Shadowing Practice: Types of Shock for Nursing | Shock NCLEX Tips Made Easy - Learn English Speaking with Video

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Hey guys, it's

Nurse Mike here from SimpleNursing .com.

Today we're breaking down the types of shock that you need to know for your nursing exams, from hypovolemic to cardiogenic and more.

We'll make it super simple, memorable, and easy to stick.

Plus, if you're a Simple Nursing member, be sure to grab your shock study guides to follow along.

Trust me, this is high -yield, top -tested stuff.

So, let's get started.

shock is a critical condition where the body has decreased tissue perfusion eventually leading to organ failure

and death the classic sign to know for your exams

and the enclex is low blood pressure

so the memory trick just think of the double s's s for shock we see severely low blood pressure

and so oxygen can't get to the organs leading to organ failure

and death now for the four stages of shock first is the initial stage

there's too little oxygen in the blood to feed the organs resulting in anaerobic metabolism meaning metabolism without oxygen

but the signs

and symptoms are absent in this stage now the second is compensatory stage

this is where the body is trying to compensate for

that low oxygen so the heart will pump faster going into tachycardia the respiratory rate will increase to get more oxygen,

so we see tachypenia, and the body compensates with the sympathetic nervous system to speed up the vital signs,

and the renin -angiotensin activation to maintain blood pressure and oxygenation to keep the organs perfused.

Now, as compensatory mechanisms fail, clients progress into the progressive stage.

Now, a key sign to know for your exams is cold and clammy skin.

This is priority.

Huge NCLEX tip.

So write that down.

This is an early sign that the body is lacking perfusion and getting worse.

Not being able to compensate anymore.

It's progressing into this progressive stage here.

So don't let the NCLEX trick you.

It's not low oxygen saturation and it's not tachycardia.

Those are compensatory as the body is trying to scramble for oxygen.

So cold and clammy skin is priority for progressive stage.

And the last stage is irreversible, basically meaning death is imminent.

For this part of the video, keep these study guides close by to help you make this knowledge actually stick.

Now there are five types of shock.

The number one most tested is septic shock, caused by widespread bloodborne infection.

Think sepsis infection causes septic shock.

Number two is neurogenic shock, caused by spinal cord injury, T6 or higher.

Number three is hypovolemic shock,

also called hemorrhagic shock, caused by blood loss from a trauma or even a gunshot wound or even from surgery or burns.

So just think blood loss for hypovolemic.

We have low blood volume.

And number four is cardiogenic shock, where the heart fails to pump, like an end -stage heart failure or heart failure exacerbation,

and even an MI heart attack, where we have weak heart muscles and a failed heart pump.

So for cardiogenic shock, just think the cardiac fails.

And lastly, number five is anaphylactic shock, from a severe allergic reaction, like from a bee sting,

or even from eating seafood or something you have an allergy to.

So for anaphylactic, think severe allergic reaction.

Now let's get into these one by one, starting with septic shock pathophysiology.

As mentioned before, this is from sepsis, that widespread blood -borne infection that overwhelms the body,

typically caused by a bacterial infection like pneumonia with an infection inside the lungs

or even a UTI or kidney infection that progressively gets worse and spreads into the bloodstream.

Whatever the cause, a systemic cytokine release inside the bloodstream causes extreme vasodilation and fluid leaking from the capillaries.

So the signs and symptoms include severely low blood pressure.

So once again, the memory trick just think s for shock is for severely

low blood pressure resulting in organ failure from the lack of perfusion

that lack of oxygen

now the key signs to know is obviously low blood pressure less than 80 systolic cool clammy skin

or pale and cool extremities with delayed capillary refill.

Write that one down.

Now, mental status change, huge NCLEX tip.

The big ones to know is confusion and disorientation.

These two signs are typically the result of hypoxemia, or basically meaning low oxygen perfusion,

and high WBC count, over 10 ,000, from the infection, and a temperature high in the initial stages,

and then very, very low, 96 degrees Fahrenheit.

Huge NCLEX tip, so write that down.

Many students get tricked on this since the early stages of the infection, the body's trying to fight off the infection with high core body temperatures.

But the septic shock progresses and very low core body temperature develops.

As well as the other signs too.

Pale, cool extremities, difficulty breathing, and decreased urinary output.

With mental confusion and disorientation, this develops very quickly in the late stages.

So you must report this to the HCP immediately.

Emergency treatment is necessary with intravenous fluids, antibiotics, and other medications.

But again, focus on the signs and symptoms that are bolded here, since these are the most tested.

Now for neurogenic shock.

