Is this patient having Hypovolemic shock or Cardiogenic Shock or both？

Nursing Students Student Assist

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This patient has been recovering in the ICU for the last 2-days following heart bypass surgery. He had medical history of Type II DM, IHD, hypertension and obesity. Obs are BP 95/70 RR 28 Temp 35.9 HR 140 and the urine output for the last 4-hours is 20mL.

These two type of shocks have the same sign and symptoms.I don't know which one.Anyone got some ideas?

Congrats on getting in to nursing school ;)

Now I am going to give you some solid gold advice.....what you do with it is up to you.

A successful student CANNOT READ ANYTHING INTO THE QUESTION/SCENARIO.....nothing can be assumed.

Let me say it again. NOTHING CAN BE ASSUMED.

If an IV fluid was not mentioned, it is not there. If edema is not mentioned it is not there.

Nursing tests and ultimately the NCLEX are NOTHING LIKE REAL LIFE.

Again, if data is not given it cannot be assumed.

Remember these words and you will likely succeed.

On the flip side if you miss a question because an assumption was not made, you can then challenge that question and likely get credit for it...(nursing tests).

The NCLEX is so well vetted that there is little room for disagreement.....

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Thanks, I have heard that about the NCLEX and will make sure to follow the great advice about it when taking tests, etc. I was sorta hoping I might find a deeper learning moment here. Lol. If all I know abt the patient was what was reported by the OP then I can't think of how to tell if it's hypovolemic or cardiogenic. I don't think there's enough data. Regardless, I will keep following, reading and hoping to learn more. Thanks!

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Yes yes...

The people who failed out of my nursing program where primarily paramedics and lpns who had years of real world experience....

They just could not block out their real life/real world insight...

And it cost them dearly

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You are correct jt, there is not enough data....

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Can I ask what might be a really stupid question? I'm about to start nursing school in May and I appreciate all the great direction that is given here. I know very, very little about cardiogenic shock. However, what I'm wondering is this: if a patient has been icu post op for 2 days, they are surely getting IV fluids, right? If the patient has hypovolemic shock due to internal bleeding, there would be dehydration signs in the pt's tissues, no? And if the patient had cardiogenic shock due to decreased capacity of the heart, the tissues would potentially show edema, would they not? The fluid coming in through the IV has to go somewhere doesn't it? Any comments on my (very inexperienced, newbie) thinking process would be greatly appreciated.

Well not exactly. Not all heart failure has edema. Not all volume losses show in the tissues. A rapid loss of blood volume will cause symptoms long before you have symptoms of dehydration. A blood loss from a surgical hemorrhage will result in low blood pressure, fast heart rate, dizziness, paleness and sweating. Children with no underlying health issues will reflect changes in their skin but chronically ill adults....not so much.

The loss from a sudden arterial rupture like the bypass graft is so acute if is very difficult to "keep up" with IVF and any fluid on board don't count.

Although there is a condition called shock lung. The pulmonary system usually does not cause the shock itself. There is cardiac, volume, infection, allergic. That's about it. For someone not in school good effort. Don't ry to get too ahead of yourself...you will learn it all in good time. You willoverhwelm yourself and get confused.

Good luck in school!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Well, the best clinical indicator of cardiac output is urine output. 20 mL over 4 hours is very poor.

However, from just the info provided it cannot be ascertained if this is caused by hypovolemia or by poor CO....

It would require reading into the scenario......

But yes, recent cardiac surgery is an issue......

We still really really really need to know that CVP and PAWP in my very humble opinion ;)

Yes humble :rolleyes:....but for a student you are usually pretty good at critical thinking and pathophysiology. ( I mean that sincerely)

I thought you had it there for a minute. But don't always depend on the fancy readings and equipment to hand your answer in a silver platter....what if in this patients deterioration he became confused and whipped out his Swan........now what would you do?

Return to the basics. Assessment. Look at the B/P........95/70 Narrow pulse pressure. A hallmark of cardiogenic shock.

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