GORDON

COLLEGE
College of Allied Health Studies
Tapinac Oval Sports Complex, Donor St., East Tapinac, Olongapo City

DETAILED LEARNING MODULE

Title: Shock Course Code: NCM 118

Module No. 7.2 Week: 8

I. Introduction
Welcome to Module 7.2. This module focuses on the nursing care of patients with a shock which
requires ongoing systematic assessment. The module will help the students to differentiate the main
types of shock, recognize clinical signs of shock, and formulate initial nursing care intervention and
management. You will be given preparatory work to read about the overview of shock. You should
be encouraged to record information on the accompanying student learning resources and
brainstorm to answer the questions and other learning tasks.
II. Learning Outcomes
After studying this module, you should be able to:
-describe the concept of shock and its underlying pathophysiology.
-compare clinical findings of the compensatory and progressive stages of shock.
-describe organ damage that may occur with shock.
-compare hypovolemic, cardiogenic, and circulatory shock in terms of causes, pathophysiologic
effects, and medical and nursing management.
-describe indications for varying types of fluid replacement. identify vasoactive medications used in
treating shock, and describe nursing implications associated with their use.
-discuss the importance of nutritional support in all forms of shock.
-identify the role of the nurse in psychosocial support of both the patient experiencing shock and the
family.

III. Topics and Key Concepts/Ideas

Topic
4.1 Shock
3.1.1 Classification of Shock
3.1.2 Stages of Shock
3.1.3 Diagnostic Studies
3.1.4 Collaborative Care
3.1.5 Nursing Management
3.1.6 Evaluation

Key Concepts/Ideas:
Anaphylactic shock, biochemical mediators, blood pressure regulation, cardiogenic shock,
circulatory shock, hypovolemic shock, neurogenic shock, septic shock, vascular responses,

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 IV. Teaching and Learning Materials and Resources
-Medical-Surgical Nursing Books/E-books -Available Open Educational Resources Portal
-Video Clips (e.g. YouTube, Khan Academy, etc.) -Study Notebook
-Slides (attached/provided by Instructor)
-Handouts/Notes (attached/provided by Instructor)

V. Learning Tasks/Activities
1. Read and review your Care of Patients with Shock. (see slides attached/provided by your
instructor)
2. For Synchronous activity:
• The instructor will discuss and present the topic in the selected online platform.
For Offline/Non-Digital activity:
• The instructor will provide the slides/handout notes/video recordings of the topic via
USB flash drive, CD, or any preferred media.
3. Watch lecture related videos if needed.
• YouTube-Shock Overview for Nursing Students https://www.youtube.com/watch?
v=Lx00aCO4GZs
• YouTube-What is Shock? (Shock Pathophysiology)
https://www.youtube.com/watch?v=aT3xsRSKq7Y
• YouTube-"Definition and Pathophysiology of Shock"
https://www.youtube.com/watch?v=J8zW4JT_KDg
• YouTube-Shock, Pathology of Different Types, Animation
https://www.youtube.com/watch?v=WueGqL58tlo
4. Read supplementary references for the topic.
5. Do a quick check of your knowledge of the overview of shock. In your own words, describe
the term given. Write your description down in your Study Notebook. When you’re done,
check the Reading Activity to see how well you did.

READING ACTIVITY:
Overview of Shock
All organs, tissues, and cells need a continuous supply of oxygen to function properly. The lungs
first bring oxygen into the body through ventilation and gas exchange, and the cardiovascular
system (heart, blood, and blood vessels) delivers oxygen by perfusion to all tissues and removes
cellular wastes. Shock is widespread abnormal cellular metabolism that occurs when gas exchange
with oxygenation and tissue perfusion needs are not met sufficiently to maintain cell function. It is a
condition rather than a disease and is the “whole-body” response that occurs when too little oxygen
is delivered to the tissues. All body organs are affected by shock and either work harder to adapt
and compensate for reduced gas exchange or perfusion or fail to function because of hypoxia.
Shock is a
“syndrome” because the problems resulting from it occur in a predictable sequence.

