NUR 156
NUR 156 Test 2 Review UPDATED 2026
Shock
inadequate tissue perfusion
Initial Stage (shock)
- Not clinically apparent
- Cells damaged through inflammation and edema
- Metabolism changes from aerobic to anaerobic
- Lactic acid accumulates and toxicity builds
Compensatory Stage (shock)
- Vasoconstriction increases HR = maintains BP and CO
- Rapid shallow breathing and respiratory alkalosis
- SX: Blood shunting = cool, clammy skin; hypoactive bowel, decreased UO,
confusion
- Perfusion gradually becomes inadequate
Progressive Stage (shock)
- Last chance to rescue patient
- BP can no longer compensate (BP + MAP decrease) DESPITE FLUID BOLUS
- Deterioration of organ perfusion, vasoconstriction, mental status
- Rapid shallow breathing (lungs begin to fail) and renal injury ensues
- SX: Narrowing pulse pressure, low CO, liver/GI dysfunction
- Multiple organ dysfunction syndrome (MODS) and disseminated intravascular
coagulation (DIC) can occur
Irreversible/Refractory Stage (shock)
NUR 156
,NUR 156
- No response to treatment
- BP remains low despite fluids and vasopressors
- Respiratory dysfunction despite mechanical ventilation
- Progresses to complete organ failure
- Worsening acidosis
- MGMT: provide family comfort and education; palliative care; advanced
directives; spiritual needs
MODS
- "Multiple Organ Dysfunction Syndrome"
- Altered function of 2 or more organs that requires intervention
- Most commonly seen in septic shock
- Due to inadequate tissue perfusion
- Lungs often fail first
Fluids for Shock
- Improves cardiac and tissue oxygenation
- Crystalloids given first (NS or LR)
- Or colloids -> albumin, hetastarch, PRBCs, FFP, platelets
- Fluid overload = pulmonary edema, cardiovascular overload, abdominal
compartment syndrome
Hypovolemic Shock
- Most common
- 15-30% loss of intravascular volume
- Due to external fluid loss or internal fluid shift
- Decreased CO and perfusion
NUR 156
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- SX: weakness, AMS/LOC, tachypnea, tachycardia, weak pulse, cool/clammy skin,
hypotension, decreased UO
- TX: replace fluids/blood, modified Trendelenburg, antidiarrheals/antiemetics
- MGMT: 2 large bore IV sites, O2, monitoring, admin of blood
Cardiogenic Shock
- Ability to pump/contract is impaired and oxygen becomes inadequate
- Decreased CO and tissue hypoxia
- Coronary cause is most common; noncoronary related that causes stress on
myocardium
- SX: anxiety, tachypnea, narrow pulse pressure, fatigue, angina, muffled heart
sounds, dysrhythmias, pulmonary congestion
- TX: O2, fluids, labs, EKG, morphine, dobutamine, nitroglycerin, dopamine
MGMT: cardiac/hemo/oxygen monitoring, 2 large bore IVs
Circulatory/Distributive Shock
- Intravascular volume pools in peripheral blood vessels causing
hypovolemia (displaced volume)
- Loss of sympathetic tone = vasodilation
- Types: Neurogenic, anaphylactic, septic
Neurogenic Shock
- Vasodilation due to parasympathetic stimulation
- Hypovolemic state
- SX: the higher the level of SCI the more severe; hypotension, bradycardia, flaccid
paralysis below injury, dry/warm skin
- TX: vasopressors, atropine, fluids, neuro checks, labs, imaging
- MGMT: monitor for hypothermia/VTE, provide nutritional support
NUR 156
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Anaphylactic Shock
- Hypersensitivity histamine release due to stored antibodies to specific antigen
- Massive vasodilation and high capillary permeability
- Cardiovascular compromise from mins to hrs after exposure
- Symptoms present 5-30 mins after exposure
- SX: rapid hypotension, neuro compromise, respiratory distress, GI distress, tissue
irritation -> need 2 or more to diagnose
- TX: epinephrine IM, antihistamines, corticosteroids, bronchodilators,
endotracheal tube, fluids, vasopressors
- MGMT: ABCs, 2 large bore IVs
Septic Shock
- Massive vasodilation leads to hypotension
- Fluids/vasopressors cannot maintain BP
- Mental confusion is EARLY SIGN
- Diagnosis needs lactic >2 or SBP <100 AFTER fluid bolus/vasopressors
- SX: AMS/LOC, temperature dysfunction, resp. failure
- TX: broad abx, fluids, vasopressors, IV sedation/analgesia, treat
hypo/hyperthermia, transfuse blood, O2 anticoagulants
- MGMT: monitor hemo, UO, nutritional support
SIRS (systemic inflammatory response syndrome)
- Can be caused by ischemia, inflammation, trauma, infection
- SX: Temp too high/too low, heart rate >90, respiratory rate >20, WBC >12K/<4K -
> must meet 2 or more to diagnose
