Distributive Shock Pathophysiology

In this video, we are going to talk about one of the types of shock that you need to know about in nursing school. This is distributive shock. Now, distributive shock is one of the trickier types of shock to understand. So we are going to bring it all down super, super simple for you so you can actually understand it all and be able to answer your nursing exam questions correctly about it. We'll also run through some nclex practice question questions at the end of the video to help it all really sink in. So hit that subscribe button and click the notification bell and let's dive in. Now, before we dive in, I just want to make sure that you snag the free shock cheat sheet that I have for you. You can click the link in the description below to snag it and print it out so that you can use it as you study in nursing school and as you go to clinical so you can remember all this stuff. So when you think about shock, the first thing that should come to your mind is a lack of blood flow to the organs. So during shock, there's this lack of blood flow that can lead to organ failure and death. So when you think of shock, you should immediately be thinking of a lack of blood flow. And this means that there is not enough blood flow to the heart, the brain, the kidneys, the liver, the tissues, all. All of it, all of the other organs and the rest of the body. So shock simply is that lack of blood flow. And this lack of blood flow means it makes all the organs very unhappy because they're not getting that blood, that oxygen, the nutrients that they need to keep functioning. So that's what shock is as a whole. But there are these different subtypes of shock, like hypovolemic shock, cardiogenic shock. And here we are, distributive shock, which we're going to talk about in this video today. So distributive shock can be tricky to identify sometimes. So I'm going to break it down super easy, make it super simple for you to remember. There is one word that you should always associate with distributive shock, and that is vasodilation. All right, so distributive shock simply means vasodilation, like massive vasodilation, meaning that the blood vessels are dilating. So let's break this down. Distributive shock, it happens when there is technically enough blood flow, enough blood in the blood vessels, but that blood just can't distribute to the organs. So there's your memory trick. In distributive shock, the blood vessels can't distribute blood to the organs. And the number one problem is vasodilation. So the blood vessels are dilating here. And when the blood vessels dilate, the blood can't move through as fast. And it's much more difficult for the heart to pump that blood because there's just so much space now and not enough pressure to help move that blood flow through those blood vessels. So let's put a visual to this. So I don't know about you, but when I wash my hands, I tend to turn on the water faucet, like way up. Because if you just turn it on a little bit, it's just kind of like streams or trickles out slowly and who has time for that, right? So I turn it way, way up. So when there's less water relative to the size of the pipes, it takes longer to get the water out. Right? And that's exactly what's happening here with distributive shock. Even though there's the same amount of blood in the body as there was before, the blood vessels now they're larger, they're super dilated. So it takes longer for that blood to get to where it needs to go, which is all of those organs and the tissues in the body. So distribut shock is caused by that vasodilation. The blood can't be distributed to the body. Now when the blood vessels dilate, that blood just can't get to the organs and the organs may start to fail. Now the number one cause of distributive shock is sepsis, because in sepsis, sepsis causes a lot of vasodilation. Now I have a whole video walking you through the pathophysiology of sepsis and how it all works. And I put it into simple steps, steps for you to follow so you can understand it. So if you want a refresher on sepsis, be sure to check that video out. I will put the link down below in the description for you. So when you think of distributive shock, think immediately. Vasodilation and the blood just can't be distributed to the organs. And of course this causes the organs to be super unhappy because they aren't getting the blood that they need to function. They can start to fail if it's not fixed. So now let's go through some of the common signs and symptoms of shock and do some critical thinking to talk about why these happen. I also have some NCLEX practice questions here on shock for you at the end to help you test your knowledge, really, and help you prepare for your exams and help this all come together for you. So we'll walk through the list of signs and symptoms here for shock first and then we're going to talk about the critical thinking behind all of them and why they happen. So this is so, so, so, so important, my friend, because when you go take your nursing school exam and if they give you a select all that apply question, or a priority question or a case study question, those are all critical thinking questions, right? And memorizing a list of signs and symptoms, it's not going to help you when you get to your exams. You need to know the why behind everything and the why behind the signs and symptom. They happen. That way you will be able to really critically think easier on your exams. So that's why I always, always, always teach it this way. We are not just going to memorize a list of signs and symptoms and let you figure it out on your own. That's not what we do here. But instead I'm going to walk you through why they happen so you understand the critical thinking behind it all. So the common signs and symptoms are an increase in heart rate, an increase in respiratory rate, decreased blood pressure, a thready pulse, capillary refill greater than 3 seconds, decreased peripheral pulses, cyanosis, neurological symptoms, things like restlessness, anxiety, confusion, lethargy, or even muscle weakness. You could see decreased urine output and absent bowel sounds. Now, looking at this list, let's notice that they all have to do without reduced blood flow to the body in this is your huge critical thinking point, right? Shock is a blood flow