Said AL Harthy

Reflect on a
patient with
shock you have What signs and
treated and symptoms were
relate the stages occurring.
of shock to this
patient.
Activity
What actions
In which stage of were taken to
shock was the stop the next
patient stage of shock
from occurring.
Learning outcomes:

By the end of this session the students will be able to:

∙ Define shock
∙ Differentiate between the stages of shock
∙ Discuss the pathophysiology, the causes and signs and
symptoms of hypovolemic, cardiogenic, neurogenic and
anaphylactic shock
∙ Describe the treatment options available for each type of
shock
∙ Explain nursing interventions necessary for each type of
shock
 Shock is an acute state in which
tissue perfusion is inadequate to
maintain the supply of oxygen and
nutrients necessary for normal cell
function. (Alexander et al 1994)

Shock
Shock is a condition where the
cardiovascular system fails to perfuse
the body tissues adequately, bringing
about a widespread disruption of
cellular metabolism, resulting in
functional disturbances at
organ/tissue level.
► Deficiency of blood supply
► Oxygen deprivation
► Buildup of waste product
► Organ failure

► Shock caused by any factor which affects

► Blood volume
► Blood pressure
► Cardiac function
Initial stage

► Cells deprivation of oxygen

► The mitochondria can no longer
continue to produce adenosine
triphosphate (ATP)
► Cell membranes become damaged.
► Production of lactic and pyruvic acids
causes
► Systemic metabolic acidosis.
Compensatory stage
(Non-progressive)
Physiological Adaptation
► Reduced cardiac output • Baroreceptors
• Sympathetic
► Release of adrenaline and noradrenaline nervous
► Vasoconstriction system
► Increase in BP and HR
► Hyperventilation
► General blood flow is reduced
► Oliguria might develop.
De-compensated (Progressive
stage)
Failure of compensatory mechanisms
► Anaerobic metabolism continues
► Increase the body’s metabolic acidosis
► Hypotension/Hypoxic injury
► Persistent hypotension
► Increase capillaries permeability

► Brain = confusion, altered mental status,

► Heart = MI
► Renal = Acute tubular necrosis, renal failure U/O less than 20 ml
► Gastro = absence peristalsis, GI ulcers and GI bleeding
► Liver = Hepatic failure
► Resp. = ARDS
► Blood Vessels = DIC
Refractory stage (Irreversible)

► Organs failure (MODS)

► Death will occur within a few hours.
 Activity:

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Topic Stages Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic Obstru

of Obstructive ctive
shock Shock

Said Said Buthaina Moza Husain Amal Said