- SIRS + INFECTION = SEPSIS
NUR 156
NUR 156 Test 2 Review UPDATED 2026
Shock
inadequate tissue perfusion
Initial Stage (shock)
- Not clinically apparent
- Cells damaged through inflammation and edema
- Metabolism changes from aerobic to anaerobic
- Lactic acid accumulates and toxicity builds
Compensatory Stage (shock)
- Vasoconstriction increases HR = maintains BP and CO
- Rapid shallow breathing and respiratory alkalosis
- SX: Blood shunting = cool, clammy skin; hypoactive bowel, decreased UO,
confusion
- Perfusion gradually becomes inadequate
Progressive Stage (shock)
- Last chance to rescue patient
- BP can no longer compensate (BP + MAP decrease) DESPITE FLUID BOLUS
- Deterioration of organ perfusion, vasoconstriction, mental status
- Rapid shallow breathing (lungs begin to fail) and renal injury ensues
- SX: Narrowing pulse pressure, low CO, liver/GI dysfunction
- Multiple organ dysfunction syndrome (MODS) and disseminated intravascular
coagulation (DIC) can occur
Irreversible/Refractory Stage (shock)
NUR 156
,NUR 156
- No response to treatment
- BP remains low despite fluids and vasopressors
- Respiratory dysfunction despite mechanical ventilation
- Progresses to complete organ failure
- Worsening acidosis
- MGMT: provide family comfort and education; palliative care; advanced
directives; spiritual needs
MODS
- "Multiple Organ Dysfunction Syndrome"
- Altered function of 2 or more organs that requires intervention
- Most commonly seen in septic shock
- Due to inadequate tissue perfusion
- Lungs often fail first
Fluids for Shock
- Improves cardiac and tissue oxygenation
- Crystalloids given first (NS or LR)
- Or colloids -> albumin, hetastarch, PRBCs, FFP, platelets
- Fluid overload = pulmonary edema, cardiovascular overload, abdominal
compartment syndrome
Hypovolemic Shock
- Most common
- 15-30% loss of intravascular volume
- Due to external fluid loss or internal fluid shift
- Decreased CO and perfusion
NUR 156
,NUR 156
- SX: weakness, AMS/LOC, tachypnea, tachycardia, weak pulse, cool/clammy skin,
hypotension, decreased UO
- TX: replace fluids/blood, modified Trendelenburg, antidiarrheals/antiemetics
- MGMT: 2 large bore IV sites, O2, monitoring, admin of blood
Cardiogenic Shock
- Ability to pump/contract is impaired and oxygen becomes inadequate
- Decreased CO and tissue hypoxia
- Coronary cause is most common; noncoronary related that causes stress on
myocardium
- SX: anxiety, tachypnea, narrow pulse pressure, fatigue, angina, muffled heart
sounds, dysrhythmias, pulmonary congestion
- TX: O2, fluids, labs, EKG, morphine, dobutamine, nitroglycerin, dopamine
MGMT: cardiac/hemo/oxygen monitoring, 2 large bore IVs
Circulatory/Distributive Shock
- Intravascular volume pools in peripheral blood vessels causing
hypovolemia (displaced volume)
- Loss of sympathetic tone = vasodilation
- Types: Neurogenic, anaphylactic, septic
Neurogenic Shock
- Vasodilation due to parasympathetic stimulation
- Hypovolemic state
- SX: the higher the level of SCI the more severe; hypotension, bradycardia, flaccid
paralysis below injury, dry/warm skin
- TX: vasopressors, atropine, fluids, neuro checks, labs, imaging
- MGMT: monitor for hypothermia/VTE, provide nutritional support
NUR 156
, NUR 156
Anaphylactic Shock
- Hypersensitivity histamine release due to stored antibodies to specific antigen
- Massive vasodilation and high capillary permeability
- Cardiovascular compromise from mins to hrs after exposure
- Symptoms present 5-30 mins after exposure
- SX: rapid hypotension, neuro compromise, respiratory distress, GI distress, tissue
irritation -> need 2 or more to diagnose
- TX: epinephrine IM, antihistamines, corticosteroids, bronchodilators,
endotracheal tube, fluids, vasopressors
- MGMT: ABCs, 2 large bore IVs
Septic Shock
- Massive vasodilation leads to hypotension
- Fluids/vasopressors cannot maintain BP
- Mental confusion is EARLY SIGN
- Diagnosis needs lactic >2 or SBP <100 AFTER fluid bolus/vasopressors
- SX: AMS/LOC, temperature dysfunction, resp. failure
- TX: broad abx, fluids, vasopressors, IV sedation/analgesia, treat
hypo/hyperthermia, transfuse blood, O2 anticoagulants
- MGMT: monitor hemo, UO, nutritional support
SIRS (systemic inflammatory response syndrome)
- Can be caused by ischemia, inflammation, trauma, infection
- SX: Temp too high/too low, heart rate >90, respiratory rate >20, WBC >12K/<4K -
> must meet 2 or more to diagnose
- SIRS + INFECTION = SEPSIS
NUR 156