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Shock
Any problem that impairs oxygen perfusion to tissues and organs can start the syndrome of shock
and lead to a life-threatening emergency. Shock can best be defined as a condition in which
systemic blood pressure is inadequate to deliver oxygen and nutrients to support vital organs and
cellular function (Mikhail, 1999).
Shock is often a result of cardiovascular problems. Patients in acute care settings are at higher risk,
but shock can occur in any setting. For example, older patients in long-term care settings are at risk
for sepsis and shock related to urinary tract infections. When the body's adaptive adjustments
(compensation) or health care interventions are not effective and shock progresses, severe hypoxia
can lead to cell loss, multiple organ dysfunction syndrome (MODS), and death. Shock is classified
by the type of impairment causing it into the categories of hypovolemic shock, cardiogenic shock,
distributive shock (which includes septic shock, neurogenic shock, and anaphylactic shock), and
obstructive shock. Most manifestations of shock are similar regardless of what starts the process or
which tissues are affected first. These manifestations result from physiologic adjustments
(compensatory mechanisms) that the body makes in the attempt to ensure continued perfusion of
vital organs. These adjustment actions are triggered by the sympathetic nervous system's stress
response activating the endocrine and cardiovascular systems. Manifestations unique to any one
type of shock result from specific tissue dysfunction.

Review of Oxygenation and Tissue Perfusion

Oxygenation with gas exchange and perfusion depend on how much oxygen from arterial blood
perfuses the tissue. Perfusion is related to mean arterial pressure (MAP). The factors that influence
MAP include:
• Total blood volume
• Cardiac output
• Size and integrity of the vascular bed, especially capillaries
Total blood volume and cardiac output are directly related to MAP, so increases in either total blood
volume or cardiac output raise MAP. Decreases in either total blood volume or cardiac output lower
MAP. The size of the vascular bed is inversely (negatively) related to MAP. This means that
increases in the size of the vascular bed lo wer MAP and decreases raise MAP. The small arteries
and veins connected to capillaries can increase in diameter by relaxing the smooth muscle in vessel
walls (dilation) or decrease in diameter by contracting the muscle (vasoconstriction). When blood
vessels dilate and total blood volume remains the same, blood pressure decreases and blood flow is
slower. When blood vessels constrict and total blood volume remains the same, blood pressure
increases and blood flow is faster. Blood vessels are innervated by the sympathetic nervous system.
Some nerves continuously stimulate vascular smooth muscle so that the blood vessels are normally
partially constricted, a condition called sympathetic tone. Increases in sympathetic stimulation
constrict smooth muscle even more, raising MAP. Decreases in sympathetic tone relax smooth
muscle, dilating blood vessels and lowering MAP. Perfusion (blood flow) to organs varies and
adjusts to changes in tissue oxygen needs. The body can selectively increase blood flow to some
areas while reducing flow to others. The skin and skeletal muscles can tolerate low levels of oxygen
for hours without dying or being damaged. Other organs (e.g., heart, brain, liver, pancreas) do not
tolerate hypoxia (low levels of tissue oxygenation), and a few minutes without oxygen results in
serious damage and cell death.

Classification of Shock
Shock can be classified by etiology and may be described as (1) hypovolemic shock, (2)
cardiogenic shock, or (3) circulatory or distributive shock. Some authors identify a fourth category,
obstructive shock, that results from disorders that cause mechanical obstruction to blood flow
through the central circulatory system despite normal myocardial function and intravascular
volume.

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Examples include pulmonary embolism, cardiac tamponade, dissecting aortic aneurysm, and
tension pneumothorax. In this discussion, obstructive disorders are discussed as examples of
noncoronary cardiogenic shock. Hypovolemic shock occurs when there is a decrease in the
intravascular volume. Cardiogenic shock occurs when the heart has an impaired pumping ability; it
may be of coronary or noncoronary origin. Circulatory shock results from a maldistribution or
mismatch of blood flow to the cells.

