Shock is a life-threatening condition with a variety of underlying causes. It is characterized by inadequate tissue perfusion that, if left untreated, results in cell death. The progression of shock, is neither linear nor predictable , and shock stages especially septic shock, comprise a current area of combined effort by members of the health care team in treating its clinical manifestations and the primary underlying cause.
Shock can be best defined as a condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs in the body in sustaining healthy cellular function and metabolism. Nurses and other members of the health care team caring for an individual with clinical shock and those at high risk of shock must understand the underlying mechanism of shock and recognize its subtle as well as more obvious signs. Rapid assessment and response are essential to the patient’s speedy and full recovery.
Clinical Significance of Shock
In shock, the body’s primary delivery and transport system of transporting oxygen rich blood to vital organ systems is either compromised or damaged. Adequate blood flow to the tissues and cells requires the following components: (1) adequate cardiac pump, (2) effective vascular or circulatory system, (3) and sufficient blood volume. If one component is impaired or is compromised, perfusion to the tissues is threatened or compromised. Without prompt and proper treatment, inadequate blood flow to the tissues results in poor delivery of oxygen and nutrients to the cells, cellular starvation, cell death, organ dysfunction which progresses to organ failure and eventually death follows.
Effects of Shock to the Body in General
Shock affects all body systems it may develop rapidly or slowly, depending on the underlying cause. During shock, the body struggles to survive, calling on all its homeostatic mechanism to restore blood flow. Any further injury to the body can create a cascade of events resulting in poor tissue perfusion. Hence, almost any patient with any disease state may be at high risk of developing shock.
Care of patients with shock requires ongoing systematic assessment. Many of the interventions required in caring for patients with shock call for close collaboration with other members of the health care team and the standard operating procedures and orders for shock cases must be rapidly implemented to prevent further complications from occurring. Members of the healthcare team must anticipate orders because such orders need to be executed rapidly and accurately.
Conditions Precipitating Shock
Conventionally, the primary underlying pathophysiologic process and the underlying disorders are used to classify the state of shock. Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These physiological responses are hypo-perfusion of the tissues, hyper-metabolism and activation of the inflammatory response. The body responds to shock states by activating the sympathetic nervous system and mounting a hyper-metabolic and inflammatory response. Once the shock develops, the patient’s survival may have more to down with the body’s response than with the initial cause of shock. The final common pathway of all forms of shock is inadequate perfusion of the cells that results in cellular hypoxia, end organ damage and ultimately death.