basic nursing knowledge: post #628 — TG.ME

Night Dose Topic: SHOCK (Critical Care Nursing) 📘 Full concept + clinical points + exam focus + easy to revise at night Night Dose – SHOCK (Critical Care Nursing) 💉 For NORCET 10 | NCLEX-Level | High-Scoring Concept 🩸 1️⃣ Definition ➡️ Shock = Inadequate tissue perfusion → cellular hypoxia → organ dysfunction. 🧠 Key Mechanism: ↓Circulating volume or ↓Cardiac output → ↓O₂ delivery → Anaerobic metabolism → Lactic acidosis. 💡 2️⃣ Types of Shock Type Primary Cause Key Signs Example Hypovolemic Fluid/blood loss ↓BP, ↑HR, ↓Urine Hemorrhage, burns Cardiogenic Pump failure Crackles, ↑CVP, weak pulse MI, arrhythmia Distributive Vasodilation → ↓Resistance Warm skin, ↓BP Septic, Anaphylactic, Neurogenic Obstructive Physical block to flow Distended neck veins, muffled heart Cardiac tamponade, PE ⚙️ 3️⃣ Stages of Shock 1️⃣ Initial: ↓O₂ → anaerobic metabolism → lactic acidosis. 2️⃣ Compensatory: SNS activation → tachycardia, vasoconstriction. 3️⃣ Progressive: ↓BP, ↓CO, altered LOC, acidosis worsens. 4️⃣ Irreversible: Multiorgan failure → death. 🩺 Goal: Detect before progressive stage! --- 🧬 4️⃣ Key Parameters to Monitor Parameter Normal Shock Finding MAP 70–105 mmHg <65 mmHg = poor perfusion Urine Output ≥0.5 mL/kg/hr ↓ indicates hypoperfusion CVP 2–8 mmHg ↓ = Hypovolemia; ↑ = Cardiogenic Lactate <2 mmol/L >4 = severe shock --- 💊 5️⃣ Management Principles (ABCDE) A – Airway: Secure, give high-flow O₂ B – Breathing: Monitor SpO₂, ABG C – Circulation:  - Rapid IV crystalloids (NS, RL)  - Vasopressors if MAP < 65 (Norepinephrine 1st choice) D – Disability: Assess LOC (GCS) E – Exposure: Identify cause (bleed, allergy, sepsis) 💉 IV Access: 2 large-bore cannulas ⚡ Avoid Trendelenburg (may impair breathing) 💉 6️⃣ Drug Focus Drug Use Key Nursing Point Norepinephrine Septic shock Titrate to MAP ≥ 65 Dopamine Cardiogenic shock Watch arrhythmia Dobutamine Low CO with adequate BP Inotrope effect Epinephrine Anaphylactic shock IM 0.3–0.5 mg mid-thigh Hydrocortisone Refractory septic shock Check glucose, infection 🧠 7️⃣ Nursing Priorities ✅ Monitor vital signs & hemodynamics continuously ✅ Measure urine hourly (insert Foley) ✅ Maintain normothermia ✅ Prevent infection (asepsis) ✅ Reassess after each fluid bolus ✅ Educate: early reporting of chest pain, SOB, dizziness 📈 8️⃣ Diagnostic Clues (Exam Focus) Septic Shock: Warm skin → Cold, mottled later Anaphylactic: Stridor, hypotension, rash Cardiogenic: Crackles, ↑CVP, weak pulse Neurogenic: ↓HR + ↓BP (only shock with bradycardia) Obstructive: JVD + muffled heart (Beck’s triad in tamponade) 🩺 9️⃣ Formula to Remember MAP = (DBP × 2 + SBP) ÷ 3 👉 Maintain MAP ≥ 65 mmHg ✨ 10️⃣ Quick NCLEX/NORCET Points Best indicator of perfusion: Urine output First sign of shock: Tachycardia Late sign: Hypotension In shock → never give vasopressors without fluids first Warm shock → septic; Cold shock → cardiogenic/hypovolemic Epinephrine = drug of choice for anaphylaxis 💭 “In Critical Care, seconds save lives — and knowledge gives speed.”