RNSG 2432 Enhanced Concepts of Adult Health

Module 15:  Providing Patient-Centered Care for the Individual with Shock:/Critical Care Nursing


Module Objectives:  

Utilizing clinical reasoning and the nursing process the student will:

  1. Analyze comprehensive assessment findings by:

a. Comparing and contrasting risk factors associated with shock.

b. Considering the etiology and pathophysiology for the following disorders:


  • A. Classification

        1. Cardiogenic  2. Hypovolemic 3. Distributive 4. Obstructive

    B. SIRS- Systemic Inflammatory Response Syndrome

C. MODS- Multiple Organ Dysfunction Syndrome

        c. Considering the signs and symptoms and complications of the disorders:

  • Shock
    • Stages of shock
    • Effect of shock on body systems- MODS
    • Types of shock
        • Cardiogenic
        • Hypovolemic (absolute and relative)
        • Distrubutive (septic, neurogenic and anaphylactic)
        • Obstructive

         d.  Integrating the diagnostic tests with the etiology, pathophysiology,and          signs and symptoms for the following:

  • Shock
        • Cardiac and hemodynamic monitoring
        • Pulse oximetry- O2 saturation
        • Frequent vital signs
        • Urine output- BUN and Creatinine
        • Lactate level
        • Blood sugar- increased early, decreased later
        • ABG’s
        • Electrolytes
        • Liver enzymes

2.  Formulate relevant prioritized nursing diagnosis that address physical,    psychosocial, and learning needs.

  • Shock
      • Decreased cardiac output
      • Ineffective tissue perfusion- renal, cerebral, cardiopulmonary, gastrointestinal, hepatic, and peripheral
      • Fear and anxiety

3. Formulate patient and family centered goals and outcomes that facilitate toward health promotion, maintenance, and restoration.

4. Utilize evidence based practice to prioritize, implement and evaluate nursing interventions related to:
  • Safe environment; Risk reduction
  • Medication therapy:
    • Shock
            • Fluid replacement
            • Positive inotropes- dobutamine, dopamine
            • Vasodilators (mainly cardiogenic)
            • Vasopressors/Vasoconstrictors- epinephrine (mainly maldistribution)
            • IV Corticosteroids
            • Xigris- only for septic shock
  • Diet therapy
    • Hypermetabolic states
  • Surgical interventions:
    • Shock
      • IAPB
      • VAD
      • Positioning of patient
      • Airway maintenance
      • Other
  • Patient teaching; Discharge teaching; Referrals
  • Therapeutic communication
  • Delegation
  • Other:
    • Organ donations

5. Collaborate with the interdisiplinary health care team when providing patient- centered care.

6. Evaluate patient responses to therapeutic interventions and revise goals and modify the nursing care plan.

7. Integrate associated issues, trends, and informatics into nursing practice.

  • Legal issues
  • Ethical considerations
  • Quality improvement
  • Complementary medicine

Learning Activities:

1. Review module objectives.

2. Learning Resources:


    • Lewis p. 1717-1743; review p. 1685-1694(hemodynamic monitoring)
    • PPT/Sirs
    • Complete: Learning Guide:Shock
    • Lewis, p.1742 Clinical Decision Making-case study-access Ch 67 StudentResources>PrepareforClass etc>Answer Key case studies
    • *AccessLewis Student Resources-ch67-Prepare for Class etc, complete (1)Case Studies- Patient with Sepsis; (2) Patient with Cardiogenic Shock (3) Patient with Acute Pancreatitis and Septic Shock, (4) Pre-assessment Quiz


3. Complete Critical Thinking Exercises:

  • Shock Tutorial (Select Shock and complete the following units: Introduction, What is Shock and Key Points; explore other units for in-depth understanding of pathophysiology of shock)
  • Nursing care plan; Patient in Shock, Lewis p. 1742; Clinical Decision making, Lewis p. 1742, answer question, ck answers

Interactive exercises:

4. Supplemental Learning:

Web sites (opt): *only for personal interest!

5. Review module objectives and check for knowledge gaps.

6. Complete module quiz

  • Blackboard: Critical Care/Shock Quiz
  • NCLEX Examination questions p.1742-1743