Early – compensatory
stim. sympathetic NS (epinephrine & norepinephrine released to ↑cardiac output send ↑blood
to tissues
2. ↑glucocorticoids & mineralcorticoids cause Na & fluid retention to ↑intravascular volume
3. hypoxemia causes hyperventilation (early respiratory alkalosis)
4. decreased capillary fluid pressure causes fluid shift from interstitial space to intravascular
5. body shunts blood from the skin, kidney, & GI to brain & lungs
Signs & symptoms (early)– classic : decreased BP
restlessness, apprehension, feeling of fright
bowel sounds hypoactive
increased thready weak pulse >100
decreased UO (20-30 ml /hr.); decreased urinary Na (because Na retained to↑volume)
increased urinary osmolarity [urine concentration]
6. skin – cool & clammy
7. temp. = normal
Medical Management
Identify cause & try to correct
Are they losing blood?
Do they need meds?
Fluid replacement?
Nursing Care
Assess, monitor, evaluate
LOC
V/S.
40 mmpulse pressure (systolic – diastolic) correlates with stroke volume. normal is 30-40 mm Hg. narrowing of pulse pressure is indicator of shock. report systolic 90
UO: 30 ml/hr (best indicator of hypoperfusion) If↓or absent, shock progressed, maintain UO
5. skin
6. with elderly check for hypertension, infections, & decreased organ perfusion. Is it a rxn to drugs?
7. lab
a. blood gases
b. ↑Na and glucose, aldosterone & catecholamines
c. capnography: CO2 measure
d. gastric tonometry – balloon to measure CO2 & pH of intestinal mucosa
e. central venous or mixed venous O2 sat
Administer IV medications
promote pt safety & decrease anxiety
confusion of the 1st things you see
explain, provide support, speak calmly, use touch, provide safety
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