NR 526 Week 7 Graded Discussion: Shock
We will move away from our patients in Second Life now and focus on an acute problem that is challenging your
... [Show More] students. Chose two types of shock from the following: cardiogenic, neurogenic, anaphylactic, and septic, hypovolemic. Compare and contrast two of them for your students, including:
• Etiology
• Pathophysiology
• Important physical assessments
• Non-pharmacological interventions.
• Pharmacological interventions
Feel free to use a table, concept map, or other device to compare and contrast.
ANSWER
When a patient goes into shock, health professionals have to quickly identify what type of shock it is. Shock is a medical emergency and has five types. The five types of shock are neurogenic, anaphylactic, septic, cardiogenic and hypovolemic. Anaphylactic shock has to do with a severe allergic reaction. Septic shock deals more with infection in the body, in particular the inflammatory response. A neurogenic shock deals with the heart and is caused by vasodilation. Cardiogenic and hypovolemic shock are similar in nature in relation to how it affects the cardiovascular system (Schub and March, 2018, p. 1). The table below compares and contrasts cardiogenic and hypovolemic shock.
Cardiogenic Hypovolemic
Etiology Coronary in 80% of patients and noncoronary in 20%; blood is not pumped to heart properly causing decrease in oxygen supply to heart and body tissues (March and Avital, 2018) The blood plasma volume drops which causes homeostasis to be off balance (Schub and Karakashian, 2017)
Pathophysiology When the myocardium has lost 40% of the ability to pump (March and Avital, 2018) “A reduction of intravascular volume of 15-30%” (Schub and Karakashian, 2017)
Physical assessment characteristics Heart: distended neck veins and either cardiac murmur, gallop, third or fourth heart sounds; Lungs: crackles (March and Avital, 2018) Assess breathing, capillary refill, and vital signs to look for tachypnea, hypotension, reduced mean arterial pressure; skin: cool, moist, blueish; breath sounds: reduced, other: abdomen is increased in size (Schub and Karakashian, 2017)
Signs and symptoms Cyanosis, tachycardia, bradycardia, hypotension, absence of hypovolemia, pallor, cool or mottled extremities, peripheral pulses (rapid and/or irregular and faint), peripheral edema, weakness, anxiety, altered mental status, restlessness, and coma (March and Avital, 2018) Tachycardia, cool and clammy skin, weakness, pallor, weak peripheral muscles, sluggish capillary refill, postural hypotension, mottled extremities, dry mucous membrane, sunken eyes, bloody vomit or stools, tachypnea, and coma (Schub and Karakashian, 2017)
Non-pharmacological interventions Vital signs, proper oxygenation, check urine output, assess for normal breath sounds and any changes in cardiac rhythm (March and Avital, 2018) Promote resuscitation and restoration of fluid volume, control where there is blood or fluid loss, and nutrition support (Schub and Karakashian, 2017)
Pharmacological interventions IV fluids, pain medication such as morphine, vasoactive agents, antiarrhythmic medication, diuretics, and thrombolytic (March and Avital, 2018) Vasopressors, antisecretory agents, and sodium bicarbonate (Schub and Karakashian, 2017)
Shock has to have a rapid diagnosis because it progresses rather quickly. It is imperative that nurses and other health professionals act fast. In many institutions, there is a shock protocol. Nurses should be educated on what those are and follow it accordingly. Schub and March (2018) state that out of all five different types of shock, septic shock has the highest mortality and cardiogenic shock relies on support for the heart. Using a table, concept map, or other means of memorizing the different types of shock can be very beneficial.
References
March, P. P., & Avital, O. R. B. M. (2018). Shock, cardiogenic. CINAHL Nursing Guide. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T701253&site=eds-live&scope=site
Schub, T. B., & Karakashian, A. R. B. (2017). Shock, hypovolemic. CINAHL Nursing Guide. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T701249&site=eds-live&scope=site
Schub, T. B., & March, P. P. (2018). Shock: an overview. CINAHL Nursing Guide. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T701250&site=eds-live&scope=site [Show Less]