heart failure and is notoriously unresponsive to treatment. With in hospital mortality rate ranging from 50% to 80%, these statistics improve with the use of percutaneous angioplasty and thrombolytic/aspirin therapy following an MI. This sentence reads awkwardly. Clinical manifestations include hypotension, urinary output of less than 0ml/hr, cold clammy skin, poor peripheral pulses, tachycardia, pulmonary congestion, tachypnea, disorientation, restlessness and continued chest pain. Nursing considerations are to administer morphine as ordered to decrease pulmonary congestion and relieve pain, administer oxygen, prepare for intubation and mechanical ventilation if necessary, administer nitrates and diuretics as ordered while monitoring B/P constantly. The nurse should also administer vasopressors and inotropics as prescribed to maintain organ perfusion, monitor ABG’s and be prepared to treat imbalances, and monitor I&O. Patient should be prepared for possible intraortic balloon pump, PTCA, CABG and insertion of Swan-Ganz catheter to assess heart failure. (Houston, 17) see above about reference punctuation


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Hypovolemic shock is characterized by a decrease in intravascular volume as a result of hemorrhage or dehydration. Clinical manifestations are cool clammy skin, tachycardia, tachypnea, weak thready pulses, hypotension, mental status changes, and a decrease in urine output with the appearance being dark and concentrated. Nursing considerations consists of maintaining client on NPO status, or fluid restrictions until cause is determined. If the cause is from hemorrhage, the bleeding is controlled and possible blood transfusions to replace lost blood volume. Medications should be administered to decrease B/P, such as Dopamine and norepinephrine. If dehydration is the underlying cause, IV fluids are administered to replace electrolytes. (Rice, 11)


Septic shock is an abnormal condition that occurs when there is an over whelming infection in the body. Clinical manifestations include fever, chills, lightheadedness, SOB, palpitations, cool pale extremities, elevated temperature, restlessness, agitation, lethargy or confusion. Nursing considerations consist of the administration of oxygen to treat respiratory distress if present, administration of antibiotics, IV fluids to replace lost volume, antipyretics to decrease temperature if present, vasoactive medication to treat decreased B/P, and hemodynamic monitoring for the evaluation of pressure in the heart. (Marieb, 15)


In summary, the major classes of shock are anaphylactic, cardiogenic, hypovolemic, and septic. Any of the above states may be combined which would complicate the picture and reduce the possibility of a successful outcome. Shock is a life threatening condition that requires immediate medical treatment. Some degree of shock can accompany any medical emergency, and can get worse very rapidly. The nursing staff should provide additional comfort measures, along with the other implementations listed above in order to help the client regain maximum level of wellness.





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