Types of shock

Mrs. Almusalhi
 Hypovolemic Shock
• Causes: most common type, caused by
reduction of fluid 15% to 30% of blood (750-
1500ml of blood in 70kg person).
• Loss of blood externally by blooding or shifts of
internal fluids by dehydration AND severe
edema,
•Effects: decreased IV fluid, decreased
blood ejected from heart, decreased
cardiaac output then BP drops and less
tissue perfusion.
 Hypovolemic Shock
• Medical management:

1. Treating underlying cause (stop bleeding by

pressure or surgery for internal organs), medication to
treat diarrhea and vomiting.

2. Fluid and blood replacement: use large vein and

two IV lines, use crystaloid solution as NS and RL or
albumen, blood products (packed RBCs for
hemoglubin to carry O2 to tissues). use 3:1 rule ( 3ml
of crystaloid to 1 ml of blood loss)
 Hypovolemic Shock
• Medical management:

1. Redistribution of fluid: (modified

tendlemberge position for returning of blood to
heart.
2. Pharmacological therapy: use of vasoactive
medication, insulin is given if dehydration is
secondary to diabetes, medication of diabetes
insipidus, anti-diarrhoeal mediation for
diarrhoea and anti emetic medication.
• Nursing management:
• Administring blood and fluids safely
• O2
• Comfort and explanation of patient is
needed.
 Cardiogenic shock
• Occurs when heart not able to pump blood
• Causes: unknown
• Seen in patient with MI
• Patho: when heart not able to pump
blood, HR decrease then BP decrease.
Resulting in low tissue perfusion.
• Clinical manifestation: angina pain,
dysrthemia, fatigue and hemdynimically
not stable.
• Medical managment:
• Correction of underlying cause: O2,
thrompolitic therapy in MI, CABAG, correction of
acidosis, and dysrrhethmia.

• Initiation of first line management: O2, pain

control (Morphin), hemodynimically monitoring
(ICU care, arterial line insertion for BP
monotoring, laboratory marker monitoring
(cardiac enzymes (CK mb and cTn-1), ECG for
ST segment monitoring and fluid therapy and
pharmacological therapy (Doputamine,,,,,p 326
• Nursing management:
• Preventing cardiogenic shock: O2,
• Monitoring hemodynamic status: V/s
checking, ECG, IV fluids
• Administering medication: record
medication and response, neurological
assessment, monitor (BUN, creatinine,
urine output ,,,,,
• Reduce anxiety and ensure comfort.
 Septic shock
• Most common by widespread infection.
• Causes: invasive procedurs, older
population and resistance to antibiotic
• Virus, fungus, gram negtive bacteria are
causes
• When it invade body immune system and
inflammation is activated, leads to
increase permiability and poor tissue
perfusion.
• S&S: normal BP, high HR, normal to low urine
output, nausea, vomitting, confusion, then
acidosis and organ dysfuntion (low BP, ,,,,,,,,

• Medical management: fluid replacement

therapy, pharmacologic therapy (anti
inflammatory,,,,,,,), nutrition therapy: to prevent
resistance to infection, started within first 24hrs
of ICU admission, enteral feeding in perfered to
prevent IV infections,
• Nursing management: use aseptic
technique, monitor injection sties for
infection, sample for C/s from any sties,
administer antibiotic and assess S&S of
infection.
 Neurogenic shock
• Vasodilatation occurs when loss of
balance between parasmpathetic and
sympathatic stimulation
• Sympathatic stimulation cause
vasoconstriction
• Blood volume is normal but
parasympathatic cause vasodilatation so
there fluid shifts.
• Causes: spinal cord injury, spinal
anesthesia, nervous system damage.
• S&S: low BP, dry and warm skin,
bradycardia
• Medical management: control spinal cord
injury, position patient carefully in spinal
anasethesia,
• Nursing management: elevate the head
of bed when using spinal anesthesia to
prevent agent spread to brain, carefully
mobilize the patient, support
cardiovascular function, apply anti-
embolism stocking and check for lower
extremity pain or tenderness or redness.
 Anaphylactic shock
• Occurs for person who develops antigen and
antibody reaction (patient with allergy)

• Causes: severe allergic reaction, leading to

systematic antigen-antibody reaction, it requires
the individual to be exposed to antigen before

• Medical management: stop antibiotic or the

agent, epinephrine (vasoconstrictive agent),
antihistamine, nebulization, CPR if it happens, IV
lines for fluids,
• Nursing management :
1.close monitoring for allergens
( medication, blood products, latex,
contrast agent, foods,,,,,),
2.assess previous reaction,
3.new antibiotic IV
4.then document it carefully and report it.