NCLEX Practice Questions: Compensated vs Decompensated Shock (Neuro)

Question:

A child is brought to the hospital for care after falling down some stairs and is in a state of neurogenic shock. The nurse performs an initial assessment on the patient. Which parameter best identifies whether the patient is in a state of compensated or decompensated shock?

Answer:

D. A drop in blood pressure

Rationale:

Shock can be divided into stages, depending on the body's response to the illness or injury; the symptoms demonstrated during the different stages of shock indicate the stage and also guide the provider toward its treatment. Compensated shock occurs when the body is trying to maintain near-normal vital signs and perfusion, despite the injury to circulation and metabolism. Alternatively, decompensated shock is a state in which the body is no longer able to keep up and deterioration occurs. One of the most significant differences between compensated and decompensated shock is a drop in blood pressure, in which the body is no longer able to maintain intravascular pressure to perfuse vital organs.

[MAXMAX-zurx]

The heart has not developed stretch receptors, so it is not capable of increasing stroke volume. Tachycardia is the only response the pediatric heart can make to circulatory insufficiency. This physiological feature, plus a child's significant capacity for vasoconstriction, means that a fall in blood pressure is a very late sign of shock. In addition, children have a greater proportion of circulating blood per body weight; 8 - 9 percent (or 80 – 90 mL/kg). However, absolute volume is less. Therefore, a 500 mL loss, for example, may be very serious. In comparison, circulating blood volume of an adult is 7 percent of the lean body mass (70 mL/kg). A 70 kg adult thus has 5000 mL of circulating blood.