LS1- Compare Stages of Shock

• In compensatory stage

  • BP is normal
  • HR is high, contractility is high to maintain adequate cardiac output
  • RR is high to compensate and remove excess CO2
  • Removing excess CO2 causes the blood pH to go up
  • Causing respiratory alkalosis
• In compensatory stage

  • body shunts blood from skin, kidneys, and GI to ensure that vital organs like brain, heart, and lungs have adequate blood supply
  • Skin is cool, pale, BS hypoactive
  • Decreased UO, because of the release of ADH
  • Mental status changes
• The nursing focus during compensatory stage is to increase perfusion and deliver O2 to tissues
• In Progressive stage

  • BP mechanism fail
  • MAP is < 65
  • SBP is < 90 or < 40 from baseline
  • hypotension
  • Autoregulation fails -> capillary permeability is increased -> interstitial edema -> < fluid return to the heart
  • RR is rapid and shallow -> O2 is low
  • On lung ausc, crackles are heard
  • Mental status decline
• Nursing management for progressive stage is to monitory ECG, ABGs, prevent complications, promote safety, and minimize delirium
• In Irreversible stage

  • Organ damage is so severe that it doesnt respond to treatment
  • BP is low
  • anaerobic metabolism
  • Renal and liver failure, resulting in metabolic acidosis
  • Cant maintain adequate MAP
• Nursing treatment for Irreversible is to provide comfort, prevent complications, and frequent monitoring
• Shock is the lack of blood flow to the tissues -> poor delivery of O2 and nutrients -> hypoxia -> cell death -> organ failure -> death
• Cardiogenic shock occurs when the heart cant contract and push blood forward
• Obstructive shock includes PE, preventing blood flow
• Distributive shock occurs when the fluid ends up collecting between the cells of organs that needs O2 and blood vessels that are delivering O2, resulting in accumulation of fluid, making it hard for O2 to reach tissues
• Nursing Interventions for shock includes

  • O2
  • IV fluids
  • Vasoactive meds
  • Nutritional needs to support metabolic demands
• Components for normal blood flow

  • effective cardiac pimp
  • adequate vasculature or circulatory system
  • Sufficient blood volume
  • If one is compromised -> inadequate blood flow -> hypoxia -> organ dysfunction
• Cardiogenic Shock

  • Occurs when the hearts ability to contract and pump blood is impaired -> supply of O2 is inadequate for heart and tissue
• In cardiogenic shock

  • CO is compromised -> when HR and SVR decrease or becomes erratic -> BP falls and tissue perfusion is decreased
  • Result: blood supply is inadequate for tissues -> impaired tissue perfusion
  • Impaired tissue perfusion -> weakens the heart -> impairs the ability to pump -> ventricles dont fully eject at systole -> fluid accumulates in lungs
• Manifestations of Cardiogenic shock includes:

  • angina, dysrhythmias, fatigue, feelings of doom, symptoms of hemodynamic instability
• Pharmacologic management for Cardiogenic shock includes:

  • Vasodilators to decrease afterload
  • Intotropes to increase contractility