This is from a spinal cord injury T6 or higher.

Make sure to know that for the NCLEX and your exams.

In neurogenic shock, the autonomic nervous system is damaged, resulting in a blockage of sympathetic nervous system,

which is supposed to speed up the vital signs and cause vasoconstriction.

So only the parasympathetic nervous system is intact, which puts the brakes on the vitals in the parasympathetic nervous system,

causing widespread vasodilation and hypotension.

So naturally, we see low and slow vitals, like a low and slow heart rate and blood pressure,

as vasodilation occurs, making it difficult for blood to return back to the heart.

This decreased blood flow back to the heart leads to decreased blood flow out of the heart,

basically decreased cardiac output, meaning less oxygenated blood out of the heart and to the body.

This results in poor tissue perfusion from the lack of oxygen and impaired cell metabolism,

resulting in organ failure and ultimately death.

So the key signs and symptoms to know for neurogenic shock, write this down, is bradycardia, huge NCLEX tip.

This is due to the parasympathetic dominance.

So just think parasympathetic puts the brakes on the vital signs.

So bradycardia results, and this is a very unique sign and symptom.

Unlike other types of shock where the heart rate increases with tachycardia due to compensation,

in neurogenic shock, the sympathetic nervous system is blocked, resulting in this bradycardia.

So Saunders mentions, a client is admitted to the hospital with a diagnosis of neurogenic shock after a traumatic motor vehicle collision.

Which manifestation best characterizes this diagnosis?

bradycardia.

So the top three signs to know for neurogenic shock is obviously number one, a low heart rate, bradycardia less than 60 beats per minute.

So write that one down.

Number two is a low blood pressure, hypotension, less than 80 systolic.

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And number three, skin that is warm, pink, and dry.

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Huge NCLEX tip right there.

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So make sure to write that one down as well.

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This is mainly from the vasodilation as blood can't return to the heart and ends up pooling inside the body.

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Now interventions for neurogenic shock, the priority here is IV normal saline or 0 .9 % sodium chloride.

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We have to do this immediately to perfuse the tissues.

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Our goal here is to increase the blood pressure and stabilize it in order to perfuse the body.

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Now for the complications.

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A little side note here.

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A deadly complication for any spinal cord injury above T6 is autonomic dysreflexia.

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Now, we have a full video on this, but just to remind you, we see severe hypertension that can kill the client,

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typically triggered by a full bladder, constipation, or tight -fitting clothes, basically anything with constriction.

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Thus, placing a Foley in spinal trauma patients to keep the bladder empty

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and offering laxatives and loose clothes can usually save a client with T6 injury or higher.

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But once again, we cover that in the full video for autonomic dysreflexia.

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Now switching gears to hypovolemic shock.

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This is caused by anything that can lower the blood volume.

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So think hypo for low blood or low fluid volume.

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Typically from excess fluid volume loss through diarrhea, vomiting, or fluid shifts in burn patients.

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And as mentioned before, from bleeding or hemorrhaging.

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From a trauma like a gunshot or knife injury.

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Or even from surgery where we get too much blood loss and even GI bleed.

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Whatever the cause, the signs and symptoms are typically the same.

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So the key point to write down is cold, clammy skin.

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This is priority.

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Huge NCLEX tip.

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As mentioned before, this is seen in the progressive stage and is indicating that the client is getting worse.

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So you must notify the healthcare provider immediately and get some IV normal saline started quickly.

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So the top three signs to know that our classic indications of hypovolemic shock is number one, hypotension.

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Just like with any shock, we see severely low blood pressure, less than 80, cystoic.

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Number two is tachycardia, due to the compensatory mechanisms to maintain the cardiac output and perfusion.

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And number three is a low central venous pressure, normally between 2 and 6.

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So anything less than 2 typically means your client is through.

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Now another classic sign of hypovolemic shock is a low urinary output, due to the fluid volume loss.

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So just think, 30 mLs per hour or less means the body is in distress.

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So Kaplan mentions, which vital sign would alert the nurse to potential hemorrhage following a nephrectomy, or basically kidney removal?

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A heart rate of 110.

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Yes, that's tachycardia over 100 beats per minute.

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Now as far as the interventions, the priority is hemodynamic stability.

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Fancy words for getting that blood pressure up.

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So number one, we have to lower the head of the bed right away.

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Huge NCLEX tip right there.

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So write that down.

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We do this to bring blood flow back to the brain and the core of the body.

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So never place the head of the bed in high

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Fowler's position or place the head of the bed up.

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Don't let the NCLEX trick you here.

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This will worsen the low blood pressure and cause even worse hypotension, dropping the blood pressure even more.

