NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
SHOCK
Shock is a life-threatening condition resulting SIGNS AND SYMPTOMS
from inadequate tissue perfusion, which leads
to possible cell dysfunction, cell death, and even Weak, thready pulse
organ failure. Hypotension
Tachycardia (Compensating to increase
TYPES OF SHOCK blood flow)
Tachypnea (Due to low oxygen level)
1. Hypovolemic Shock
Cool, clammy skin (>3 seconds – ↓Capillary
2. Cardiogenic Shock
Refill)
3. Distributive Shock
Cyanosis (Bluish tint of the lips, tongue, and
Septic Shock
fingertips)
Neurogenic Shock
Dry skin, crack lips
Anaphylactic Shock
TREATMENT
HYPOVOLEMIC SHOCK
Crystalloids (Normal Saline or Lactated
Ringer’s solution)
Colloids (Albumin)
Blood Products (plasma, PRBCs and PLTs)
CARDIOGENIC SHOCK
Pump failure cause inadequate tissue
perfusion; can cause hypovolemic shock.
Conduction problem (dysrhythmias)
Heart not blood; There is enough blood but
the heart just cannot pump it to the body
which causes fluid accumulation in the lungs.
Coronary cardiogenic shock (Heart
problems) is more common than non-
Loss of fluid resulting in inadequate tissue coronary cardiogenic shock and is seen most
perfusion; blood/fluid loss. often in patients with acute myocardial
Common type of shock. infarction.
Non-hemorrhagic Causes: Fluid shift (edema Causes: Damage from acute MI, severe
or ascites), Severe dehydration (vomiting, hypoxemia, acidosis, hypoglycemia,
diarrhea, burns) cardiomyopathy, cardiac tamponade,
Hemorrhagic Causes: Trauma, GI Bleed, dysrhythmias.
Postpartum
Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
SHOCK
SIGNS AND SYMPTOMS is NOT perfusing the vital organs, which causes
relative hypovolemia.
Hypo-tachy-tachy
Jugular vein distention, chest pain SEPTIC SHOCK (SEPSIS)
Most common type of shock.
TREATMENT Etiology: Caused by widespread infection or
sepsis.
Vasopressors (E.g., epinephrine, Dysregulated host response to infection
dobutamine, dopamine) – it causes Hospital associated infection
vasoconstriction which ↑ BP and ↑ perfusion Bacteremia, pneumonia, urosepsis
to the organs. Risk Factors: Immunosuppression, extreme of
For an MI: Angioplasty, Thrombolytics (Clot age, malnourishment, chronic illness, invasive
Busters) procedure, indwelling medical devices
Diuretics to ↓ Workload of the heart and ↓ (Gateway of microorganism: IFC, IV, TPN).
Extra blood volume.
CLINICAL MANIFESTATIONS
DISTRIBUTIVE SHOCK
Hypo-tachy-tachy
Fever: >38.3°C
Unresponsive to fluid resuscitation
WBC >12,000
>10% immature WBC
Note: In laboratory tests, sepsis often coincides
with high white blood cell counts.
OTHER SIGNS AND SYMPTOMS
Bounding pulses
Initially warm and flushed skim, but as BP
drops, the skin becomes cool, pale and
mottled
TREATMENT
CORRECT THE UNDERLYING CAUSE
Fluid Replacement
Broad-spectrum antibiotics – used when
the organism that is causing infection is not
yet known/determined.
ANTIBIOTICS
NEUROGENUC SHOCK (VASOGENIC)
Vasodilation due to a loss of balance
between sympathetic and parasympathetic
stimulation.
Predominant parasympathetic response
Causes: Spinal Cord Injury, Spinal
anesthesia, Nervous system damage, insulin
Leaky blood vessels (Excessive Vasodilation) →
reaction.
Intravascular volume pools in the peripheral blood
The patient mainly experiences
vessels → Since the blood is in the peripherals, it
parasympathetic stimulation which causes
VASODILATION for an extended period.
Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
SHOCK
Note: Parasympathetic Stimulation causes Dry, warm extremities (venous blood pooling)
dilation/relaxation of the smooth muscles. Hypotension
Sympathetic Stimulation on the other hand, ↓ HR or bradycardia
causes constriction/tightening of the smooth
muscles. ANAPHYLACTIC SHOCK
Severe allergic reaction
Foreign substance (antigen) → Systemic
antigen-antibody reaction (IgE) → Mast cells
release potent vasoactive substance
(histamine/bradykinin) → Activates
inflammatory cytokines → Causes
VASODILATION and capillary permeability.
