NLE Emergency & Critical Care Nursing — Shock, Sepsis & Multi-Organ DysfunctionConcept Map

Concept

Four Classes of Shock

Sub Concepts

• Hypovolemic Shock - Volume Loss
• Cardiogenic Shock - Pump Failure
• Distributive Shock - Vascular Tone Loss
• Obstructive Shock - Mechanical Blockade

Relationship To Central

Classification based on underlying mechanism of perfusion failure

Concept

Stages of Shock Progression

Sub Concepts

• Initial Stage - Cellular Level Changes
• Compensatory Stage - Protective Reflexes Active
• Progressive Stage - Compensation Fails
• Refractory Stage - Irreversible Damage

Relationship To Central

Temporal progression through which all shock evolves, with narrowing treatment windows

Concept

Sepsis & Septic Shock

Sub Concepts

• SIRS - Systemic Inflammatory Response Syndrome
• Sepsis - Organ Dysfunction from Infection
• Septic Shock - Shock requiring vasopressors
• Sepsis Bundle - Hour-1 interventions

Relationship To Central

Most common and lethal form of distributive shock caused by dysregulated response to infection

Concept

Multi-Organ Dysfunction Syndrome (MODS)

Sub Concepts

• Organ failure sequence and progression
• Systemic inflammation and microvascular injury
• Support measures by organ system
• Prevention through early intervention

Relationship To Central

Progressive consequence of untreated or late-treated shock and severe sepsis

Concept

Disseminated Intravascular Coagulation (DIC)

Sub Concepts

• Pathophysiology - Coagulation cascade activation
• Laboratory findings - Coagulation markers
• Clinical manifestations - Bleeding and thrombosis
• Treatment - Source control and component replacement

Relationship To Central

Complication of severe shock and sepsis; simultaneous thrombosis and bleeding

Concept

Nursing Management & Priority Interventions

Sub Concepts

• Airway and oxygenation management
• Circulation support - Fluids and vasoactive drugs
• Perfusion monitoring - Lactate, MAP, urine output
• Class-specific therapy matching

Relationship To Central

Evidence-based, time-critical nursing care aligned with shock class and stage

To

Four Classes of Shock

From

Shock: Inadequate Tissue Perfusion

Strength

strong

Relationship

Shock is classified by its underlying mechanism; all classes converge on the same final pathway of failing perfusion

To

Hypovolemic Shock

From

Four Classes of Shock

Strength

strong

Relationship

Loss of circulating volume (hemorrhage, dehydration, burns, third-spacing); preload falls, cardiac output falls

To

Cardiogenic Shock

From

Four Classes of Shock

Strength

strong

Relationship

Pump failure despite adequate volume; cardiac output falls while filling pressures rise; pulmonary congestion results

To

Distributive Shock

From

Four Classes of Shock

Strength

strong

Relationship

Profound loss of vascular tone causes blood pooling; normal volume cannot maintain perfusion; includes septic, neurogenic, and anaphylactic subtypes

To

Septic Shock

From

Distributive Shock

Strength

strong

Relationship

Vasodilation and capillary leak driven by overwhelming infection; most common and lethal form of distributive shock; requires rapid sepsis bundle implementation

To

Neurogenic Shock

From

Distributive Shock

Strength

strong

Relationship

Loss of sympathetic tone after spinal cord injury above T6; distinctive for bradycardia with hypotension (not tachycardia like other shocks)

To

Anaphylactic Shock

From

Distributive Shock

Strength

strong

Relationship

IgE-mediated massive histamine release; causes vasodilation, capillary leak, and bronchospasm; requires immediate IM epinephrine

To

Obstructive Shock

From

Four Classes of Shock

Strength

strong

Relationship

Mechanical obstruction blocks blood flow (tension pneumothorax, tamponade, massive PE); requires mechanical relief, not just fluids and drugs

To

Stages of Shock Progression

From

Shock: Inadequate Tissue Perfusion

Strength

strong

Relationship

All shock progresses through four predictable stages; treatment window narrows at each step; early intervention in compensatory stage is most effective

