Stages of Shock - NCLEX Review

Introduction

Shock results in decreased tissue perfusion and affects all cells and organs.
Types of shock: Septic, Hypovolemic, Cardiogenic, Anaphylactic, Neurogenic, and Obstructive.
Distributive shock encompasses septic, anaphylactic, and neurogenic.
Multiple Organ Dysfunction Syndrome (MODS) can occur if shock is not treated.

Initial Stage
- Cells experience hypoxia due to reduced perfusion.
- Metabolism switches from aerobic (with oxygen) to anaerobic (without oxygen), producing lactic acid.
- Subtle symptoms; lactic acid accumulation poses a problem.
Compensatory Stage
- Body attempts to compensate using the sympathetic nervous system and renin-angiotensin system.
- Signs become more apparent, but stage is reversible if treated.
- Mechanisms:
  - Brain and heart get prioritized blood flow.
  - Baroreceptors stimulate catecholamine release, increasing blood pressure and cardiac output.
  - Fluid shifts into vasculature to improve venous return.
  - Kidneys activate renin-angiotensin system, increasing vasoconstriction and blood volume.
Progressive Stage
- Compensatory mechanisms fail, leading to worsening conditions.
- Significant drop in cardiac output, leading to reduced organ perfusion.
- Symptoms by system:
  - Neuro: Mental status changes due to reduced cerebral perfusion.
  - Lungs: ARDS develops; decreased oxygen exchange.
  - Heart: Dysrhythmias due to myocardial hypoxia.
  - Kidneys: Acute tubular necrosis leading to renal failure.
  - Gut: Risk of ulcers and GI bleeding due to loss of protective lining.
  - Liver: Reduced function affects clotting and waste clearance.
- Potential for disseminated intravascular coagulation (DIC).
Refractory Stage
- Unmanageable, irreversible stage leading to death.
- Complete organ failure as shock progresses.