Circulatory Shock

Circulatory Shock also known as ‘Shock’ is a state where there is hypo-perfusion of blood and other relevant nutrients to the cells of vital organs. This is a medical emergency condition which could lead to death when not given prompt and urgent management.

CAUSES
Causes of circulatory shock could be its forms taking in to consideration its occurrence;
1. Cardiogenic Shock: Occurs where there is compromised myocardial contractility and hence cardiac output. This further reduces the amount of blood that reaches all parts of the body; especially the peripherals and also the brain cells, causing depletion of oxygen and other vital nutrient’s supply to these cells.
2. Hypovolemic Shock: Occurs as a result of excessive loss of intravascular fluid. This could either be as a result of dehydration or hemorrhage; internal or external. The lower the amount of intravascular fluid, the lower the ability of the cardiac muscles to ensure blood reaches all parts of the body.
3. Anaphylactic Shock: Occurs as a result of severe reaction to an allergen leading to inappropriately dilatation of veins causing pool of blood.
4. Neurogenic Shock: Sympathetic nervous system is stimulated leading to inappropriately dilatation of the veins causing pool of blood
5. Septic Shock: severe systemic infections leads to capillary dilatation leading to the escape of fluid from the intravascular compartment and subsequently causing hypotension and perfusion.

STAGES OF SHOCK
I. The Initial Stage – This stage is the initial or onset level of the disorder. It is characterized by;

a. Decreased cardiac output and perfusion
b. Interrupted cellular function
c. Anaerobic metabolism increase
d. No clinical symptoms shown at this stage

II. Compensatory Stage – At this stage, the system tries to avert the situation and prevent complications by stimulating available reflex mechanisms to rescue the situation. This is done by neural, hormonal or chemical receptors.

a. Neural Compensation: Aortic pre-receptors activate sympathetic nervous system leading to contraction of blood vessels; causing the skin to be cool and clammy. Thus; stimulation of the sympathetic derive leads to adrenergic actions, causing pupillary dilatation, tachycardia and among others.
b. Hormonal Compensation: when there is decrease renal perfusion, the juxtaglomerular apparatus picks the signal and stimulates the Renin-Angiotensin-Aldosterone-System (RAAS).
c. Chemical Compensation: Decreased pulmonary blood flow causes hypoxemia. Chemoreceptors increases the rate and depth of respiration; thus causing respiratory alkalosis.

Signs and Symptoms of the Compensatory Stage
• Tarchycardia
• Pupillary dilation
• Altered level of consciousness
• Thirst Anxiety and restlessness
• Cool and clammy skin
• Concentrated urine
• Diaphoresis
• Weak and thread peripheral pulse
• Tarchypnea

III. Progressive Stage – here, Compensatory mechanism can no longer maintain perfusion. It is characterized by;
o Severe hypotension
o Massive cell death
o Organs begin to fail
Signs and Symptoms of this stage
1. Severe Depression
2. Hypoventilation; moist crackles
3. Tarchycardia, irregular pulse, weak and thread peripheral pulse
4. Urine volume below 20cc/hour

IV. Refractory Stage of Shock – Death results from system organ failure; cardiac, respiratory, liver dysfunction and kidneys shut-down

MANAGEMENT (NURSING) OF SHOCK
The objective of management is to correct underlying cause and prevent progression or complication. The nurse incharge should;
 Maintain complete bed rest in a flat position or with legs slightly raised to increase venous return
Keep client warm by covering with blanket
 Monitor mean hemodynamic indicators as ordered
 Administer parenteral therapy; medications and oxygen as ordered
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Abdul-Manaf

A final year BSc Nursing Student; School of Allied Health Science, University for Development Studies.

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