ฝึกพูดภาษาอังกฤษด้วยเทคนิค Shadowing จากวิดีโอ: Types of Shock for Nursing | Shock NCLEX Tips Made Easy

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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.

100

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.

144

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

157

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.

177

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

178

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?

180

Increase the rate of intravenous fluids.

181

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

184

on the vessels the pulse oximeter is often not accurate

185

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

186

so be sure to write

187

this down for the spo2 the sensor should be placed on

188

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

189

Next is cardiogenic shock.

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

191

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

192

So again, think cardiogenic shock as the cardiac fails.

193

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

194

Remember, this one is always the most tested.

195

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

196

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

197

Refer to the exhibit.

198

So cardiogenic shock, we have a cardiac problem.

199

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

200

So MI think heart tissues die.

201

The heart fails to pump adequately.

202

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

203

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

204

Severely low blood pressure with any type of shock.

205

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

206

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.

208

Kind of like when you know the answer to something.

209

You're like, I know the answer.

210

It's very, very forceful.

211

So inotropic means a forceful contraction.

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Now D for dopamine is also a vasopressor

213

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

214

But a big caution here.

215

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

216

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.

217

But really, the most tested here was tachycardia.

218

Typically means that the dose may need to be lowered.

219

And the next D is for digoxin.

220

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

221

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

222

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

223

the nurse knows which intervention is priority for this client.

224

Administration of digoxin.

225

Yes, we need a dig for that deeper contraction.

226

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.

230

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.

233

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

234

which inevitably leads to death via cardiac and respiratory arrest.

235

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

237

and hypotension we use an epi pen

238

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

241

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

243

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

244

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

245

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

246

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.

251

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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Thanks for watching.

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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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วิดีโอแนะนำ

21 ประโยค

คำศัพท์และข้อสังเกตด้านการพูดสำหรับบทเรียนนี้

บทเรียนฝึกพูดนี้ใช้วิดีโอ “Types of Shock for Nursing” เป็นสื่อ คำที่ถูกพูดซ้ำบ่อยที่สุด: shock, blood, sign, pressure, client วิดีโอนี้มี 285 ประโยค และ 3385 คำ สำหรับฝึกพูดตาม ช่วงที่มีเสียงพูดยาว 23:51 ผู้พูดพูดด้วยความเร็วสม่ำเสมอ ประมาณ 142 คำต่อนาที เหมาะกับการฝึกพูดตาม มีเพียง 75% ของคำที่อยู่ใน 3,000 คำที่ใช้บ่อยที่สุดในภาษาอังกฤษ คำศัพท์จึงค่อนข้างยาก

คำศัพท์สำคัญในวิดีโอนี้

คำที่ควรเรียนรู้ 15 คำจากวิดีโอ พร้อมคำอ่านและความหมาย:

คำศัพท์	คำอ่าน	ความหมาย
symptom คำนาม	/ˈsɪm(p)təm/	อาการ
fluid คำนาม	/ˈflu.ɪd/	ของไหล
oxygen คำนาม	/ˈɑksɪd͡ʒən/	ออกซิเจน
nurse คำนาม	/nɝs/	พยาบาล
infection คำนาม	/ɪnˈfɛkʃən/	การติดเชื้อ
pump คำนาม	/pʌmp/	เครื่องสูบลม, เครื่องสูบน้ำ
priority คำนาม	/pɹaɪˈɒɹɪti/	สิทธิไปก่อน, ความสำคัญ
organ คำนาม	/ˈɔːɡən/	อวัยวะ, องค์
tissue คำนาม	/ˈtɪʃ.(j)u/	ทิชชู่
allergy คำนาม	/ˈæl.əɹ.d͡ʒi/	ภูมิแพ้
output คำนาม	/ˈaʊtpʊt/	เอาท์พุต
delay คำนาม	/dɪˈleɪ̯/	ดีเลย์
vessel คำนาม	/ˈvɛsəl/	เรือ
resolve คำกริยา	/ɹɪˈzɑlv/	ตั้งมั่น, มุ่งมั่น
thigh คำนาม	/θaɪ/	ขาอ่อน

ไวยากรณ์ในวิดีโอนี้

โครงสร้างที่ผู้พูดใช้บ่อยที่สุด พร้อมคำพูดจริงจากวิดีโอ:

