Abstract
Nursing shock patients in the Intensive Care Unit entails medication accuracy and critical judgment to save the lives of the patients. As such it is important to know the nature, pathophysiology and types of shock, which are named as hypovolemic, cardiogenic, neurogenic, and distributive tasks. Also it is important to know the roles of ICU nurses in the health care service for the shock patients, from the time the patient is sent to the ICU up to the monitoring and communication with the relatives of the patients. This paper is intended for a qualitative literature review which follows ethical and reliability standards,
Key Words: Shock, ICU, Critical Care, Nursing Practice
Introduction
Nursing of patients in the Intensive Care Unit is one of the most critical tasks assigned in a hospital setting because every situation inside is a matter of life and death, As such, nurses have to move with utmost care and precision to avoid worsening the condition of the patients. Among the most critical conditions include patients who are in state of shock. Thus, it is important for the nurses to know the different types of shock, their nature, as well as the etiology and pathophysiology of each one of the condition.
Abstract 2
Introduction 2
Objectives 3
Presentation of Theoretical Basis 3
Hypovolemic Shock 4
Cardiogenic Shock 4
Neurogenic Shock 5
Distributive Shock 5
Nursing Practice in the Intensive Care Unit 5
Method of Implementation and Ethicalness 7
Reliability 7
References 8
Objectives
Generally, there are four considered types of shock, and all of them are classified as highly fatal when not treated properly. In order to know more about the every types of shock, this paper will discuss, in details, the different types of shock: hypovolemic, cardiogenic, neurogenic, and distributive. Furthermore, this paper will also discuss how nurses administer the health care service for the patients.
Presentation of the Theoretical Basis
One main point of the thesis is to be able to familiarize its readers about the concept of shock, as well as to define the characteristics of the different types in terms of etiology and pathophysiology. As such, it is important to orient the readers about this topic as well as how nurses treat their patients considering the type of shock in which the patient is suffering. The definition of the concepts must be presented so that readers will be guided all throughout the research paper. Knowing the importance of the nature of the different types of shock is important in terms of applying the most suitable type of remedy that will be used on the patient.
Hypovolemic Shock
Hypovolemic shock is a result of having a relatively low volume of blood circulating the body, which might have been caused by conditions that indicate a significantly high blood loss, either due to internal or external bleeding (Kelley 2005). The intensity of the shock is dependent on how much blood was lost inside the patient’s body. Early signs of hypovolemic shock might include signs of anxiety in the form of disgust or depression. Furthermore, the condition can also be associated with low blood pressure and narrowing of blood vessels, or the so-called vasoconstriction (Kelley 2005). In worst case scenarios, hypovolemic shock may lead to comatose, as well as lowered volume of circulating blood, which might decrease to as low as 30 percent of the normal volume of circulating blood (Kelley 2005)
Cardiogenic Shock
Cardiogenic shock is often associated with having the systolic blood pressure reading to be at most 90 mm Hg, which means that the individual might be suffering from a lowered blood pressure (Tehrani, Malik, & Hausenloy 2013). However, it is not a significant indication of the disease because persons who experienced cardiogenic shock have wide varieties of symptoms. Despite the variation, it can also be said that the condition is linked with heart failure because there is a study that showed that heart failure affects the systolic blood pressure of the patients 50 percent of the time. Besides heart failure, other significant signs of cardiogenic shock include low urine production and sinus tachycardia (Tehrani, Malik, & Hausenloy 2013). Further into the details, the presence of high levels of nitric oxide synthase expression cause the increase of white cells and C reactive protein (CRP). As a result, patients are in high risks of necrosis and multiple organ failure (Tehrani, Malik, & Hausenloy 2013).
Neurogenic Shock
Neurogenic shock is a result of previous spine injury. As a result, the sympathetic pathways are affected, resulting to a decreased systematic vascular resistance and vasodilation (Mack 2013). Neurogenic shock often results to hypotension, which gives the patients higher risks or recurring spinal injury in the future. Some indications of neurogenic shock include low blood pressure and bradycardia. In terms of physical manifestations, the skin is described as warm and flushed, which might result to hypothermia due to high possibility of heat loss (Mack 2013). Moreover, a series of alternating hypertension and hypotension is more likely to occur as an aftermath of the spinal cord injury (Mack 2013).
