a serious abnormal physiologic state characterized by an imbalance between the amount of circulating blood

volume and the size of the vascular bed resulting in insufficient blood flow to the tissues
a life-threatening medical emergency and is considered one of the most common causes of death for critically-
ill patients
body's response to shock:
1. hyerventilation leading to respiratory alkalosis
2. vasoconstriction--> shunts blood to heart and brain
3. intracellular to intracellular fluid shifts
4. tissue anoxia--> anaerobic metabolism--> increased capillary permeability and lactic acid build-up--
>metabolic acidosis
5. impaired organ function: renal failure and ARDS (adult respiratory distress syndrome)
types of shock (note: think C-H-A-N-S)
1. cardiogenic--> failure of heart to pump properly
2. hypovolemic--> decreased circualting blood volume
3. anaphylactic shock--> massive dilatation caused by an allergic reactionleading to release of histamine and
related substances
4. neurogenic shock--> failure of arteriolar resistance, leading to massive dilatation and pooling of the blood
5. septic shock--> lethal drop in blood pressure as a consequence of bacteremia
Assessment Findings
skin--> cool, pale, and moist for cardiogenic and hypovolemic shock; warm, dry , and pink in septic and
neurogenic shock
tachycardia
weak and thready pulse
blood pressure: normal during early stages but will drop in late stages
rapid, shallow respirations--> due to tissue anoxia and increase in CO2 levels
restlessness and apprehension--> may progress to coma
decreased urinary output due to impaired circulation to the kidneys
decreased temperature (except in septic shock)
Medical Management
1. fluid replacement using crystalloid solutions (Ringer's lactate, normal saline), colloid solutions (albumin,
plasmanate, dextran) and/or blood products ( whole blood, packed RBC, fresh frozen plasma)
2. drugs such as dopamine, dobutamine, isoproterenol, norepinephrine, sodium nitroprusside, corticosteroids and
antibiotics (for septic shock)
Nursing Management
1. maintain patent airway
2. administer oxygen as ordered
3. resuscitate as necessary
4. continuously monitor : VS,respiratory status, CVP, ECG, ABG, CBC, electrolytes, BUN, creatinine, urine output,
and other parameters as indicated
5. administer fluid and blood replacement as ordered
6. administer medications as ordered
7. elevate extremities to 45 deg.--> promotes venous return to the heart (avoid trendelenburg position as it
increases respiratory impairment)
8. if narcotics will be administered for pain, use cautiously via IV and in small doses only--> incomplete absorption
due to vasoconstriction may lead to overdose when circulation improves
9. promote rest and maintain a quiet, warm environment
10. provide psychological support for client and family
Prognosis

Prognosis depends on the underlying cause and the extent of complications. Hypovolemic,
anaphylactic, and neurogenic shock repond well to therapy. Septic shock has a mortality rate of
30% to 50%. Cardiogenic shock has the poorest prognosis.

Prevention

Shock can be prevented by minimizing factors that favor a specific type of schock. Treatment
goals include re-establishing perfusion to the organs by restoring and maintaining the blood
circulating volume, ensuring oxygenation and blood pressure are adequate, achieving and
maintaining effective cardiac function, and preventing further complications.