Pathogenesis of shock
◆ Initial stage
◗ Decrease in cardiac output leads to decrease in mean arterial pressure
◗ Sympathetic nervous system is stimulated, leading to initiation of stress response ◗ Signs and
symptoms include normal to slightly increased heart rate, normal to slightly decreased blood
pressure, thirst, and pale, cool, moist skin over the face
◆ Compensatory stage
◗ Decrease in mean arterial pressure stimulates the sympathetic nervous system to release
epinephrine and norepinephrine to try to achieve homeostasis
◗ Stimulation of alpha1-adrenergic fibers causes vasoconstriction of vessels in the skin, GI organs,
kidneys, muscles, and lungs, shunting blood to the heart and brain
◗ Stimulation of beta-adrenergic fibers causes vasodilation of coronary and cerebral arteries,
increases heart rate, and increases force of myocardial contractions, resulting in increased cardiac
output
◗ Reduced renal blood fl ow leads to release of renin and production of angiotensin, resulting in
vasoconstriction and stimulation of the adrenal cortex to release aldosterone, increasing renal
sodium reabsorption
◗ Increased serum osmolarity stimulates the release of antidiuretic hormone, resulting in increased
water reabsorption by the kidneys and increased venous blood return to the heart and, ultimately,
increased cardiac output
◗ Signs and symptoms include restlessness, normal or decreasing blood pressure, bounding or
thready pulse, tachycardia, tachypnea, normal or hypoactive bowel sounds, slightly decreased urine
output, and pale, cool skin (flushed and warm in septic shock)
◆ Progressive stage
◗ Compensatory mechanisms become ineffective and possibly even counterproductive
◗ Falling cardiac output and vasoconstriction cause cellular hypoxia and anaerobic metabolism;
metabolic acidosis occurs as lactic acid levels rise
◗ Renal ischemia stimulates the renin-angiotensin-aldosterone system, causing further
vasoconstriction ◗ Fluid shifts from intravascular to interstitial space
◗ Signs and symptoms include falling blood pressure; narrowed pulse pressure; cold, clammy skin;
rapid, shallow respirations; tachycardia; weak, thready, or absent pulses; arrhythmias; absent bowel
sounds; anuria; and subnormal body temperature (subnormal or elevated in septic shock) ◆
Irreversible stage
◗ Compensatory mechanisms are ineffective
◗ Lactic acid continues to accumulate, and capillary permeability dilation increases, resulting in
loss of intravascular volume and tachycardia; this further aggravates falling blood pressure and
cardiac output
◗ Coronary and cerebral perfusion decline, and organ systems fail
◗ Signs and symptoms include unresponsiveness; areflexia; severe hypotension; slow, irregular
heart rate; absent pulses; slow, shallow, irregular respirations; Cheyne-Stokes respirations; and
respiratory and cardiac arrest