To

Initial Stage

From

Stages of Shock Progression

Strength

strong

Relationship

Perfusion drops at cellular level; cells shift to anaerobic metabolism; lactic acid accumulates; no visible clinical signs yet; biochemical changes only

To

Compensatory Stage

From

Stages of Shock Progression

Strength

strong

Relationship

Body activates protective reflexes; sympathetic activation produces tachycardia, vasoconstriction, increased RR; blood pressure often maintained (false reassurance); MOST TREATABLE stage

To

Progressive Stage

From

Stages of Shock Progression

Strength

strong

Relationship

Compensation fails; blood pressure falls; tissue ischemia worsens; acidosis severe; altered mental status; organs begin failing; aggressive intervention can still save but margin is thin

To

Refractory Stage

From

Stages of Shock Progression

Strength

strong

Relationship

Cellular and organ damage is irreversible; patient does not respond to any therapy; death follows despite maximal support

To

SIRS

From

Septic Shock

Strength

moderate

Relationship

SIRS (≥2 of: fever/hypothermia, tachycardia, tachypnea, abnormal WBC) is a precursor to sepsis; can be triggered by infection or non-infectious insults

To

Sepsis

From

Septic Shock

Strength

strong

Relationship

Sepsis is life-threatening organ dysfunction from dysregulated response to infection; septic shock is sepsis with circulatory collapse requiring vasopressors and elevated lactate despite fluids

To

Sepsis Bundle

From

Septic Shock

Strength

strong

Relationship

Hour-1 bundle of interventions (lactate, blood cultures, antibiotics, fluids, vasopressors) is the evidence-based protocol that saves lives; each hour of delay increases mortality

To

Blood Cultures Before Antibiotics

From

Sepsis Bundle

Strength

strong

Relationship

Critical sequencing: obtain cultures first, then antibiotics; cultures drawn after antibiotics are far less useful for identifying pathogen

To

Rapid Crystalloid Resuscitation

From

Sepsis Bundle

Strength

strong

Relationship

30 mL/kg IV push is standard first-line fluid resuscitation; goal is to restore perfusion and reduce lactate; done before vasopressors

To

Vasopressor Initiation

From

Sepsis Bundle

Strength

strong

Relationship

Norepinephrine is first-line vasopressor; started only if hypotension persists after fluid resuscitation; goal MAP ≥65 mmHg

To

Multi-Organ Dysfunction Syndrome

From

Septic Shock

Strength

strong

Relationship

Untreated or late-treated septic shock is the most common cause of MODS; prolonged hypoperfusion triggers systemic inflammation and cascading organ failure

To

Multi-Organ Dysfunction Syndrome

From

Shock: Inadequate Tissue Perfusion

Strength

strong

Relationship

MODS is the progressive consequence of severe shock; failure of ≥2 organ systems; mortality increases steeply with each additional failing organ

To

Organ Failure Sequence

From

Multi-Organ Dysfunction Syndrome

Strength

strong

Relationship

Typical sequence: lungs (ARDS) first, then kidneys (AKI), liver, coagulation, GI, cardiac; progression is not always linear but reflects cumulative hypoperfusion injury

To

Disseminated Intravascular Coagulation

From

Shock: Inadequate Tissue Perfusion

Strength

moderate

Relationship

DIC is a complication of severe shock and sepsis; widespread clotting activation consumes platelets and factors, producing simultaneous thrombosis and bleeding

To

Laboratory Findings in DIC

From

Disseminated Intravascular Coagulation

Strength

strong

Relationship

Prolonged PT and aPTT, low platelets, low fibrinogen, and elevated D-dimer are hallmark findings; reflect both consumption of factors and activation of fibrinolysis

To

DIC Treatment

From

Disseminated Intravascular Coagulation

Strength

strong

Relationship

Cornerstone is correcting the underlying cause (treating infection in sepsis); supportive care replaces consumed components with FFP, cryoprecipitate, and platelets

