Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Shock States (Anaphylactic, Hypovolemic)
Definition/Etiology:
- Definition
- Circulatory failure
- Poor Perfusion = tissue/organ ischemia = Anoxia
- Impaired cellular metabolism = organ dysfunction
- Death
- Circulatory failure
- Etiology – Think of a gas station
- Anaphylactic – Vascular loses fluid (Leaking Gas Hose)
- Contrast media
- Medication reactions
- Blood transfusion reactions
- Food allergies
- Insect bites or stings
- Snake bites
- Hypovolemic Shock = Fluid loss (No Gasoline)
- Bleeding
- Vomiting
- Diarrhea
- Burns
- Third-Spacing
- Anaphylactic – Vascular loses fluid (Leaking Gas Hose)
Pathophysiology:
- Anaphylactic Shock
- Impaired tissue perfusion resulting from antigen-antibody reaction that releases histamine into the bloodstream.
- Capillary permeability increases, and arteriolar dilatation occurs.
- SVR falls. Blood return to the heart is decreased dramatically. Hypotension results
- Hypovolemic Shock
- Impaired tissue perfusion resulting from severely diminished circulating blood volume
- SVR increases to TRY to return blood to the heart, but there is no blood/fluid there.
Noticing: Assessment & Recognizing Cues:
- All Shock leads to MODs from lack of Perfusion
- ↑HR, ↓BP,
- ↓ Cardiac Output + ↓ urine output
- Anaphylactic Shock
- Brain
- ↓ LOC
- Skin
- Rash/hives, itching, flushed, warm skin
- Lungs
- Bronchospasm: Stridor wheezing
- Brain
- Hypovolemic Shock
- Brain
- Syncope
- Skin
- Pale Cool and Clammy
- Signs of Bleeding
- Poor capillary refill
- Collapsed neck veins
- Brain
Interpreting: Analyzing & Planning:
- Labs – Reflect Shock + Organ damage
- ABGS
- Metabolic Acidosis
- anaerobic metabolism by hypoxia
- Respiratory Alkalosis
- Compensation from breathing fast
- Metabolic Acidosis
- Serum Lactate
- Greater than 4
- Blood Count & Fibrinogen – Hemorrhage
- BUN/creatinine – Kidney damage
- ABGS
- Diagnostics
- ECG – Electricity
- Arrhythmias
- CXR
- Pulmonary Edema/Effusion
- ECG – Electricity
Responding: Patient Interventions & Taking Action:
- ABCs Shock Stabilization
- Optimize 02 delivery
- Mask → Ventilator
- Keep Normothermic
- Shivering ↑ 02 demand
- Non-invasive Hemodynamics (PCCN Level)
- MAP
- Keep >60
- CVP
- Normal 2-6
- Should increase with fluids
- MAP
- Anaphylactic Shock
- Epinephrine
- Bronchodilators
- Steroids
- Hypovolemic Shock
- Volume Replacement
- Massive Transfusion Protocol
- plasma, platelets, and clotting factors
- Prevents clotting issues
- Massive Transfusion Protocol
- Volume Replacement
- Optimize 02 delivery
Reflecting: Evaluating Patient Outcomes:
- Airway/Breathing
- Sufficient oxygenation is provided
- Pulmonary congestion is decreased
- Hemodynamics/Circulation
- MAP is increased to adequately perfuse tissues and vital organs.
- BP and pulse are within normal limits for the patient.
- Fluid and electrolyte balances are maintained
- Intake and output are balanced
Linchpins (Key Points):
- Notice -Objective/Subjective Cues ↓ Perfusion
- Interpret – Labs/Diagnostic (Anaphylaxis vs Hypovolemia)
- Labs can differentiate (CRP vs H/H)
- Respond
- Hemodynamics
- Treating underlying cause
- Wheezes = Bronchospasms
- Bleeding = Fluids
- Reflect
- MAP & Urine Output
Transcript
References
- AACN, & Hartjes, T. (2023). AACN Core Curriculum for Progressive and Critical Care Nursing (8th ed.). Elsevier Health Sciences (US).
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2017). Ace The Pccn®!: You can do it!: Practice question review book. Nicole Kupchik Consulting, Inc.
- Stone, L. M. (2018). Certification and Core Review for High Acuity, Progressive, and Critical Care Nursing (7th ed.). Elsevier Health Sciences (US).
- Trivium Test Prep. (2019). Pccn review book 2019-2020: Pccn Study Guide and Practice Test Questions for the Progressive Care Certified Nurse Exam.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System