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Types of Shock
Types of shock vary because shock is a manifestation of a pathologic condition rather than a disease
state. More than one type of shock can be present at the same time. For example, trauma caused by
a car crash may trigger hemorrhage (leading to hypovolemic shock) and a myocardial infarction
(leading to cardiogenic shock).
Hypovolemic shock occurs when too little circulating blood volume decreases MAP, resulting in
inadequate total body perfusion and oxygenation. Common problems leading to hypovolemic shock
are poor clotting with hemorrhage and dehydration.
Cardiogenic shock occurs when the heart muscle is unhealthy and pumping is impaired.
Myocardial infarction is the most common cause of direct pump failure. Any type of pump failure
decreases cardiac output and MAP.
Distributive shock occurs when blood volume is not lost from the body but is distributed to the
interstitial tissues where it cannot perfuse organs. It can be caused by blood vessel dilation, pooling
of blood in venous and capillary beds, and increased capillary leak. All these factors decrease mean
arterial pressure (MAP) and may be started either by nerve changes (neural-induced) or by the
presence of some chemicals (chemical-induced). Neural-induced distributive shock is a loss of
MAP that occurs when sympathetic nerve impulses are decreased and blood vessel smooth muscles
relax, causing vasodilation and poor perfusion. Shock results when vasodilation is widespread.
Chemicalinduced distributive shock has three common origins: anaphylaxis, sepsis, and capillary
leak syndrome. It occurs when certain body chemicals or foreign substances in the blood and
vessels start widespread changes in blood vessel walls. The chemicals are usually exogenous
(originate outside the body), but this type of shock also can be induced by substances normally
found in the body, such as excessive amounts of histamine.
Anaphylaxis is an extreme type I allergic reaction. It begins within seconds to minutes after
exposure to a specific allergen in a susceptible person. The result is widespread loss of blood vessel
tone, with decreased blood pressure and decreased cardiac output. Sepsis is a widespread infection
that triggers whole-body inflammation. It leads to distributive shock when infectious
microorganisms are present in the blood and is most commonly called septic shock. Capillary leak
syndrome is the response of capillaries to the presence of body chemicals that enlarge capillary
pores and allow fluid to shift from the capillaries into the interstitial tissues. Once in the interstitial
tissue, these fluids are stagnant and cannot deliver oxygen or remove tissue waste products.
Problems causing fluid shifts include severe burns, liver disorders, ascites, peritonitis, large
wounds, kidney disease, hypoproteinemia, and trauma. Obstructive shock is cau sed by problems
that impair the ability of the normal heart to pump effectively. The heart itself remains normal, but
conditions outside the heart prevent either adequate filling of the heart or adequate contraction of
the healthy heart muscle. The most common cause of obstructive shock is cardiac tamponade.
Although the causes and initial manifestations associated with the different types of shock vary,
eventually the effects of hypotension and anaerobic cellular metabolism (metabolism without
oxygen).
Obstructive shock results from a physical obstruction that reduces cardiac output despite
normal contractility and intravascular volume; it’s caused by pulmonary embolism, dissecting aortic
aneurysm, atrial myxoma, cardiac tamponade, and tension pneumothorax.

Assessment and Diagnostic Findings

Chances of survival depend on the patient’s general health before the shock state as well as the
amount of time it takes to restore tissue perfusion. As shock progresses, organ systems
decompensate. Respiratory Effects The lungs, which become compromised early in shock, are
affected at this stage. Subsequent decompensation of the lungs increases the likelihood that
mechanical ventilation will be needed if shock progresses. Respirations are rapid and shallow.
Crackles are heard over the lung fields. Decreased pulmonary blood flow causes arterial oxygen
levels to decrease and carbon dioxide levels to increase. Hypoxemia and biochemical mediators
cause an intense inflammatory response and pulmonary vasoconstriction, perpetuating the