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So the memory trick, put the head low in hypovolemic or hypotension to prevent further hypotension there.

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And number two is IV normal saline or 0 .9 % sodium chloride.

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We do this before vasopressor medications.

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This is a huge key point right here as the fluid bolus will increase intravascular volume

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and increase blood pressure and perfused tissues.

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Then only after, then we give the vasopressors like IV norepinephrine and dopamine.

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Always use second, as these vasopressor drugs mainly press on the vessels to press up the vitals.

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They do this by increasing blood flow back to the heart to increase the blood pressure.

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So again, the key point is to give normal saline first

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so that the vasopressors can press that added fluid back to the heart.

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Now, initially, the vital signs will improve from the normal saline, but it won't last.

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So that's why we do norepi and dopamine.

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This is definitely needed to maintain the blood pressure for long term.

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Now, another key point here.

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This one's really critical.

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Do not delay a new bag of norepinephrine when the first bag is almost done.

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Huge NCLEX tip.

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Even if the client is showing signs of improvement with stabilized blood pressure, this is expected initially.

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But it won't last long term.

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So remember, do not delay a new bag of norepinephrine when the first one's almost done.

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Now the goal here is to maintain MAP, that mean arterial pressure,

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over the key number 65 mmHg which means

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that the average blood pressure all over the body is adequate for tissue perfusion

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or in other words to oxygenate the body and keep the organs alive.

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Now another thing CVP central venous pressure as mentioned before it should be maintained between two to six millimeters of mercury.

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Less than two means your client is through.

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Basically they need more fluids

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And over six needs a fix.

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They have too much fluid here.

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So the client needs some diuretics to drain some of that fluid from the body and into the potty.

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So Saunders mentions, a client in shock develops a central venous pressure of less than two.

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Which prescribed intervention should the nurse implement first?

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Increase the rate of intravenous fluids.

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Yes, less than two, your patient is through.

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So increase those fluids.

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and lastly since vasopressors cause narrowing of blood vessels by pressing

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on the vessels the pulse oximeter is often not accurate

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when placed on the finger as blood flow is shunted away from the extremities toward the core of the body

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so be sure to write

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this down for the spo2 the sensor should be placed on

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the forehead instead of the extremities since there will be lack of perfusion there next

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Next is cardiogenic shock.

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As mentioned before, the heart fails to pump blood out of the heart to the body.

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Like in a heart attack, where heart muscles die, or even heart failure exacerbation, where the heart fails to pump.

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So again, think cardiogenic shock as the cardiac fails.

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And just like with any shock, we see a severe drop in blood pressure.

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Remember, this one is always the most tested.

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Saunders mentions, A client having a myocardial infarction, based on the elevated troponin levels,

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the nurse should alert the HCP because the vital sign changes are most consistent with which complication.

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Refer to the exhibit.

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So cardiogenic shock, we have a cardiac problem.

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And the question mentions a heart attack, an MI, or myocardial infarction.

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So MI think heart tissues die.

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The heart fails to pump adequately.

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So just look at the blood pressure here when clicking on the exhibit.

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The lower and lower it goes indicates that we have a cardiogenic shock problem.

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Severely low blood pressure with any type of shock.

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So the key treatment to help out our failed heart pump is the double D's here.

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Dopamine and digoxin, which both have inotropic properties, meaning it helps the heart to pump more forcefully.

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So just think, inotropic is very forceful.

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Kind of like when you know the answer to something.

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You're like, I know the answer.

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It's very, very forceful.

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So inotropic means a forceful contraction.

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Now D for dopamine is also a vasopressor

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which presses down the vessels in vasoconstriction to press up the heart rate and blood pressure.

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But a big caution here.

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Our vasopressors can work too well and may cause adverse effects.

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Like tachycardia, a heart rate over 100 beats per minute, which is a huge NCLEX tip, so write that one down, as well as arrhythmias.

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But really, the most tested here was tachycardia.

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Typically means that the dose may need to be lowered.

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And the next D is for digoxin.

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Just think, digoxin digs for a deeper contraction here especially for our clients

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in heart failure who have a failed heart pump with a weaker contraction.

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And Saunders mentions, A client with heart failure exacerbation and suspected state of shock,

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the nurse knows which intervention is priority for this client.

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Administration of digoxin.

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Yes, we need a dig for that deeper contraction.

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And lastly here, Anaphylactic shock our severe allergic reaction.

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Like from a bee sting or even a peanut allergy, again, anaphylactic shock, we have that severe allergic reaction.

