Question

1. Identify two medical management that are specific to each of the following types of shock and discuss briefly.

TYPE OF SHOCK	MEDICAL MANAGEMENT
CARDIOGENIC
SEPTIC
HYPOVOLEMIC
ANAPHYLACTIC

2. Explain the physiologic reasons for the following assessment findings in a patient experiencing shock and one priority nursing interventions that can improve the patient’s condition. The first one is done as a guide.

ASSESSMENT FINDING	PHYSIOLOGIC BASIS	NURSING INTERVENTION
DECREASED LOC	DECREASED TISSUE PERFUSION TO THE BRAIN AND HYPOXIA OF BRAIN CELLS	REORIENTATION AND INFORM THE PATIENT OF ALL CARE RENDERED
TACHYCARDIA
FEVER
OLIGURIA
HYPERGLYCEMIA

Answer 1

1.CARDIOGENIC SHOCK MEDICAL MANAGEMENT
✓There is circulatory failure and sudden drop in cardiac output. Blood volume remains normal in this type of shock.
✓ firstly assess the current medication regimen of the patient.they may cause further hypotension.
✓Inotropes like dobutamine increase contractility of the heart.
✓vasopressors like epinephrine, norepinephrine to increase blood pressure.

SEPTIC SHOCK MEDICAL MANAGEMENT
✓caused due to severe bacterial infections. More commonly caused by gram negative bacteria.
✓antibiotic therapy must be started as soon as possible. It decreases chances of mortality.
✓low doses of corticosteroid ( if patient is hemodynamically stable).

HYPOVOLEMIC SHOCK MEDICAL MANAGEMENt
✓caused as a result of inadequate blood volume in circulation.
✓isotonic crystalloid solution to balance fluid deficit.
✓anti fibrinolytic agents are given to patients with severe hemorrhage.

ANAPHYLACTIC SHOCK MEDICAL MANAGEMENT
✓a hypersensitivity reaction to an antigen
✓vasoconstrictors like adrenaline to reduce vascular permeability and edema.
✓vasopressin to treat hypotension in severe cases.

2.
A) TACHYCARDIA
✓ physiologic basis -
•Decreased blood volume caused inadequate tissue perfusion. This shifts cellular respiration to be anaerobic.
•body compensates by activation of baroreceptors and stimulation of sympathetic nervous system --> leads to increased heart rate.
✓nursing intervention-
• treat the cause of decreased blood volume.
• fluid resustication therapy is given .

B)FEVER-
✓ physiologic basis-
•common in cases of sepsis.
•there is a structure called organum vasculosum of lamina terminalis, which is located in anterior hypothalamus. It is does not have a blood brain barrier . So, the pyrogens interact with this structure and alters the functioning of hypothalamus. Hypothalamus can now no longer regulate body temperature and hence fever occurs.
✓ intervention-
•antipyretics are given
•IV antibiotics to control infection.

C)OLIGURIA
✓physiologic basis- it indicates acute renal injury.
•impaired tissue perfusion causes metabolic acidosis. It releases cytokines , causing damage to renal tissue. This causes decreased urinary output.
✓ intervention -
• cardiac output is regained to normal by fluid resustication . This improves tissue perfusion.
• closely monitor renal functions after that.

D) HYPERGLYCEMIA-
✓ physiologic basis -
• tissue hypoperfusion creates stress in the body. Stress is responsible for activation of hormones like cortisol and glucagon.these hormones increase glucose production leading to hyperglycemia.
✓ intervention- insulin therapy to normalise blood glucose levels.