Distributive Shock
Distributive shock, commonly known as septic shock or sepsis is one of the most fatal diseases among hospital patients (Qureshi & Rajah, 2008). The reason as to why it has a high mortality rate is due to the complexity of the condition, which makes it difficult for physicians to identify the cause and the treatment that is suitable for curing the patients. Sepsis targets the immunity system of the individual. Afterwards, inflammation will happen as response for fighting the foreign matter infecting the immune system. From this inflammation, various complications in different body organs will happen due to excessive production of immune responses (Qureshi & Rajah, 2008). Due to this development, a coagulation of the chemicals and minerals inside the body will happen, and this will result to more active inflammation and multiple organ failure, and eventually, sepsis (Qureshi & Rajah, 2008).
Nursing Practice in Intensive Care Unit
Knowing the nature of the condition, what comes next is the familiarization of nursing practices in the Intensive Care Unit where patients with severe shock conditions are brought. Aside from having the sufficient knowledge about the nature of shock, it is also important to have a presence of mind and good managing skills, especially in dealing with patients along the line of life and death.
After being diagnosed with severe shock conditions, patients will be sent into the ICU and will be left into the care of the nurses. As for the ICU nurses, their role is to provide sufficient support and needed health care service in order to control shock. They are the ones responsible for monitoring the progress of the patients and the disease as well. During the first three hours of severe occurrence of sepsis, nurses are responsible for measuring the lactate level and obtaining blood test results. This is done with the purpose of identifying the suitable antibiotics for the patient. Also, nurses must administer crystalloids to control hypotension and lactation (Harrison 2013).
As for the next six hours, nurses will apply vapopressors to patients whose hypotension was not alleviated during resuscitation. If hypotension still persists, nurses will measure venous pressure and oxygen levels. Within this hour, nurses are required to measure the lactate level of the patients to track its progress (Harrison 2013). Aside from these tasks, nurses are also responsible for continuous monitoring of the patients, as well as the maintenance of hygiene and regular communication with the relatives about the patient’s condition.
Though the study will focus on the nursing practices and the concept of shock, there are certain limitations that are needed to be emphasized. First is that the treatment stated is generalized for all types of shock conditions. This means that the efficiency of the nursing practice will be relatively lower than dealing with patients on a case to case basis. Second is that the study relies only on past researches, and even though the articles used are recently published, the data that will be gathered in hospital will be different compared to the ones gathered through literature review. This implies that the results may diverged from the practical and realistic basis considering that the approach of the research is theoretical in nature.
Method of Implementation and Ethicalness
The research will be a qualitative literature review of related studies. The research materials that will be used will come from online journals and library, and will be analyzed through a systematic literature review of the research materials. This is the method chosen because it will provide accurate insights about the condition and a suitable conclusion can also be made due to the reliability of data. Also, this will save time for the researchers from gathering data directly from the hospital because direct data gathering will require more permits and consent from the physicians and the relatives alike.
As for ethical issues, the results will be reported with complete honesty and objectivity so that bias will be avoided. Proper credits will be given to the original authors of the articles that will be used so that plagiarism will be avoided. Finally, the data will be assured to be high quality and will avoid misleading information and contradicting contents.
Reliability
References
Harrison, P., 2013, ‘Nurses Critical to Implementing New Sepsis Guidelines’, Medscape, viewed 5 March 2016, from http://www.medscape.com/viewarticle/804630#vp_2
Kelley, D., 2005, ‘Hypovolemic Shock: An Overview’, Critical Care Nursing Quarterly 28(1), 2-19.
Mack, E., 2013, ‘Neurogenic Shock’, The Open Pediatric Medicine Journal 7, 16-18.
Qureshi, K., & Rajah, A., 2008. ‘Septic Shock: A Review Article’, British Journal of Medical Practices 1(2), 7-12
Tehrani. S., Malik, A., & Hausenloy, D., 2013, ‘Cardiogenic shock and the ICU patient’, The Intensive Care Society 14(3), 235-243.