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pulmonary capillary hypoperfusion and hypoxemia. The hypoperfused alveoli stop producing
surfactant and subsequently collapse. Pulmonary capillaries begin to leak their contents, causing
pulmonary edema, diffusion abnormalities
(shunting), and additional alveolar collapse. Interstitial inflammation and fibrosis are common as
the pulmonary damage progresses (Fein & Calalang-Colucci, 2000). This condition is sometimes
referred to as acute respiratory distress syndrome (ARDS), acute lung injury (ALI), shock lung, or
noncardiogenic pulmonary edema.
Cardiovascular Effects A lack of adequate blood supply leads to dysrhythmias and ischemia. The
patient has a rapid heart rate, sometimes exceeding 150 bpm.
The patient may complain of chest pain and even suffer a myocardial infarction. Cardiac enzyme
levels (eg, lactate dehydrogenase, CPK-MB, and cTn-I) rise. In addition, myocardial depression and
ventricular dilation may further impair the heart’s ability to pump enough blood to the tissues to
meet oxygen requirements.
Neurologic Effects As blood flow to the brain becomes impaired, the patient’s mental status
deteriorates. Changes in mental status occur as a result of decreased cerebral perfusion and hypoxia;
the patient may initially exhibit confusion or a subtle change in behavior. Subsequently, lethargy
increases and the patient begins to lose consciousness. The pupils dilate and are only sluggishly
reactive to light.
Renal Effects When the MAP falls below 80 mm Hg (Guyton & Hall, 2000), the glomerular
filtration rate of the kidneys cannot be maintained, and drastic changes in renal function occur.
Acute renal failure (ARF) can develop. ARF is characterized by an increase in blood urea nitrogen
(BUN) and serum creatinine levels, fluid and electrolyte shifts, acid–base imbalances, and a loss of
the renal hormonal regulation of blood pressure. Urinary output usually decreases to below
0.5/mL/kg per hour (or below 30 mL per hour) but can be variable depending on the phase of ARF.
For further information about ARF, see Chapter 45.
Hepatic Effects Decreased blood flow to the liver impairs the liver cells’ ability to perform
metabolic and phagocytic functions. Consequently, the patient is less able to metabolize
medications and metabolic waste products, such as ammonia and lactic acid. The patient becomes
more susceptible to infection as the liver fails to filter bacteria from the blood. Liver enzymes
(aspartate aminotransferase [AST], formerly serum glutamic-oxaloacetic transaminase [SGOT];
alanine aminotransferase [ALT], formerly serum glutamate pyruvate transaminase [SGPT]; lactate
dehydrogenase) and bilirubin levels are elevated, and the patient appears jaundiced.
Gastrointestinal Effects Gastrointestinal ischemia can cause stress ulcers in the stomach, placing the
patient at risk for gastrointestin al bleeding. In the small intestine, the mucosa can become necrotic
and slough off, causing bloody diarrhea. Beyond the local effects of impaired perfusion,
gastrointestinal ischemia leads to bacterial toxin translocation, in which bacterial toxins enter the
bloodstream through the lymph system. In addition to causing infection, bacterial toxins can cause
cardiac depression, vasodilation, increased capillary permeability, and an intense inflammatory
response with activetion of additional biochemical mediators. The net result is interference with
healthy cells and their ability to metabolize nutrients (Balk, 2000b; Jindal et al., 2000).
Hematologic Effects The combination of hypotension, sluggish blood flow, metabolic acidosis, and
generalized hypoxemia can interfere with normal hemostatic mechanisms. Disseminated
intravascular coagulation (DIC) can occur either as a cause or as a complication of shock. In this
condition, widespread clotting and bleeding occur simultaneously. Bruises (ecchymoses) and
bleeding (petechiae) may appear in the skin. Coagulation times (prothrombin time, partial
thromboplastin time) are prolonged. Clotting factors and platelets are consumed and require
replacement therapy to achieve hemostasis.

Complications of shock
◆ Myocardial depression may be caused by decreased coronary blood flow and acidosis and can
lead to arrhythmias, MI, and cardiac failure
◆

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◆
◆

◆ Acute respiratory distress syndrome, also known as shock lung, may result from decreased
perfusion to pulmonary capillaries
◆ Renal failure may occur when prolonged renal hypoperfusion causes acute tubular necrosis
Hepatic insufficiency may stem from poor perfusion to the liver and can lead to recirculation of
bacteria and cellular debris
Disseminated intravascular coagulation may occur because shock causes excessive consumption
of clotting factors
GI ulcerations may occur when reduced blood fl ow increases acid production

