What is Shock?
widespread abnormal cellular metabolism that occurs when the bodies need for O2 and tissue perfusion is not met for the level to maintain cell function
Shock is what type of response?
“Whole-body” response
What are the stages of Shock?
Initial stage
Nonprogressive stage (compensatory)
Progressive stage
Refractory stage
What happens during the initial stage?
- cells switch to anaerobic metabolism creating lactic acid
- low CO
- HR/RR increase or slight increase in BP
- baseline MAP decreased by < 10
What happens in Nonprogressive Stage?
- MAP decreases by 10-15
- kidney and hormonal adaptive mechanisms activated
- tissue hypoxia in nonvital organs
What adaptive mechanisms begin in Nonprogressive stage?
- SNS begins “fight or flight response”
- Epinephrine/norepinephrine release = vasoconstriction = increase BP/HR
- Kidney’s begins Renin-Angiotensin System
Renin-Angiotensin System
Renin stimulates angiotensin = Angiotensin I which turns to Angio II
- causes vasoconstriction
- releases aldosterone causing sodium and water retention
- releases ADH to help increase blood volume
What stage at shock can you still correct damage done to body?
Nonprogressive
What happens during Progressive Stage?
- decrease in MAP of more than 20
- vital organs develop hypoxia
- progressing to MODS
When conditions enter Progressive Stage how long does the nurse have to correct the cause?
1 hour
What happens in Refractory Stage of Shock?
- too much cell death and tissue damage from too little oxygen
- body can no longer respond effectively to interventions
What is Multiple Organ Dysfunction Syndrome? (MODS)
-sequence of cell damage caused by massive release of toxic metabolites and enzymes
Where does MODS occur first?
liver
heart
brain
kidney
Where are metabolites released from?
dead cells
What happens in MODS?
- metabolites released
- microthrombi form
- myocardial depressant factor released from the ischemic pancreas
When does Cardiogenic Shock occur?
the heart can not pump enough blood to meet the perfusion needs of the body
Why does Cardiogenic Shock occur?
- Filling issue (Diastolic dysfunction)
- Contraction issue (systolic dysfunction)
- dysrhythmias
- structural defect
Cardio Shock leads to what?
- Decreased CO and perfusion
- Decreased oxygen to cells that make up organs/tissues
What is Cardiogenic Shock?
actual heart muscle is unhealthy and pumping is directly impaired
What is the most common cause of direct pump failure?
Myocardial infarction
Causes of Cardio Shock
- MI (main cause)
- pericardial tamponade
- dysrhythmias
- myo-endo/carditis
S/S of Cardio Shock
- JVD
- increased CVP/PCNP/PAWP
- weak pulses
- pulmonary edema
- dyspnea
- increased RR/HR
- severe SOB
- mental alteration
Nursing Interventions For Cardio Shock
- mech. ventilation
- central line placement
- vasopressors
- fibrinolysis
- revascularization-PCI/CABG
- cardiac transplant
Medications for Cardio Shock
- diuretics
- vasopressors
- dobutamine
- dopamine
