Cardiovascular cheat sheet

Shock & Sepsis Cheat Sheet

All six shock types, the stages of shock, and the septic shock bundle — with each disorder's signature sign and go-to treatment for fast NCLEX-RN review.

What's in this cheat sheet

Shock is a life-threatening state where the body cannot deliver enough oxygen and blood flow to tissues. This cheat sheet covers the stages of shock and the universal priorities, then walks through all six types — hypovolemic, septic, anaphylactic, neurogenic, cardiogenic and obstructive — each with its signature finding and the treatment the NCLEX expects you to choose.

What Is Shock?

The four categories, the compensatory → progressive → refractory stages, and the three universal priorities.

Hypovolemic & Septic

Stop the leak then replace volume; the warm vs cold faces of sepsis and the fluids-cultures-drugs bundle.

Anaphylactic & Neurogenic

Epinephrine first for anaphylaxis; bradycardia with warm dry skin as the neurogenic signature.

Cardiogenic & Obstructive

Pump failure vs a physical block — JVD clues, inotropes, and fixing the obstruction.

Key Takeaways

High-yield facts most likely to appear on the NCLEX-RN.

Hypotension + ↓ urine output + altered LOC is the universal red flag for shock — investigate immediately, regardless of type.

Septic shock = fluids and cultures BEFORE drugs: 30 mL/kg crystalloid and blood cultures come before the first antibiotic.

Keep MAP > 65 mmHg in septic shock — add norepinephrine if fluids alone aren't enough.

Anaphylaxis = epinephrine first, every time — don't wait on antihistamines or steroids.

Neurogenic shock's signature is bradycardia with warm, dry skin — unlike the tachycardia of other shocks.

For hypovolemic shock, stop the cause (control bleeding) THEN replace fluids — fluids alone won't help ongoing loss.

1. What Is Shock? Types & Stages

Without rapid correction, cells switch to anaerobic metabolism, lactate rises, and organs begin to fail.

Four categories

Hypovolemic

Volume lost — hemorrhage, severe dehydration, burns.

Distributive

Vessels dilate too much — sepsis, anaphylaxis, spinal injury.

Cardiogenic

Heart can't pump — MI, dysrhythmia, pump failure.

Obstructive

Flow physically blocked — PE, tamponade, tension pneumothorax.

Stages: Compensatory (BP still normal) → Progressive (symptomatic ↓ BP) → Refractory (organ death, irreversible). Catching shock in the compensatory stage is what saves the patient.

Three universal priorities (any shock type)

Recognize early — watch BP trends, mentation, urine output
Protect oxygenation — supplemental O2, prepare to intubate
Track perfusion — BP, MAP, cap refill, serial lactate

2. Hypovolemic & Septic Shock

Hypovolemic — clinical picture & action

Hypotension with reflex tachycardia; weak, thready pulses
Cool, pale, clammy skin; falling urine output (early kidney sign)
Stop the leak first (control bleeding, antiemetics for fluid loss)
Replace volume with isotonic crystalloid (NS or LR); give blood if hemorrhagic

Exam logic: For hypovolemic shock the sequence is stop the cause → THEN replace fluids. Don't pick fluids alone if active bleeding or loss is still ongoing.

The two faces of sepsis

Warm / early phase

Fever/chills (or hypothermia), tachycardia, tachypnea, confusion, flushed warm skin, BP normal or mildly low.

Cold / decompensated phase

BP stays low despite fluids, cool mottled skin, urine output drops, lactate climbs, breathing fails.

Septic shock sequence — fluids → cultures → drugs → watch

30 mL/kg isotonic crystalloid bolus, fast
Draw blood cultures BEFORE antibiotics
Broad-spectrum antibiotics within 1 hour (e.g. vancomycin + piperacillin-tazobactam)
Keep MAP > 65 mmHg — add norepinephrine if fluids aren't enough
Trend lactate, BP, CVP, urine output; arterial line if on pressors

Sepsis complications: DIC (clotting factors used up → bleeding, petechiae), ARDS (fluid floods alveoli → hypoxemia), and MODS (2+ organ systems failing).

3. Anaphylactic & Neurogenic Shock

Anaphylactic shock

Severe rapid allergic reaction → whole-body vasodilation PLUS airway swelling
Hives, angioedema (lip/tongue/airway), stridor, wheeze, hypotension + tachycardia
#1 action: give epinephrine IM or IV immediately
Then: prepare for intubation, diphenhydramine, corticosteroids

Neurogenic shock

Spinal cord injury knocks out sympathetic tone → vessels dilate, HR drops
Bradycardia is the signature finding (sets it apart from other shocks)
Skin stays warm and dry; hypotension present
Immobilize the spine; cautious fluids; phenylephrine for tone, atropine for bradycardia

Anaphylaxis: Epinephrine first, every time — it reverses vasodilation and opens the airway. Antihistamines and steroids come after, never before.

4. Cardiogenic & Obstructive Shock

Cardiogenic shock

Heart muscle fails as a pump (MI, dysrhythmia) → ↓ cardiac output, blood backs into lungs
Hypotension with weak pulses, cold extremities, crackles/pulmonary edema, JVD
O2 for hypoxemia; rush to cath lab if MI suspected
Inotropes (dobutamine) to boost contractility; diuretics (furosemide) for overload

Obstructive shock

A physical block of flow into/out of the heart — PE, tension pneumothorax, tamponade
JVD + sudden sharp hypotension, tachycardia, tachypnea
Treat the cause: PE → thrombolytics/anticoagulants; pneumothorax → needle decompression; tamponade → pericardiocentesis
IV fluids support BP meanwhile

Shock at a glance

Type	Signature sign	Go-to treatment
Hypovolemic	Cool/clammy, weak pulses, ↓ output	Stop loss → isotonic fluids → blood
Septic	Warm→cold shift, ↑ lactate	Fluids → cultures → antibiotics → norepinephrine (MAP >65)
Anaphylactic	Hives, angioedema, stridor	Epinephrine IM/IV first
Neurogenic	Bradycardia + warm dry skin	Spinal precautions, cautious fluids, phenylephrine, atropine
Cardiogenic	JVD + pulmonary crackles	O2, inotropes, diuretics, cath lab
Obstructive	JVD + sudden hypotension	Fix the obstruction

Shock & Sepsis Self-Test

6 quick questions — answers reveal after you submit.

Q1. A client with suspected sepsis has a lactate of 4 mmol/L. Which intervention should the nurse complete FIRST?

Q2. A client develops hives, lip swelling, and stridor minutes after a bee sting. What is the nurse's priority action?

Q3. A client with a T4 spinal cord injury has a BP of 84/50 and a heart rate of 48. The skin is warm and dry. Which type of shock is most likely?

Q4. A trauma client with active hemorrhage is hypotensive and tachycardic. Which action takes priority?

Q5. Which set of findings is the universal red flag that should prompt the nurse to investigate for shock?

Q6. A client with a tension pneumothorax shows JVD, sudden hypotension, and tracheal deviation. What is the priority intervention?

Answered 0 / 6 — unanswered count as incorrect.

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