Nursing interventions
◆ Ensure an adequate airway
◗ Encourage coughing and deep breathing; administer medications for pain as needed to ensure
deep breathing; suction as needed; and position the patient to maintain a patent airway and
maximum ventilation
◗ Turn the patient frequently, and elevate the head of the bed, unless contraindicated
◗ Administer oxygen as prescribed
◗ Perform postural drainage and chest physiotherapy to mobilize secretions
◗ Evaluate breath sounds for crackles and wheezes
◆ Maintain hemodynamic stability
◗ Assess pulse rate and rhythm
◗ Assess blood pressure for changes, using a Doppler ultrasound transducer if a
sphygmomanometer doesn’t provide an audible blood pressure
◆ Maintain a normal temperature
◗ Prevent hypothermia (core temperature less than 95° F [35° C]) by setting the room thermostat
higher, warming the room with infrared lights, covering the patient with warmed blankets, using a
warming mat as prescribed, warming lavage solutions, and using a fluid warmer when infusing I.V.
solutions or blood
◗ Prevent hyperthermia (increase in body temperature and metabolic rate) by removing excess
blankets, administering medications as prescribed to decrease temperature, giving a tepid sponge
bath, and using a cooling mat as prescribed
◆ Maintain normal volume status to prevent fluid imbalance
◗ Assess skin turgor for signs and symptoms of dehydration
◗
◗ Note signs of extreme thirst
◗ Monitor urine output (amount, color, and specific gravity)
◗ Monitor drainage (wound, gastric, and chest tube drainage)
◗ Check for abnormal breath sounds
◗ Assess the patient for weight gain or loss
◗ Infuse fluids as prescribed
◆ Assess blood loss, if possible
◗ Prevent complications of shock
◗ Assess nutritional status to ensure adequate caloric intake to meet metabolic demands
Watch for signs of decreased tissue perfusion, such as changes in skin color and temperature,
◗
level of consciousness (LOC), peripheral pulses, and urine output
◆ Reduce
Prepare patient andtofamily
for transfer anxiety
the critical care unit if the patient’s status deteriorates
◗ Explain all procedures in understandable terms
◗ Medicate the patient for pain to ensure patient comfort
◗ Teach the patient relaxation techniques used to reduce anxiety
◗ Give family members time to ask questions and express concerns
◆ Follow infection control policies

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Overall Management Strategies in Shock
Management in all types and all phases of shock includes the following:
• Fluid replacement to restore intravascular volume
• Vasoactive medications to restore vasomotor tone and improve cardiac function
• Nutritional support to address the metabolic requirements that are often dramatically increased in
shock.

6. Now, read, analyze, and answer the learning tasks below.

TASK 1. CRITICAL THINKING EXERCISE

Instructions: Briefly answer the exercise. (see rubrics for scoring)

Several people are admitted to the critical care unit, including (1) a 79-year-old man with a small
anterior myocardial infarction and no prior cardiac history, (2) a 47-year-old man being given
contrast media during a diagnostic procedure, (3) a 17-year-old adolescent with a cervical spine
injury after a diving accident, and (4) a 72-year-old woman who was admitted with a bowel
perforation caused by intestinal malignancy. Discuss what additional assessment information is
needed to determine which of these patients has the potential to develop shock and the rationale for
your decision.

TASK 2. ASSESSING YOUR UNDERSTANDING

Instructions: List down at least three (3) common key features of shock based on specific tissue
dysfunction/manifestations. (1 point each item)

Tissue/Organ Key Features/Manifestations

Cardiovascular The cardiovascular system consists of
the heart, blood vessels, and blood. Its
primary function is to transport nutrients
and oxygen-rich blood to all parts of the
body and to carry deoxygenated blood
back to the lungs

Signs and symptoms can include: Chest

pain, chest tightness, chest pressure and
chest discomfort (angina) Shortness of
breath. Pain, numbness, weakness or
coldness in your legs or arms if the
blood vessels in those parts of your
body are narrowed.
Respiratory Allows you to talk and to smell.
Warms air to match your body
temperature and moisturizes it to the
humidity level your body needs.
Delivers oxygen to the cells in your
body.
Removes waste gases, including carbon
dioxide, from the body when you
exhale.

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 Respiratory symptoms are common
symptoms of lung or heart conditions,
emotions, or injury. The medical terms
for respiratory symptoms include
dyspnea (difficulty breathing),
tachypnea (rapid breathing), hypopnea
(shallow breathing), hyperpnea (deep
breathing), and apnea (absence of
breathing).
Gastrointestinal The digestive system is composed of
the gastrointestinal (GI) tract, or the
alimentary canal, salivary glands, the
liver, and the exocrine pancreas. The
principal functions of the
gastrointestinal tract are to digest and
absorb ingested nutrients, and to excrete
waste products of digestion.

The Most Common Signs & Symptoms

of Gastrointestinal Disorders
Bloating & Excess Gas. Bloating could
be a sign of several GI disorders, like
Irritable Bowel Syndrome (IBS), or
food intolerance such as Celiac disease.
Constipation. ...
Diarrhea. ...
Heartburn. ...
Nausea & Vomiting. ...
Abdominal Pain.