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The key treatment to know for the NCLEX, and write this down, epinephrine or epi -auto -injector.

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We have to know this and the key points, so let's play a segment from our pharmacology master course.

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For this lecture, we're talking about anaphylaxis, that severe allergic reaction.

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We give an EpiPen or aka auto -injector to inject straight into the outer thigh for an IM injection,

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typically after severe allergic reactions, for example, a bee sting or food allergies.

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Say we're eating shellfish with an allergy, the client goes into an anaphylactic shock, resulting in deadly hypotension and bronchoconstriction,

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which inevitably leads to death via cardiac and respiratory arrest.

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so the key points to know hesse mentions epi is the first drug used for anaphylaxis

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and ati backs this up by saying first signs of anaphylaxis reaction those hives dyspnea

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and hypotension we use an epi pen

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so the key term here to know is it's the first drug for the first sign of anaphylactic reaction

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we always use epi first now two big enclex tips we repeat every 5 to 15 minutes

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if the signs and symptoms continue and we repeat epi until the signs

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and symptoms resolve so we keep on repeating epi until those signs

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and symptoms go away then we give the other medications

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and in the enclex world we just keep on giving this drug forever until those symptoms resolve Thank you.

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Now, how do you know if it's a supersized anaphylactic reaction and not just a mild allergic reaction?

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Well, any allergy that affects the ABCs, the airway, breathing, and circulation,

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or even induces hives, this is deadly anaphylaxis, the supersized allergy reaction.

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So again, don't delay epi injection.

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We inject immediately upon these signs and symptoms.

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And no skin prep is necessary.

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Just stab that outer thigh straight through the pants and hold it there for about 10 seconds.

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So the correct medication sequence is epi first, then diphenhydramine, or basically Benadryl, and lastly, albuterol and steroids.

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But out of all these, most question banks only stress about epi being that first drug during anaphylaxis.

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And the rest, only after the acute signs and symptoms have resolved.

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Remember, we repeat epi as a priority until those signs and symptoms resolve.

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Now, Kaplan mentions a patient scenario.

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Administration of ampicillin and the client reports itchiness and difficulty breathing.

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The priority actions is number one, stop the infusion that's causing the problem number two you assess by auscultating the lungs

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or listening to the lungs and number three you prepare to administer epinephrine first

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so again not steroids not albuterol it's always epi first

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and secondly the capman mentions effective management of shock you have a bp that's a little bit high apical pulse

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that is 99 and a cap refill that's less than two seconds guys this indicates good perfusion,

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meaning epi is doing its job to press on the veins as a vasopressor.

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So it's pressing those vital signs up.

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And speaking of, normal expected side effects to know after giving this medication.

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Tachycardia, that heart rate over 100, palpitations, and dizziness.

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Again, these side effects means that epi is doing its job to prevent that shock, or basically that death from low blood pressure.

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Now for patient education, how to use the EpiPen, the three big key points here.

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Number one, we inject into the outer thigh at a 90 degree angle on the onset of symptoms.

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So Hesse mentions we stab the pen into the outer thigh and we hold it in place for about 10 seconds.

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So not five seconds, not three seconds, but a full 10 seconds here.

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Now number two is we seek immediate medical attention after use.

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So go to the hospital.

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Don't wait since epi wears off in about 10 to 20 minutes and signs and symptoms may return.

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Lastly, number three, this is a big one here.

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Store epi pens in a dark place at room temperature.

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So not too cold, not too hot.

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So not in a refrigerator and not in a car, since this medication can be deactivated by heat and light.

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And don't forget to subscribe to our YouTube channel.

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Happy studying, and we'll see you in the next videos.

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Woordenschat en spreektips bij deze les

Deze spreekles is gebaseerd op de video “Types of Shock for Nursing”. Deze woorden komen het vaakst terug: shock, blood, sign, pressure, client. Deze video bevat 285 zinnen en 3385 woorden om na te spreken. Het gesproken deel duurt 23:51. De spreker praat in een gelijkmatig tempo van ongeveer 142 woorden per minuut, prettig om te shadowen. Slechts 75% van de woorden hoort bij de 3.000 meest gebruikte Engelse woorden, dus de woordenschat is pittig.

