THE NURSING CORNER

SHOCK- In shock, the first hour of treatment is most critical. Early detection is key. There are different ways to categorize shock. Basically, shock presents three potential problems:

1. Not enough fluid in the blood vessels (hypovolemia) OR
2. Fluid has moved outside the vessels, so cannot be pumped to the organs (distributive) OR
3. Heart cannot pump fluid that is present (cardiogenic)

Shock and Temperature

In septic shock, the skin and body temperature may increase. In other shock states, body and skin temperature will decrease.

Shock and Heart Signs

1. Early stages of shock activate the sympathetic nervous system. So in early stages, the client will not always be hypotensive.
2. Bradycardia is a very late sign in shock.
3. Another late sign is cardiac arrhythmia (other than sinus tachycardia). Arrhythmias reflect less perfusion of the coronary arteries and myocarditis.
4. As the myocardium receives less perfusion, heart pumps less.
5. Because less blood perfuses the brain, level of consciousness drops.

Shock and Urinary Output

Average adult urinary output is 0.5 to 1.0 ml/kg/hr. Less than 35 ml/hour reflects decreased renal blood flow. Acute renal failure can result.

Shock and Respiration

1. As blood flow to lungs decreases, less gas exchange will occur.
2. When tissues receive less oxygen, they produce more lactate and metabolic acidosis sets in. Metabolic acidosis increases risk of cardiac arrhythmias.
3. For a client in shock, body cells receive less oxygen and nutrients. Thus treatment aims at increasing both available oxygen and volume of blood in vessels (unless the heart has failed).
4. Medications can improve tone of blood vessels (inotropes) or treat the cause of shock (corticosteroids, antibiotics).
5. When treating a trauma client, you must quickly assess ABCs. After you know the client is breathing and has a pulse, vital signs can wait while you stop any bleeding and start other interventions (such as starting IVS). Don't rely only on the vital sign numbers.

Head and Spine Injury

1. If client has head injury, the most important assessment is level of consciousness; next is pupil response to light. Changes in vitals are very late sign.
2. With trauma clients, assume spine is injured until proven otherwise. While you open the airway, you must keep cervical spine immobile.