Neuromuscular The neuromuscular system is composed

of a neural circuit including motor
neurons, sensory neurons, and skeletal
muscle fibers. The system is essential to
movements of the body, the control of
posture, and breathing. The motor nerve
fiber makes synaptic contacts with the
muscle fiber at the neuromuscular
junction.

Some symptoms common to

neuromuscular disorders include:
Muscle weakness that can lead to
twitching, cramps, aches and pains.
Muscle loss. Movement issues. Balance
problems.
Kidney The kidneys are powerful chemical
factories that perform the following
functions:

remove waste products from the body

remove drugs from the body

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 balance the body's fluids
release hormones that regulate blood
pressure
produce an active form of vitamin D
that promotes strong, healthy bones
control the production of red blood cells

Signs and symptoms of acute kidney

failure may include: Decreased urine
output, although occasionally urine
output remains normal. Fluid retention,
causing swelling in your legs, ankles or
feet. Shortness of breath
Integumentary The integumentary system includes the
epidermis, dermis, hypodermis,
associated glands, hair, and nails. In
addition to its barrier function, this
system performs many intricate
functions such as body temperature
regulation, cell fluid maintenance,
synthesis of Vitamin D, and detection of
stimuli.

Skin irregularities that are typically

symptoms of a skin disorder include:
raised bumps that are red or white.
a rash, which might be painful or itchy.
scaly or rough skin.
peeling skin.
ulcers.
open sores or lesions.
dry, cracked skin.
discolored patches of skin.

TASK 3. APPLYING YOUR KNOWLEDGE

Instructions: Briefly answer the following. (see rubrics for scoring)
1. Name three medical management goals for cardiogenic shock.
Prevent recurrence of cardiogenic shock.
Monitor hemodynamic status.
Administer medications and intravenous fluids

2. Discuss the four stages of hypovolemic shock.

Loss of up to 750 cubic centimeters (cc) or milliliters (mL) of blood, up to 15% of your total
volume. Your blood vessels narrow slightly to keep blood pressure up. Your heart rate is
normal, and your body makes as much urine as usual.

Loss of 750 to 1,500 cc of blood. Your heart rate rises. Your body starts to pull blood away
from your limbs and intestines and sends it to vital organs like your heart and brain. Your
blood pressure and urine are regular, but you may feel some anxiety.

Loss of 1,500 to 2,000 cc of blood, about a half-gallon. Your blood pressure drops. Your
body stops making as much pee. Your limbs are cold and clammy, and your skin is pale.

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 You may become confused or flustered.

Loss of more than 2,000 cc of blood, more than 40% of your total blood volume. Your heart
is racing, but you feel sluggish. Your blood pressure is very low. Your body is making little
or no pee.

TASK 4. CASE STUDY

Instructions: Consider the scenarios and answer the questions. Write down your answers in a
separate sheet of paper. At a minimum, you must cite the journal, textbook, article, and other
reading materials. Make sure to cite any references you use. Use APA style (7 th edition) for proper
citation format for your references. (see rubrics for scoring)
1. A new nurse on your medical unit tells you that she believes a patient with myocardial
infarction is going into shock. She does not know if the patient is experiencing anaphylactic
shock related to a medication he received or cardiogenic shock due to his cardiac disorder.
How would you differentiate between anaphylactic and cardiogenic shock, and what
medical treatments would you anticipate?
- Anaphylactic shock is a type of severe hypersensitivity or allergic reaction. Causes include
allergy to insect stings, medicines, or foods (nuts, berries, seafood), etc. Cardiogenic shock
happens when the heart is damaged and unable to supply sufficient blood to the body.

Anaphylactic shock is treated with diphenhydramine (Benadryl), epinephrine (an "Epi-

pen"), and steroid medications (solumedrol). Cardiogenic shock is treated by identifying and
treating the underlying cause. Hypovolemic shock is treated with fluids (saline) in minor
cases, and blood transfusions in severe cases.

