Stages of Shock Flashcards
(23 cards)
What are the different stages of shock?
- initial
- compensatory
- progressive
- refractory
What is the inital stage?
What is happening?
- things are happening, but clinical manifestations are not completely apparent
- altered cellular metabolism → going from aerobic to anaerobic metabolism (due to ↓ O₂)
- lactic acid will build up (moving to acidotic type of things bc ↑ acid)
- lactic acid is removed from liver, but this requires O₂ but there is no O₂
- lactic acid will build up (moving to acidotic type of things bc ↑ acid)
when things happen
things = ↓ O₂ , ↓ tissue perfusion, altered cellular metabolism
What is a classic sign of shock?
- drop in BP
- due to ↓ CO and low pulse pressure
What is the compensatory stage?
- will start to see manifestations
- body starts to compensate for ↓ CO and low pulse pressure
What is happening in the compensatory stage?
SNS
- ↓ CO, alarms will go off to compensate
- baroreceptors activate SNS
- SNS will cause vasoconstriction
- helps get more blood to heart to help ↑ CO
- release of epinepherine/norepinephrine will ↑ HR
What is happening in the compensatory stage?
blood flow
- blood flow will be prioritized to heart and brain
- blood will be shunted to other parts of body
- even the lungs! ↓ O₂ and perfusion
- coronary arteries will dilate
- trying to meet O₂ demand
- skin → cool and clammy
domino effect → ↓ blood flow → everything stops working
bc the blood is being prioritized to heart and brain, blood flow will be lacking in other organs (they’re already lacking) and therefore will start to see dysfunction everywhere else (kidneys, lungs, liver, etc.)
What is happening in the compensatory stage?
GI
GI → impaired motility
- peristalsis
- ileus is paralyzed
What is happening in the compensatory stage?
kidneys
- altered kidney function
- AKI (↓ O₂ and blood flow)
- vasoconstriction (from release of renin → angiotensin I → angiotensin II)
What is happening in the compensatory stage?
lungs
- ↓ arterial O₂
- ↑ deep respirations (tachypnea)
What is the progressive stage?
- begins as compensatory mechanisms start to fail
- will start to see altered mental status
- usually will be moved to ICU
shock is progressing, things are about to go DOWNHILL
tachycardia can only get you so far, now that priority (heart and brain) is out the window, it’s every organ for themselves
What is happening in the progressive stage?
fluids
- ↑ capillary permeability
- edema
- anasarca (edema everywhere)
- fluid leakage into tissues (ex: liver, spleen, lungs, etc.)
- weak, peripheral pulses
everything that happened during compensatory stage, but worse bc there is no compensation
What is happening in the progressive stage?
heart
- ↓ blood flow and tissue perfusion to the heart
- symptoms of angina which can progress to MI
- end result: complete deterioration of CV system
- no longer responding to treatment
heart starts to feel the pain now, no longer the favorite, on its own
What is happening in the progressive stage?
lungs
- first system to show critical signs of dysfunction, starts to shut down
- rales
- fluid is accumulating in places they shoudn’t be
- alveolar edema (due to ↑ capillary permeability)
- ↓ surfactant production
- tachypnea, deep respirations
was never the favorite, was already dysfunctioning during compensatory
when you see respiratory stuff going on, you’re going to see heart stuff going on bc they’re next door neighbors
What is happening in the progressive stage?
GI
- TPN
- ↓ protective mucosal layer
- ulcers
- GI bleeding
- ↓ ability to absorb nutrients
probably not eating at this point
What is happening in the progressive stage?
kidneys and liver
- ↓ kidney function
- metabolic acidosis (AKI)
- hyperkalemia
- ↓ liver function
- hepatits and cirrhosis
- can’t metabolize drugs (but we’re giving them drugs)
- jaundice
What is the refractory stage?
- final stage
- everything gets worse
- MODS (mutli organ dysfunction syndrome)
- failure of one system is gonna effect other systems
- recovery is unlikely at this stage
all those things that been happening, even worse. everything shuts down
once they make it progressive and refractory stage, mortality gets higher and higher
How to give interprofessional care regarding oxygenation?
- ensure patent airway (to get O₂ in)
- either natural or intubation
- there is ↑ demand but ↓ supply of O₂
- we are trying to reverse that
- monitor MAP (shows tissue perfusion)
- ↓ space activities if possible
- suctioning, position changing → ↑ O₂ consumption
How to give interprofessional care regarding fluids?
- give fluids
- may be on diuretics
- want to get rid of edema, but want to stay hydrated
What is the goal of vasopressor therapy?
↑ BP and improve perfusion to vital organs by constricting blood vessels
What is a potential complication from receiving vasopressor therapy?
severe peripheral vasoconstriction and ↑ SVR can cause greater ↓ tissue perfusion
SVR = Systemic Vascular Resistance
High SVR = the heart has to work harder to push blood out.
Why are vasodilators used in the treatment of shock?
- ↓ afterload
- ↓ myocardial workload and O2 requirements
- improve CO
What are the ways a patient may receive nutrition when they are in shock?
- enteral nutrition (within the first 24 hours)
- parenteral nutrition if enteral feedings are contraindicated
- enhances perfusion of the GI tract and helps maintain the gut mucosa
How does the diet change when the patient is able to take food by mouth?
- start with clear liquids (broth, water, juice)
- gradually advance to soft/bland foods.
- move to high-protein, high-calorie diets (helps healing and energy)