โครงสร้าง	ในวิดีโอ
Passive voice be + กริยาช่อง 3 — เน้นสิ่งที่เกิดขึ้น ไม่ใช่ผู้กระทำ	are bolded · is damaged · is blocked
Present perfect have/has + กริยาช่อง 3 — เหตุการณ์ในอดีตที่ยังเกี่ยวข้องกับปัจจุบัน	has decreased · have resolved
Relative clauses who / which + อนุประโยค — ข้อมูลเพิ่มเติมเกี่ยวกับคนหรือสิ่งของ	mmHg which means · minute, which is

การออกเสียงที่ควรระวัง

ผู้พูดใช้รูปย่อและรูปลดเสียง 18 ครั้ง เช่น don't, we're, can't ให้พูดแบบสั้นตามที่ได้ยิน

เสียง “th”: thigh /θaɪ/, breathe /bɹiːð/, sympathetic /ˌsɪm.pəˈθɛt.ɪk/, parasympathetic /ˌpɛɹ.ə.sɪm.pəˈθɛt.ɪk/
เสียง “sh” และ “zh”: shock /ʃɔk/, infection /ɪnˈfɛkʃən/, tissue /ˈtɪʃ.(j)u/, medication /mɛdɪˈkeɪʃən/, intervention /ɪntɚˈvɛnʃən/
คำยาว — ลงเสียงหนักให้ถูกพยางค์: priority /pɹaɪˈɒɹɪti/, medication /mɛdɪˈkeɪʃən/, intervention /ɪntɚˈvɛnʃən/, sympathetic /ˌsɪm.pəˈθɛt.ɪk/, metabolism /məˈtæb.əˌlɪz.əm/

เสียงที่คนไทยมักออกเสียงยาก:

เสียงท้ายคำ — ออกเสียงให้ครบ ไม่เปลี่ยนเป็นตัวสะกดแบบไทย: vital /ˈvaɪtəl/, nurse /nɝs/, decrease /dɪˈkɹiːs/, progressive /pɹəˈɡɹɛsɪv/, vessel /ˈvɛsəl/
/v/ — ไม่ใช่ /w/ ให้ฟันบนแตะริมฝีปากล่าง: vital /ˈvaɪtəl/, progressive /pɹəˈɡɹɛsɪv/, vessel /ˈvɛsəl/, intervention /ɪntɚˈvɛnʃən/, resolve /ɹɪˈzɑlv/
/z/ — เสียงก้อง ไม่ใช่ /s/: exam /ɪɡˈzæm/, resolve /ɹɪˈzɑlv/, metabolism /məˈtæb.əˌlɪz.əm/, mechanism /ˈmɛk.ə.nɪ.zəm/, exhibit /ɪɡˈzɪbɪt/

วิธีฝึกกับวิดีโอนี้

ฟังวิดีโอให้จบหนึ่งรอบโดยยังไม่ต้องพูด แล้วจดคำที่ยังไม่รู้จัก
พูดตามทีละประโยคด้วยความเร็วปกติ ทำซ้ำแต่ละประโยคจนจังหวะของคุณตรงกับผู้พูด
อัดเสียงตัวเองแล้วเทียบกับต้นฉบับ โดยสังเกตคำอย่าง symptom, fluid, oxygen เป็นพิเศษ

เทคนิค Shadowing คืออะไร?

Shadowing เป็นเทคนิคการเรียนรู้ภาษาที่ได้รับการรับรองทางวิทยาศาสตร์ พัฒนาขึ้นสำหรับการฝึกนักแปลมืออาชีพ วิธีการนี้เรียบง่ายแต่ทรงพลัง: คุณฟังเสียงภาษาอังกฤษจากเจ้าของภาษาและพูดตามทันที — เหมือนเงาที่ตามผู้พูดด้วยช่วงเวลาห่าง 1-2 วินาที การวิจัยแสดงว่าเทคนิคนี้ปรับปรุงความแม่นยำในการออกเสียง ทำนองเสียง จังหวะ การเชื่อมเสียง การฟังเข้าใจ และความคล่องแคล่วในการพูดได้อย่างมีนัยสำคัญ

เทคนิค shadowing: อ่านคู่มือฉบับเต็มทีละขั้นตอน →

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เทคนิค Shadowing คืออะไร?