problem. The organs are not getting the blood that they need to function and stay happy. So the body always wants to stay in balance, right? So when the organs aren't getting enough blood, they are going to send signals to the brain that say, hello up there, I need some blood, please. And the brain is then going to send that signal to the heart to pull, pump faster, to try to get more blood to the body. It's going to go to the lungs, to lungs to breathe faster, to get more oxygen flowing. The blood pressure is going to drop because the heart isn't able to pump out as much blood as it was before. The pulses will be thready, the capillary refill time will be longer, and the peripheral pulses, those will be diminished and cyanosis can occur all because of that lack of blood flow to those parts of the body. The Patient may also have some neurological symptoms. You could see things like restlessness, anxiety, right? Confusion, lethargy or muscle weakness. Now this is all because of that reduced blood flow to the brain and the muscles. If the brain isn't getting any blood or enough blood, it gets super unhappy, obviously. And that's when you may see some of those mental status changes happening. And then decreased urine output and absent bowel sounds, those can occur because there just isn't enough blood going to the kidneys or to the GI tract, so they can't do their job as well. So now let's go through some nclex practice questions to really help this all come together for you. Nclex practice questions and practicing them as you go through nursing school can be a really, really helpful way to help all the concepts come together. And it also trains your mind on how to answer these NCLEX style questions properly. And now inside the nursing SOS membership community, we just added brand new cardia nclex question workbooks for you. So when you join the nmc, you're going to get all those workbooks filled with practice problems to help you understand all these topics and all these concepts way faster and way easier. So I hope you check that out. The link is down below in the description for you to check out all the details. So question number one. A nurse is reviewing the pathophysiology of different types of shock. Which of the following best describes the primary mechanism of distributive shock? Is it A, a significant loss of circulating blood volume or B, the inability of the heart to pump blood effectively? Is it C, widespread vasodilation leading to inadequate tissue perfusion, or is it D, a mechanical obstruction preventing blood flow to the organs? Now the correct answer here, when you look at this list is C, widespread vasodilation. Remember distributive shock, Vasodilation. We gotta be thinking massive vasodilation. This is leading to that inadequate tissue perfusion. Now this is because in distributive shock, this is where that blood can't be distributed right to the organs. And this is caused by that vasodilation. With answer A, that would be more hypovolemic shock where there's just not enough blood flow or blood volume in the first place. And then with answer B, if the heart can't pump effectively, that would be a cardiac problem, indicating more a cardiovascular cryogenic shock. And then with answer D, that would be obstructive shock because there is something that's physically blocking that blood flow to the Organs. Now let's go through question number two. A nurse is caring for a patient exhibiting signs of shock. Which of the following assessment findings is the most important to correct first? Now here's a priority question for you. When you see the word first, it's a priority. So is it A, elevated white blood cell count, B, blood pressure of 88 over 54, a pain level of 6 out of 10 or blood cultures positive for staphylococcus aureus. So here the correct answer is B, A blood pressure of 88 over 54, which is low. And this indicates a perfusion problem. So all of the other answers, they would not be a priority because they don't pose an immediate threat to the patient's life and the patient's safety like that blood pressure does. So with shock, the organs aren't being perfused. Right. This is a life threatening problem for the patient and it needs to be reversed immediately, as soon as possible. So that's why answer B is correct. Now let's go through question number three. A nurse is assessing a patient in the emergency department. Which of the following assessment findings does the nurse recognize as signs of shock? Now this is a select all that apply. These are tricky sometimes. So 1, respiratory rate of 26 breaths per minute, 2, a blood pressure of 84 over 62. 3, a white blood cell count of 9,000 cells per microliter, 4, urine output of 5 mils per hour or 5, a heart rate of 130 beats per minute. All right, so let's look at that list. The correct answers are 1, 2, 4 and 5. So with shock, remember there's that lack of blood flow causes that drop in blood pressure. The body's going to try to compensate for that lack of blood flow. So it's going to increase that respiratory rate in the heart rate to try to help to increase that oxygen and that perfusion. And it's going to shunt blood away from the kidneys which causes that decrease in urine output. Now the white blood cells, however, those are actually within normal range here. And changes in white blood cells, those are not a distinct sign of shock. If the white blood cells were elevated, it could indicate that the shock may be caused by an infection or like sepsis. But elevated white blood cells themselves aren't necessarily a sign of shock. And the must know infection that you need to know about a nursing school, of course, is sepsis. Like we've talked about nursing school exams, love to test you on sepsis. So please, please, please, my friend, if you need help with sepsis, be sure to check out this video here where I walk you through the pathophysiology of sepsis to help you pass your exams. And be sure to snag the free shock cheat sheet that I have for you. I'm going to put the link to that in the description below this video for you to snag it. And if you like this video, hit that like button, share it with a friend and of course, subscribe and hit the bell so you never miss a video. And as always, my friend, go become the nurse that God created only you to be, and I will see you next time on the Nursing School Show.