Belangrijke woorden in deze video

15 woorden uit de video die het leren waard zijn, met uitspraak en betekenis:

Woord	Uitspraak	Betekenis
shock zelfstandig naamwoord	/ʃɔk/	schok, shock
symptom zelfstandig naamwoord	/ˈsɪm(p)təm/	symptoom
fluid zelfstandig naamwoord	/ˈflu.ɪd/	fluïdum, vloeistof
vital bijvoeglijk naamwoord	/ˈvaɪtəl/	levens-
oxygen zelfstandig naamwoord	/ˈɑksɪd͡ʒən/	zuurstof
nurse zelfstandig naamwoord	/nɝs/	verpleegkundige
infection zelfstandig naamwoord	/ɪnˈfɛkʃən/	infectie, infectering
pump zelfstandig naamwoord	/pʌmp/	pomp
priority zelfstandig naamwoord	/pɹaɪˈɒɹɪti/	voorrang, prioriteit
organ zelfstandig naamwoord	/ˈɔːɡən/	orgaan
allergic bijvoeglijk naamwoord	/əˈlɝ.d͡ʒɪk/	allergisch
tissue zelfstandig naamwoord	/ˈtɪʃ.(j)u/	weefsel
medication zelfstandig naamwoord	/mɛdɪˈkeɪʃən/	medicatie
decrease werkwoord	/dɪˈkɹiːs/	afnemen, verminderen
allergy zelfstandig naamwoord	/ˈæl.əɹ.d͡ʒi/	allergie

Phrasal verbs die je zult horen

Woord	Betekenis
break down werkwoord	stukgaan, kapot gaan
end up werkwoord	belanden, terechtkomen
go away werkwoord	weggaan
write down werkwoord	opschrijven, neerschrijven

Grammatica in deze video

De structuren die de spreker het meest gebruikt, met de exacte woorden uit de video:

Structuur	In de video
Lijdende vorm be + voltooid deelwoord — het gaat om wat er gebeurt, niet om wie het doet	are bolded · is damaged · is blocked
Present perfect have/has + voltooid deelwoord — iets uit het verleden dat nu nog telt	has decreased · have resolved
Betrekkelijke bijzinnen who / which + zin — extra informatie over een persoon of ding	mmHg which means · minute, which is

Uitspraak om op te letten

De spreker gebruikt 18 samentrekkingen en verkorte vormen, zoals don't, we're, can't. Spreek ze kort uit, zoals je ze hoort.

De “th”-klanken: thigh /θaɪ/, breathe /bɹiːð/, sympathetic /ˌsɪm.pəˈθɛt.ɪk/, parasympathetic /ˌpɛɹ.ə.sɪm.pəˈθɛt.ɪk/
De klanken “sh” en “zh”: shock /ʃɔk/, infection /ɪnˈfɛkʃən/, tissue /ˈtɪʃ.(j)u/, medication /mɛdɪˈkeɪʃən/, intervention /ɪntɚˈvɛnʃən/
Lange woorden — let op de klemtoon: priority /pɹaɪˈɒɹɪti/, medication /mɛdɪˈkeɪʃən/, intervention /ɪntɚˈvɛnʃən/, sympathetic /ˌsɪm.pəˈθɛt.ɪk/, metabolism /məˈtæb.əˌlɪz.əm/

Klanken die Nederlandstaligen lastig vinden:

Stemhebbende eindmedeklinker — /b/, /d/, /g/, /z/, /v/ niet verscherpen: fluid /ˈflu.ɪd/, progressive /pɹəˈɡɹɛsɪv/, resolve /ɹɪˈzɑlv/, widespread /ˌwaɪdˈspɹɛd/, cord /ˈkoɹd/
/æ/ — opener dan de Nederlandse “e”: cardiac /ˈkɑɹdiˌæk/, lastly /ˈlæstli/, allergy /ˈæl.əɹ.d͡ʒi/, exam /ɪɡˈzæm/, metabolism /məˈtæb.əˌlɪz.əm/
/g/ — een harde plofklank, geen Nederlandse “g”: organ /ˈɔːɡən/, progressive /pɹəˈɡɹɛsɪv/, exam /ɪɡˈzæm/, diagnosis /daɪəɡˈnəʊsɪs/, exhibit /ɪɡˈzɪbɪt/

Zo oefen je met deze video

Luister de hele video één keer zonder te spreken en noteer de woorden die je niet kent.
Spreek zin voor zin na op normale snelheid en herhaal elke zin tot je ritme gelijk is aan dat van de spreker.
Neem jezelf op en vergelijk met het origineel; let daarbij op woorden als shock, symptom, fluid.

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Shadowing Practice: Types of Shock for Nursing | Shock NCLEX Tips Made Easy - Learn English Speaking with Video

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Woordenschat en spreektips bij deze les

Belangrijke woorden in deze video

Phrasal verbs die je zult horen

Grammatica in deze video

Uitspraak om op te letten

Zo oefen je met deze video

Wat is de Shadowing-techniek?