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What is shock?
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It is a life threatening response to alterations in circulation. It results in inadequate tissue perfusion d/t an imbalance between cellular oxygen supply and demand.
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What body systems can shock affect?
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All of them! If there is a lack of cellular oxygen and cells make up tissues, tissues make up organs, organs run our body... you get the idea.
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What are the five classifications of shock?
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1. hypovolemic
2. septic 3. anaphylactic 4. neurogenic 5. cardiogenic |
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Shock begins with cardiovascular system failure. What are the four components that can be altered that result in shock?
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Alterations in:
1. blood volume 2. blood flow 3. vascular resistance 4. myocardial contractility. |
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What are some of the cellular consequences of shock?
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The sodium/potassium pump is inefficient, mitochondria aren't being fed, sodium enters the cells (causing them to swell and burst), anaerobic metabolism kicks in causing an increase in lactic acid buildup.
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Explain what the vascular response to shock is?
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Oxygen attaches to the hemoglobin molecule in red blood cells. The hemoglobin is reluctant to give up the O2, starving the body of oxygen.
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What are two ways that BP is regulated?
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1. baroreceptors that stimulate catecholamine release from SNS
2. stimulation of the renin angiotensin mechanism, vasoconstriction leads to release of aldosterone, which promotes retention of sodium and water. |
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Name the 4 stages of shock
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1. Initiation
2. Compensatory 3. Progressive 4. Refractory |
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What happens in the 1st stage of shock?
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Stage 1 - Initiation
Hypoperfusion: inadequate deliver or extraction of oxygen. There are no obvious clinical signs yet. This is an early stage, so it is reversible. You might see a decreased cardiac output if you are using invasive monitoring. |
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What happens in the 2nd stage of shock?
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Stage 2 - Compensatory
There is a sustained reduction in tissue perfusion, which initiates compensatory mechanisms. Baroreceptors and chemoreceptors kick in, Aldosterone is released, there is low oxygen tension, and hyperventilation and respiratory alkalosis occurs. The patient's vitals may still be normal d/t vasoconstriction, increased HR (sympathetic NS kicks in) |
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What sort of clinical findings would indicate that the patient is in a compensatory stage?
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Cool and clammy skin, hypoactive bowel sounds, decreased urine output, increased respiratory rate. (think SNS stimulation)
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How would you treat a patient in the compensatory stage of shock?
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Identify and treat cause of shock, support physiological processes, replace fluids (fill the tank), medicate.
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What are four nursing management techniques to utilize during the compensatory stage?
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1. early intervention (assess LOC, BP, etc.)
2. monitor tissue perfusion 3. reduce anxiety 4. promote safety |
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How do you calculate pulse pressure? What does it correlate with?
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Systolic
- Diastolic Pulse Pressure This correlates with stroke volume and is a better indicator of shock |
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What happens in the third stage of shock?
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Stage 3 - Progressive
Compensatory mechanisms fail.There is an increase in capillary hydrostatic pressure. Intravascular fluids shift (interstitial edema, decreased circulating intravascular volume). Decreased coronary perfusion (Myocardial Depressant Factor is released) causing decreased myocardial contractility. Increased hypoperfusion and vasoconstriction (extremity ischemia, cellular hypoxia, lactic acid production, failure of Na/K pump) |
