STAGES OF SHOCK

1. Compensatory - BP remains within normal limit

➢ “Non Progressive stage”, MAP decreases 10 -15 mmHg from client’s baseline
➢ S/S : cold , clammy, hypoactive bowel sounds, decreased urine output
Management
a. Directed toward identifying the cause of shock
b. Fluid replacement and medication therapy

Nursing Interventions
a. Monitor tissue perfusion by observing changes in LOC, v/s, pulse pressure, urine
output, lab values
○ Narrowed Pulse Pressure – early indication of decreased SV
a. Reducing anxiety
b. Promoting safety

1. Progressive – Occurs when there is sustained decrease in MAP of more than 20

mmHg from baseline
➢ “ Intermediate stage “
➢ Failure of cardiac pump, autoregulatory function of the microcirculation fails
➢ Life-threatening emergency
Management
a. IV fluids
b. Medications to restore tissue perfusion
c. Enteral nutritional support

1. Refractory – severe tissue hypoxia with ischemia and necrosis

➢ “ Irreversible stage”
➢ The body is unable to respond effectively to interventions & shock continues
➢ Multiple organ dysfunction

ASSESSMENT AND DIAGNOSTIC FINDINGS

1. Respiratory – rapid, shallow RR

– Crackles, Cyanosis
1. CVS – rapid HR
– Dysrhythmias & ischemia
– Thread pulse, narrowed pulse pressure, decrease BP
– Postural hypotension
1. Neurologic deficits – loss of consciousness
– Pupils sluggishly reactive to light
– Diminished or absent deep tendon reflex
1. Renal – ARF : increase in Bun, Creatinine
1. UO decreases
1. Hepatic effects – liver enzymes elevated
1. Less able to metabolize medications & metabolic waste products
 1. GIT effects – decreased motility
– Decreased or absent bowel sounds
– n/v, constipation
1. Integumentary effects – cool to cold
– Moist & clammy
– Mouth dry, pastelike coating present

MANAGEMENT STRATEGIES IN SHOCK

1. Oxygen Therapy
2. Fluid replacement – to restore intravascular volume, administered in all types of Shock
a. Crystalloids – electrolyte solution that moves freely between intravascular &
interstitial spaces
– 0.9 % sodium chloride (NS) & LR’s solution
a. Colloid – large molecules intravenous solution
– Plasma proteins, expand intravascular volume by exerting oncotic pressure
– E.g: albumin prepared from human plasma, dextran, whole blood, PRBC
– Synthetic plasma expanders

NURSING INTERVENTIONS
1. Monitor UO, changes in mental status, skin perfusion V/S
2. Monitor for lung sounds
3. Monitor central venous pressure – monitor right atrial pressure

ANAPHYLACTIC SHOCK – caused by severe allergic reaction & potentially fatal multisystem
syndrome resulting from massive release of inflammatory mediators.

ASSESSMENT

1. Respiratory – sneezing, bronchospasm, laryngeal/ pharyngeal edema

2. Skin manifestations – flushing, generalized itching, urticaria & angioedema
3. Cardiovascular – tachycardia, bradycardia, decreasing BP, circulatory failure
4. GIT – n/v, diarrhea, abdominal pain

MANAGEMENT
1. Remove the causative agent
2. Assess all patients for allergies or previous reactions to antigens
3. Administer medications such as Epinephrine, Diphenhydramine & Nebulized
albuterol.