Progressive Shock

Progressive

1. mechanisms that regulate BP no longer compensate. 90 40 mm Hg

2. myocardial depression - heart becomes dysfunctional

3.body's inability to meet O₂ requirements produces ischemia

4. autoregulatory function of microcirculation fails – results in ↑capillary permeability, so fluid

leaks from capillaries which causes interstitial edema, less fluid return to heart

5. arteriole & venous constriction further compromise cellular perfusion

6. relaxation of capillary spincters

7. inflammatory response is activated, coagulation response is activated

8. body mobilizes energy stores & increases O₂ consumption to help meet metabolic needs – need

to treat symptoms of shock. Surviving shock depends on health of individual prior to shock.

Signs & Symptoms

1. rapid, shallow respirations with crackles O₂ ↓ CO₂ ↑ due to pulmonary edema (pt can get MI, cardiac enzymes released) BNP (B-type naturetic P) lose consciousness

2. BP 80-90 mm Hg

3. HR 150

4. skin mottled, petechiae

5. UO 5-15 mL / hr (oliguria)

6. lethargy – confused due to hypoxia

7. metabolic acidosis

8. get adult respiratory edema "ARDS" or adult respiratory distress syndrome or "shock lung"

9. check cardiac enzymes: CPK, MB, tryponin I, LDH. these increase when ventricles distended

10. MAP can affect GFR, then BUN & creatinine will be high

GI

1. stress ulcers – can get necrotic / gangrene

2. bloody diarrhea

Hematologic –

1. toxins can pass into bloodstream due to ↑permeability

2. disseminated intravascular coagulation "DIC" from clotting

Nursing care

1. assess for subtle changes

   a. ABG

b. electrolytes

c. mental LOC

d. is pt on dialysis or ventilator?

*balloon in heart can increase cardiac effectiveness "balloon pump"

2. coordinate everything

3. prevent infection

4. promote rest & comfort (get pt warm, but not too warm) – BP will ↓

5. provide support to family

Irreversible – later: not survive

noncompensatory – organ damage severe, continue to treat, but start to make end of life decision

1. decreased blood flow to heart

2. anaerobic metabolism (acidosis)

3. arteriolar dilation

4. decreased blood flow to kidney – aneuric (retention) failure of N-K pump, Na enters cell, shifts to hypovolemia from intravascular to interstitial

5. multiple organ failure

Progresses

1.BP decreases

2.Urinary volume decreases

3.metabolic acidosis

4.signs & symptoms of failure of most organs

Signs & Symptoms

1. BP requires mechanical or pharmacologic support

2. HR erratic or asystole

3. respiratory requires intubation

4. jaundice – liver failure

5. aneuric – requires dialysis

6. unconscious

7. profound acidosis