Part 2 – Progression of Shock (A thread)
We are now going to look at how shock progresses from it’s early stages as compensated through to irreversible. #CYPStNN #Nursing @WeCYPnurses

As mentioned in part 1, shock is an illness which progresses rapidly and begins to rapidly diminish our physiological reserve the more the shock progresses. #CYPStNN #Nursing

Shock begins off as having profound impacts which exponentially increase as our patients body exhausts itself trying to fight the effects of the condition. #CYPStNN #Nursing

Phase 1 of shock is called Compensated Shock. Compensated shock is the first stage where the body begins trying to adjust to minimise the damage caused by the deficiency in oxygen and nutrients. #CYPStNN #Nursing

In compensated shock, the patient will begin to undertake automatic processes to preserve the vital organs – the brain and the heart – and begin to reduce flow to other less important areas in the peripheries. #CYPStNN #Nursing

Measures the body undertakes to compensate include raising heart rate to maintain blood pressure, increasing antidiuretic hormone secretion to retain electrolytes and vasoconstriction to reduce peripheral blood flow. #CYPStNN #Nursing

Clinical signs of phase 1 compensated shock include:
- Agitation/Confusion
- Tachycardia
- Reduced Urine Output
- Cold Peripheries
- Normal Blood Pressure
#CYPStNN #Nursing

As the physiological reserve reduces throughout compensating, i.e. the body begins to get tired of fighting we progress into phase 2 shock. #CYPStNN #Nursing

Phase 2 shock is called uncompensated shock. As the name suggests the compensatory measure the body implemented in phase 1 shock have now failed, and the physiological reserve is depleted to a dangerous level #CYPStNN #Nursing

Normal cellular function is drastically interrupted, which leads to poor perfusion. At this point the body is fighting itself, as the effects worsen as part of this vicious cycle. #CYPStNN #Nursing

As such, the effects are exponentially increased and the body cannot compensate any more to fight the effects of the shock #CYPStNN #Nursing

At this stage effective identification and treatment of the shock is essential to prevent the shock escalating to an irreversible level. #CYPStNN #Nursing

Clinical signs of phase 2 uncompensated shock include:
- Depressed Consciousness
- Tachycardia
- Severe Hypotension
- Prolonged capillary refill
- Reduced or no urine output
#CYPStNN #Nursing

Blood pressure will plummet in uncompensated shock as the body cannot effectively maintain the pressure to sustain perfusion despite tachycardia. This is a critical point for the patient. #CYPStNN #Nursing

If left untreated or unresponsive to treatment the patient will then deteriorate into phase 3 shock. #CYPStNN #Nursing

Phase 3 shock is called irreversible shock. Irreversible shock is the stage at which the affects of the shock have progressed to unsustainable, irreversible levels. #CYPStNN #Nursing

At this stage of shock, the patient has progressed through to a state where tissues have been exposed to vast amounts of anaerobic respiration, as well as prolonged insufficient oxygen and nutrient perfusion. #CYPStNN #Nursing

As such, the patient is in a state of diffused oxygen damage and multi organ failure due to the long periods of inadequate perfusion. At this stage the body has reached a point where it is “locked in” to the shock cycle. #CYPStNN #Nursing

Irreversible shock is not something diagnosed or identified during the event, rather identified after the patient has passed away. #CYPStNN #Nursing

Irreversible shock leaves the body in a state where it is incompatible with life, and as such death is inevitable for the patient. #CYPStNN #Nursing

As this thread has hopefully demonstrated, shock is a very extensive and serious condition, with profound impacts to the patient in a short period of time. #CYPStNN #Nursing

Although it can be said anyone suffering from shock is at risk, early intervention is essential to limit the damage to the patient. #CYPStNN #Nursing

Safeguarding and protecting life is our primary role as nurses, and so accurate intervention at the early stages gives us the best chance to minimise harm to our patients. #CYPStNN #Nursing

That brings us to an end of part 2 – development of shock. Next we will look at hypovolaemic shock and septic shock in greater detail in part 3! #CYPStNN #Nursing