Shock Stages Nursing NCLEX: Initial, Compensatory, Progressive, Refractory

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Shock stages include initial, compensatory, progressive, and refractory stages.

Shock results from a cause of some type that leads to decrease tissue perfusion to organ/tissue's cells. When the cells are deprived of perfusion they lack oxygen to function and can suffer hypoxic injury. If this is not corrected, multiple organ dysfunction syndrome can occurs along with death.

Types of shock include the following:

-Hypovolemic shock
-Cardiogenic shock
-Neurogenic shock
-Septic shock
-Obstructive shock
-Anaphylactic shock

During the initial stage of shock, the cells start to switch from aerobic metabolism to anaerboic. This results in the accumulation of lactic acid in the body. The signs and symptoms during this stage are not yet noticeable.

During the compensatory stage of shock, the body utilizes it neural, biochemical, and hormonal faculties in attempt to increase cardiac output and perfusion to the cells. For a while this works but will eventually fail in the cause of shock is not treated. This stage is reversible and the patient can recovery is the shock is successfully treated. If the patient is not treated correctly, they will progress to the progressive stage of shock.

During the progressive stage of stock, the body has failed to compensate and it is progressing to MODS. This stage is highlighted by the malfunction of all the organs. The patient's neuro status will be impaired due to a severe decrease of cerebral perfusion. The mean arterial pressure (MAP) will be less than 60 mmHg. Renal failure will ensure along with GI bleeding, acute respiratory distress syndrome (ARDS), DIC (disseminated intravascular coagulation) and so forth.

The last stage of shock is the refractory stage. The word refractory means "unmanageable". This stage is irreversible and MODS will occurs along with death.

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