Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)

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Outline

Definition
- Circulatory failure
  - Poor Perfusion = tissue/organ ischemia = Anoxia
  - Impaired cellular metabolism = organ dysfunction
  - Death
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 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.

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
Hypovolemic Shock
- Brain
  - Syncope
- Skin
  - Pale Cool and Clammy
- Signs of Bleeding
  - Poor capillary refill
  - Collapsed neck veins

Labs – Reflect Shock + Organ damage
- ABGS
  - Metabolic Acidosis
    - anaerobic metabolism by hypoxia
  - Respiratory Alkalosis
    - Compensation from breathing fast
- Serum Lactate
  - Greater than 4
- Blood Count & Fibrinogen – Hemorrhage
- BUN/creatinine – Kidney damage
Diagnostics
- ECG – Electricity
  - Arrhythmias
- CXR
  - Pulmonary Edema/Effusion

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

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

When you start a FREE trial you gain access to the full outline as well as:

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.