Part V: Cardiovascular Assessment in Specific Disease Conditions, Con't.Hypertension and ShockHypertension and shock are two additional disorders which will be discussed in this section. You might even say that these disorders are not precisely named as peripheral vascular diseases, but for our purposes, will be considered under this heading. They are very common disorders and often not assess properly. Hypertension: in review, there are two basic types of hypertension, primary and secondary. Primary or essential hypertension is idiopathic. Secondary hypertension may or may not have a treatable cause. In secondary type, there is a medical problem causing the symptom of hypertension. When assessing these patients, keep in mind the pathologies that server hypertonic cause to other body systems such as kidneys, brain, liver, and others. Assessment in Hypertension:
Perform your complete assessment for these patients, but particularly these items mentioned above. Nursing care for patients may include drug therapy, rest, comfort measure, sedation when necessary, and discharge planning and teaching. The patient must make changes in lifestyle and in many instances and needs the support of the nursing staff and family. Today patients are not in the hospital for very long, the nurse much being discharge planning and teaching immediately upon admission. The nurses’ assessment of the family situation should include interviews with the family and to include them in the teaching of the patient. Assessment in Cardiovascular collapse: SHOCK: This section will deal with assessing the patient at risk for developing the symptoms of sock. If a patient is in shock, he is seriously ill. We will present the evaluation of the cardiovascular signs of impending shock, so that the nurse can hopefully prevent this life-threatening disorder. One of the most important factors for the prevention of shock is an adequate baseline of information. We have discussed throughout this test, the importance of history and general assessment. We much always have a baseline of information in order to asses shock in the patient. We must know the person’s “average” blood pressure and TPR. We must know the person’s “average” response to disease. This means, do they respond appropriately to questions/ do they have “normal” intelligence? Do they have “normal” skin color, (normal for them), etc.? once we determine a baseline, the nurse can very easily assess the cardiovascular system for changes. the nurse will then be able to assess the patient for deterioration of the body systems. Guide to Assessment of Shock The following guide will include assessment for the prevention of shock, and it will contain guidelines for assessing the patient already in shock. This nurse should be able to assess both situations. Shock is defined as “cardiovascular collapse.” There are many different types of shock, originating from many conditions. For example, allergy can lead to shock, anaphylaxis. Hemorrhage can cause shock, due to blood loss, hypovolemia shock. Whatever the condition, shock is a disease by itself, and it can be also be considered as a symptom that there is another condition present. The initial problem leads to shock, then, like a snowball downhill, gathers momentum and gets worse. Cardiovascular collapse means that the body’s response to the primary condition, leads to loss of tone of the entire cardiovascular system. The heart action weakens, arteries lose elasticity, blood pressure falls, pulse increased and weakens, there is mental confusion, changes I level of consciousness (LOC), and many other possible related symptoms. Clinical Assessment of Shock: As shock develops in a person, many different and varied symptoms can be seen. Some types actually cause symptoms which are confusion, because they do not follow the usual patterns of shock. In this text, we will concentrate on “what to look for” if your patient begins to develop shock or who is at risk of developing shock. Stages of Shock: State I: Baseline Shock – this is beginning shock, the patient “baseline” must be obtained and compared to the next stage of shock; the patient in this stage is essentially stable. State II: Early Shock – compared to baseline, the patient’s blood pressure is going down, and perfusion to the vital organs decreases. State III: Late Shock – complete collapse and poor perfusion to vital organs, next to death. Again, this is only a guide. Some authorities call early shock “compensated shock” due to the fact that the patient has only early symptoms and can still easily be treated. Late shock is also called by some “decompensated shock” due to the fact that it is so severe that it usually cannot be reversed, except by extraordinary means. Circulatory Effects of Shock Most forms of shock cause an immediate decline of perfusion to the vital organs. Peripheral vessels are constricted and therefore flow is decreased. Some types of shock may be slightly different as to pattern of blood flow, but most types follow this pattern of declining peripheral blood flow. Due to peripheral shutdown, many and varied symptoms of shock may occur. There are some common symptoms which have been mentioned, but other symptoms can occur due to reduced blood flow to the organs of the body. F or example, neurological changes may occur. They are very non-specific in most cases, so a baseline is very important. Have any changes occurred in your patients mental status? If so, it may be due to reduced peripheral flow of blood. The same may be true for the renal system and the hepatic system and all others. Assessment
The above is a guide to assessing the patient if you suspect shock. If you do suspect shock, you must institute emergency measures. Each facility has a procedure, but here are some general guidelines: For Suspected Shock (What Should You Do?)
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