Adult Health

Shock—

– Syndrome characterized by ↓ tissue perfusion and impaired cellular metabolism resulting in an
imbalance b/w the supply of and demand for O2 and nutrients (exchange is essential for life).
When cells experience hypo tissue perfusion, the demand for O2 and nutrients exceeds the
supply at the microcirculatory level.
– Types of Shock
o Distributive shock
o Hypovolemic shock
o Cardiogenic shock
o Obstructive shock
Cardiogenic shock
– Occurs when systolic or diastolic dysfunction of the heart’s pumping action results in reduced
CO
o Most common cause is acute MI
o Early clinical presentation can be
▪ Tachycardia
▪ Hypotension
▪ Tachypnea with crackles & cyanosis
– Manifestations to include
o Decreased cap refill
o Increased Na+ and water retention
o Decreased urine output
o Decreased bowels, N/V
o Increased blood glucose
o Increased BUN
Hypovolemic Shock
– Occurs after a loss of intravascular fluid volume
o Absolute – loss through hemorrhage, GI loss, body drainage, diabetes insipidus or
diuresis
▪ Loss of blood, loss of other body fluids through vomiting, diarrhea, GI bleeding,
excessive diuresis
o Relative – when fluid volume moves out of the vascular space into the extravascular
space
▪ fluid shift, internal bleeding, massive vasodilation and pooling of blood or other
body fluids
– Manifestations to include
o Tachypnea leading to the late sign of bradypnea
o Decreased urine output
o Pallor, cool clammy skin
o Anxiety, confusion, agitation
o Absent bowels
o Decreased HCT & HGB
o Increased lactate
Neurogenic Shock
– Can occur within 30 minutes of a spinal cord injury an can last up to 6 weeks
– Most important clinical manifestations are
Adult Health II
Chapter 66 – shock, sepsis & MODS
o Hypotension
o Bradycardia
– Manifestations to include
o Skin will initially be warm from massive vasodilation, then risk for hypothermia once
heat disperses
o Flaccid paralysis
o Bladder dysfunction
Anaphylactic Shock
– An acute, life threatening hypersensitivity allergic reaction.
– Reactions causes massive vasodilation, release of vasoactive mediators (can constrict or dilate)
and increased capillary permeability leading to fluid leaks from the vascular space into the
interstitial space
– Can lead to respiratory distress
– Sudden onset of symptoms include
o Dizziness
o Chest pain
o Incontinence
o Swelling of lips and tongue
o Wheezing and stridor
o Flushing skin
o Pruritus and urticaria
o Confusion

– Sepsis is defined as a set of symptoms or syndrome in response to an infection
– Shock is a subset of sepsis with an increased mortality. It is characterized by persistent
hypotension and inadequate tissue perfusion
– Manifestations to include
o Hyperventilation
o Crackles
o Respiratory alkalosis leading to acidosis
o Pulmonary HTN
o Respiratory failure
o Warm & flushed skin leading to the late sign of cool & mottled
o Confusion & agitation, can lead to coma (late)
o Increase glucose
o Increased lactate

o Invasion of microorganism with an amplified response to the infection
▪ Bacteria (most common)
▪ Fungus, virus or parasites