IgE-mediated response.
Occurs within 2-30 minutes to several hours
of exposure to antigen.
Causes/Triggers: Foods, Medications,
Insects, Latex.
Treatment: First line drug is epinephrine
(epipen), high-flow oxygen, antihistamines,
albuterol, corticosteroids, fluids.
CLINICAL MANIFESTATIONS
Hypo-tachy-tachy
Headaches
Lightheadedness
N/V, pruritus
Impending doom
Erythema, generalized flushing
Bronchospasm
Hypotension
GENERAL MANAGEMENT (SHOCK)
Treatment of underlying cause
Fluid replacement: Crystalloid, colloid,
plasma
Blood loss – 3:1 rule (Crystalloid)
Blood loss – 1:1:1 ratio
(Transfusion)
Oxygen
Vasoactive medications
Nutritional Support
Note: 1mL of blood loss is equivalent to 3mL of
crystalloid.
Crystalloid (Small Molecules)
1. Hypotonic
2. Isotonic
SIGNS AND SYMPTOMS 3. Hypertonic
Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
SHOCK
Colloids & Plasma Expanders (Large Beginning of P wave to beginning of QRS
Molecules) interval
Sinus node stimulation, atrial
1. Natural (Human Albumin, FFP)
depolarization, conduction through AV
2. Synthetic (Dextrans, Gelatins, Starches)
node before ventricular depolarization
ELECTROCARDIOGRAM (ECG) 5. RR interval
One QRS to next QRS
Used to determine ventricular rate and
rhythm
6. ST segment
End of QRS to beginning of T wave
7. QT interval
Time for ventricular depolarization and
repolarization
Beginning of QRS to end of T wave.
0.32 to 0.40 seconds
8. TP interval
End of T wave to beginning of next P wave
9. PP interval
Beginning of one P wave to beginning of
next P wave
DETERMINING HEART RATE
Normal Heart Rhythm/ Normal Sinus Rhythm
HR=1500/small squares R-R interval
HR=300/large squares R-R interval
PARTS OF AN ECG SIGNAL
1. P wave
Atrial depolarization
0.11s or less
2. QRS Complex
Ventricular depolarization
3. T wave
Ventricular repolarization
4. PR interval
Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
SHOCK
Note: 1 small box is equivalent to 0.2 in large
box.
Abnormal Heart Rhythm
6-second method (complete QRS
complexes in a 6-second strip) x 10
6-second strip: 30 large boxes
Note: Normal Sinus Rhythm – regular rate and
rhythm; 60-100bpm.
DYSRHYTHMIAS
A cardiac dysrhythmia (arrhythmia) is an
abnormal or irregular heartbeat. The heart
might beat too fast or too slowly.
TYPES OF DYSRHYTHMIAS
1. ATRIAL FIBRILLATION
2. VENTRICULAR TACHYCARDIA
3. VENTRICULAR FIBRILLATION
4. AYSTOLE
5. PULSELESS ELECTRICAL ACTIVITY
Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
SHOCK
ATRIAL FIBRILLATION Ineffective quivering of ventricles, no atrial
An irregular and often very rapid heart rhythm. activity.
Can lead to blood clots in the heart.
300-600bpm
Rapid, disorganized, and uncoordinated
twitching of atrial musculature.
No P-wave
Heart Failure, MI, Stroke
VENTRICULAR TACHYCARDIA ASYTOLE
An emergency case, patient nearly always “FLATLINE”
unresponsive and pulseless. Absent QRS, no heartbeat, no palpable pulse,
100-200bpm no respiration.
Irregular interval Apparent P-waves for short duration.
Cardiac Arrest
Note: It is a state of cardiac standstill with no
cardiac output and no ventricular depolarization.
VENTRICULAR FIBRILLATION PULSELESS ELECTRICAL ACTIVITY
Rapid, disorganized, ventricular rhythm.
Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
SHOCK
PEA is a condition where you do not have a
pulse. Your heart stops, and you are in
cardiac arrest.
No detectable pulse.
TYPES OF DYSRHYTHMIAS (ECG SAMPLE)
Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