2. An elderly man is admitted from a nursing home with a recent onset of confusion and
combative behavior. You know that sudden changes in mental status may be an early sign of
sepsis in the elderly. How would you assess this patient for the possibility of septic shock,
and how would the management of the elderly patient differ from that of a younger patient?
Vital signs need to be closely monitored. Although many patients with sepsis will be
febrile, up to half of septic patients can be hypothermic or normothermic.
Tachycardia is a common sign as is tachypnoea and respiratory status needs to be
closely monitored for evidence of respiratory failure. Blood pressure particularly
diastolic pressure is usually lower than normal, with severe sepsis being the most
common cause of vasodilatory shock.

-The management of severe sepsis and septic shock in the elderly should be
performed as per the International Surviving Sepsis Guidelines. The sepsis
resuscitation and management bundles should be started early and have been shown
to improve survival with good compliance over different age groups. The similar
principles of management as used in young adults, including early source control,
early goal-directed therapy, use of low tidal volume during mechanical ventilation,
should be followed. There are, however, a few specific considerations which should
be kept in mind while managing severe sepsis and septic shock in the elderly.

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Rubrics
Features 5 4 3 2 1
Focus/Analys All key Only modest Some Adequate in Weak
is aspects abstraction potential parts; gaps progression
The single identified and beyond connections in the logical of ideas
controlling related facts; missed development
point is made overly
with derivative
an
awareness of
the task about
a specific
topic.
Task Fully Sufficiently Presents a Presents Arranges
achievement addresses all addresses all clear position relevant ideas information
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task to connections connections inappropriate ab between the
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Guidelines:
The following instructions shall apply:
1.Free medium to use. You can convert your answer sheet in the following format:
a. Picture/Image b. PDF file c. Microsoft Word
2. Submit your answer to our Google Classroom/GC LAMP and use your GC domain google
account.
3. You may also use the GC Academic Assistance Desk for the submission of accomplished
modules.

NURSING CARE MANAGEMENT 118-1ST SEM 2021-2022. NOT FOR SALE. EXCLUSIVE FOR GORDON COLLEGE ONLY.
4. At a minimum, you must cite the journal, textbook, article, and other reading materials. Make
sure to cite any references you use. Use APA style (7th edition) for proper citation format for your
references.
VI. References (Online Sources/E-books)
Brunner, L. S. (2014). Study guide for Brunner & Suddarth's textbook of medical-surgical
nursing, 13th edition (Philippine). Lippincott Williams & Wilkins.
Ignatavicius, D. D., & Workman, M. L. (2016). Medical-surgical nursing: patient-centered
collaborative care (8th ed.). Elsevier Saunders.
Smeltzer, S. C., Brunner, L. S., & Suddarth, D. S. (2010). Brunner and Suddarth's textbook of
medical-surgical nursing (12th). Wolters Kluwer. https://www.pdfdrive.com/brunner-
andsuddarths-textbook-of-medical-surgical-nursing-two-volume-set-twelfth-
editione162158494.html.
Smeltzer, S. C. E. (2003). Brunner and Suddarth's textbook of medical-surgical nursing. 10th ed.
Lippincott Williams & Wilkins.
Timby, B. K., & Smith, N. E. (2010). Introductory medical-surgical nursing. Wolters Kluwer
Health/Lippincott Williams & Wilkins.

Wolters Kluwer Health/Lippincott Williams & Wilkins. (2012). Lippincott's review for
medicalsurgical nursing certification.

NURSING CARE MANAGEMENT 118-1ST SEM 2021-2022. NOT FOR SALE. EXCLUSIVE FOR GORDON COLLEGE ONLY.
 YOU HAVE COMPLETED M ODULE 7.2 . WELL DONE!

It’s now time for you to discuss your i nsights and reflections with
your classmates in the Online Discussion. Coordinate with your
Lecturer for the final details and clarifications of the topic. Before
Online Session, make sure you have organized your ideas in your
Study Notebook at hand.
Once you have completed, you may proceed to Module 8.

NURSING CARE MANAGEMENT 118-1ST SEM 2021-2022. NOT FOR SALE. EXCLUSIVE FOR GORDON COLLEGE ONLY.