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Shock (Stages of Shock (Progressive Stage Decrease in MAP of >20 mm…

- - - - Early manifestations: tachycardia, hypotension, narrowed pulse pressure, increased myocardial O2 consumption
        Physical assessment: tachypnea, pulmonary congestion, dec capillary refill time, anxiety, confusion, agitation
        
        increased PAWP, decreased renal perfusion and urine output
- - - - Teaching and Interventions
        
        Teach all people to prevent dehydration by having adequate fluid intake during exercise and when in hot, dry environments
        
        Urge people to prevent trauma and hemorrhage by using proper safety equipment and seat belts and being aware of hazards in the home or workplace
        
        Identify pts at risk for dehydration and assess for early manifestations
        
        Assess all patients who have invasive procedures or trauma for obvious occult bleeding
        
        Compare pulse quality and rate with baseline
        
        Compare urine output with fluid intake
        
        Check vital signs for patients who have persistent thirst
        
        Assess for shock in any patient who develops a change in mental status, an increase in pain, or an increase in anxiety.
        
        When pts have procedures and then go home, teach s/s of shock
      - Assessment
        
        Ask about recent illness, trauma, procedures, or chronic health problems
        
        Ask about the use of aspirin, other NSAIDs, and diuretics
        
        Ask about fluid intake and output during the previous 24 hours
        
        Assess for obvious signs or factors that could lead to shock
        
        Assess gums, wounds, sites of dressings, drains, and vascular access (checkunder the pt for blood)
        
        Observe for any swelling or skin discoloration that may indicate an internal hemorrhage
      - Clinical Manifestations
        Cardiovascular: occur with dec MAP leading to compensatory responses. Assess the central and peripheral pulses for rate and quality. In the initial stage, HR inc (first manifestation). Stroke vol is dec, peripheral pulses are difficult to palpate (as shock progresses may become absent). When assessing BP, compare to baseline. Systolic pressure dec. as shock progresses and CO dec. leading to dec. pulse pressure. At this stage, BP is difficult to hear. O2 sats are 90-95% during the nonprogressive stage of shock and between 75-80% with the progressive stage.
        Respiratory: Assess rate, depth, and ease of respirations. RR inc. during hypovolemic shock. When shock progresses to the stage at which lactic acidosis is present, the rr depth also inc.
        Kidney/Urinary: Assess urine for volume, color, specific gravity, and the presence of blood or protein. Measure urine output every hour. (dec urine output is a sensitive indicator of early shock). Kidney can tolerate anoxia for up to 1 hr.
        Skin: Assess for temp, color, and moisture (cool, cold, moist). Observe oral mucosa. As shock progresses, skin becomes mottled. Evaluate capillary refill. With shock, may be slow or absent.
        CNS: Assess LOC and orientation. Pt may be restless, agitated or anxious. As hypoxia progresses, leads to lethargy and loss of consciousness.
        Skeletal: Muscle weakness and pain in response to tissue hypoxia. Deep tendon reflexes are decreased or absent. Assess muscle strength. Assess deep tendon reflexes.