Neurogenic Shock: Stages and Assessment (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Now, let's look at the stages and assessment findings in neurogenic shock.

    00:05 We've already kind of given you some hints and cues as to what is going to happen.

    00:09 Now, speaking of cues, we're bringing in the NCSBN Clinical Judgment Measurement Model.

    00:15 We've looked at the layers before Layer 0, Layer 1, Layer 2, what I really want to focus in on is like usual, Layer 3.

    00:24 recognizing queues, analyzing queues.

    00:27 So, before we go on, what would be some cues that you can pause the video, write down and see what you can recall.

    00:33 Alright, don't peek.

    00:34 Just try and see what you can recall.

    00:36 This will help you study with us as we go.

    00:44 Hey, welcome back.

    00:46 Alright, I hope you took advantage of that, because that is the best way to study if we can do it together.

    00:52 Because if you don't look at your notes, and you try to remember or recall, I promise you, that's going to make it stick in your brain that much better.

    01:00 So we're moving through those options in Layer 3.

    01:03 And layer four is also important.

    01:05 But remember, we're focusing on Layer 3, particularly in physiological adaptation type questions.

    01:13 Here are the four stages of shock that we've used in our other video series.

    01:17 Initial stage, things are kind of okay.

    01:20 But as you continue down that spectrum, from compensatory, to progressive, to refractory, those are definitely signs of decline your patient is doing worse.

    01:32 So, the idea is that you recognize the cues in the initial stage, so you can catch it and resolve the underlying cause, so you don't end up declining.

    01:42 Alright, so you got it. Those are the four stages.

    01:45 I want to talk to you about something that is different in neurogenic shock than what we talked about in hypovolemic shock.

    01:51 Remember, in hypovolemic shock, you have less volume in your intravascular space, so your heart rate goes up, and your body tries to move that around faster.

    02:01 In neurogenic shock, you don't have the sympathetic nervous system tone to respond like that.

    02:07 So instead of everything going faster, you end up with bradycardia, or slow heart rate, and your blood pressure is also low.

    02:16 Why? I know I've said it many times in this video.

    02:20 And I'll keep reinforcing that for you.

    02:22 In neurogenic shock, you've lost the sympathetic nervous system tone.

    02:26 So, that parasympathetic system is running wild.

    02:29 That's why you have a slow heart rate and low blood pressure. Okay.

    02:34 This is what's different than something like hypovolemic shock.

    02:38 Now, at first, the patient's skin is warm because of the massive vasodilation.

    02:42 So that's another sign that would be different than the other types of shock that we've discussed.

    About the Lecture

    The lecture Neurogenic Shock: Stages and Assessment (Nursing) by Rhonda Lawes, PhD, RN is from the course Shock (Nursing).

    Included Quiz Questions

    1. Bradycardia and hypotension
    2. Bradycardia and hypertension
    3. Tachycardia and hypotension
    4. Tachycardia and hypertension

    Author of lecture Neurogenic Shock: Stages and Assessment (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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