To

Airway & Oxygenation

From

Nursing Management & Priority Interventions

Strength

strong

Relationship

First priority in all shock: ensure patent airway, adequate oxygenation, and prepare for ventilatory support; hypoxia worsens tissue perfusion

To

Circulation Support

From

Nursing Management & Priority Interventions

Strength

strong

Relationship

Position most patients supine with legs elevated to promote venous return and improve preload; exception is cardiogenic shock with pulmonary congestion (more upright position)

To

Volume & Vasoactive Drug Titration

From

Nursing Management & Priority Interventions

Strength

strong

Relationship

Rapid crystalloids through large-bore access; vasoactive drugs titrated to MAP ≥65 mmHg; therapy choice depends on shock class (fluids for hypovolemic, inotropes for cardiogenic, vasopressors for distributive)

To

Perfusion Monitoring

From

Nursing Management & Priority Interventions

Strength

strong

Relationship

Hourly assessment of urine output (≥0.5 mL/kg/hr), lactate trend, mental status, skin perfusion, and hemodynamic parameters; trends are more important than isolated values

To

Class-Specific Therapy Matching

From

Nursing Management & Priority Interventions

Strength

strong

Relationship

Critical nursing judgment: match therapy to the identified shock class; fluids for hypovolemia, inotropes for cardiogenic, vasopressors + fluids for septic, epinephrine for anaphylactic, mechanical relief for obstructive

To

Early Warning Signs

From

Compensatory Stage

Strength

strong

Relationship

Rising respiratory rate and narrowing pulse pressure are among the earliest reliable warnings of inadequate compensation; recognition at this stage enables intervention before blood pressure falls

To

Volume Replacement Treatment

From

Hypovolemic Shock

Strength

strong

Relationship

Crystalloids (normal saline or lactated Ringer's) plus blood products for hemorrhage; treatment includes source control (stop the bleeding, replace fluids)

To

Inotrope & Vasodilator Treatment

From

Cardiogenic Shock

Strength

strong

Relationship

Dobutamine or other inotropes support failing pump; vasodilators or cautious diuresis reduce afterload; aggressive fluid loading (which helps hypovolemic shock) can worsen cardiogenic shock

To

Epinephrine IM

From

Anaphylactic Shock

Strength

strong

Relationship

Priority drug is epinephrine 0.3 to 0.5 mg IM (1:1000 solution); given IM not IV for safer absorption; followed by IV access, antihistamines, and corticosteroids

To

Mechanical Relief

From

Obstructive Shock

Strength

strong

Relationship

Tension pneumothorax requires needle decompression and chest tube; tamponade requires pericardiocentesis; massive PE requires thrombolysis or embolectomy; fluids alone will not restore perfusion

To

Bradycardia Exception

From

Neurogenic Shock

Strength

strong

Relationship

Unique feature: bradycardia + hypotension + warm dry skin; every other shock is tachycardic; recognition of this distinctive pattern guides appropriate treatment (fluids, possibly atropine)

To

Early Shock Recognition

From

Prevention of MODS

Strength

strong

Relationship

Recognizing shock in compensatory stage (before hypotension) enables early intervention; waiting for blood pressure to fall means intervening in progressive stage with narrowed treatment window

To

Rapid Fluid Resuscitation

From

Prevention of MODS

Strength

strong

Relationship

30 mL/kg crystalloid bolus is standard; restores circulating volume, improves organ perfusion, and reduces lactate; critical for preventing progression to MODS

To

Timely Antibiotics in Sepsis

From

Prevention of MODS

Strength

strong

Relationship

Each hour of antibiotic delay in septic shock increases mortality; broad-spectrum coverage must start within 1 hour of recognition; cultures drawn first but do not delay antibiotics

To

Source Control

From

Prevention of MODS

Strength

strong

Relationship

Identifying and treating the infection source (imaging, cultures, possible drainage/surgery) is essential; antibiotics alone cannot cure an undrained abscess or remove infected tissue