Case: Mrs. LaRue
Mrs. LaRue, a 19-year-old woman with no previous medical history, was involved in a serious automobile accident in which her best friend died. Examination by EMT personnel first on the scene revealed she had only minor scrapes and bruises and no sign of head trauma. While en route by ambulance to the hospital, Mrs. LaRue complained of thirst and appeared restless. Further examination indicated a rapid pulse and respirations, with her blood pressure now at 100/60 mm Hg. She appeared less responsive to the paramedics. She was slipping into circulatory shock as they checked her again for internal injuries. NUR 265 Advanced Med Surge 2 (Shock) Questions
Question 1
Discuss the contributing factors to shock in this case and the pathophysiologic changes causing the changes in vital signs.
Mrs. LaRue was going in to shock due to the motor vehicle accident, and internally bleeding. The patient’s respirations and pulse started to increase indicating hyperventilation, and her blood pressure changing. There has been low perfusion of blood to tissues.
Question 2
Discuss the signs and symptoms of shock, including the rationale for each, as seen in the early stage, and as compensation mechanisms respond.
Signs and symptoms of shock include rapid breathing and shortness of breath due to hypoxia (no oxygen to tissues in the body). Another sign of shock is loss of consciousness and pale skin, no perfusion to the brain will cause confusion.
Question 3
Discuss emergency and follow-up treatment for shock and for complications that may arise if not treated quickly.
Hypovolemic shock is an emergency, this requires immediate emergency medical attention. In this type of shock you lose more than 20% of your body blood or fluid supply. This severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood to the body and can lead to organ failure. Bleeding from cuts or wounds, traumatic injuries due to accidents, internal bleeding, bleeding from digestive tract, severe burns, excessive diarrhea and significant vaginal bleeding can all lead to hypovolemic shock.
If shock is untreated it will lead to death, the person must lie flat with feet elevated. It is important to refrain from moving to the person if you suspect head, neck or back injury, keep them warm and do not give them fluids by mouth.
Question 4
Compare the types of shock, giving a specific cause, classification, and any significant changes in onset or manifestations.
Cardiogenic shock: Happens when the heart is damaged and unable to supply sufficient blood to the body. End result of heart attack or heart failure.
Hypovolemic shock: too little blood volume in the body. Severe fluid loss from traumatic bodily injury.
Anaphylactic shock: caused by allergic reaction. Allergy to insect stings, medicines, or foods.
Septic Shock: due to infections. Results from bacteria multiplying in the blood and releasing toxins.
Neurogenic shock: caused by damage to nervous system, spinal cord injury.
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