Neurogenic Shock: Stages and Assessment (Nursing)

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.