Circulatory failure that starves tissues of oxygen; a falling blood pressure with a fast, weak pulse is the classic picture.
Shock is inadequate tissue perfusion that starves cells of oxygen, with types including hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), and obstructive. Early shock shows tachycardia and restlessness as the body compensates; hypotension is a late and dangerous sign of decompensation. Restoring perfusion early — with fluids, oxygen, and treatment of the underlying cause — improves survival.
A body-wide, life-threatening reaction to infection; fever, a rising heart rate and a falling blood pressure need immediate reporting.
Sepsis is the body’s response to an infection turning against it and damaging its own organs. It can move to septic shock within hours, so the LPN’s contribution is catching it early and escalating fast rather than waiting to see whether the client improves.
Watch the vital signs together rather than one at a time. Fever or an unexpectedly low temperature, a heart rate climbing above 90, breathing faster than 20, and a blood pressure drifting down make a pattern that should go to the RN immediately. New confusion in an older adult is often the first thing anyone notices, and urine output falling off is an early sign the kidneys are already affected. Report the trend, not just the single reading, and say plainly that you are concerned about sepsis. Treatment is time-critical: cultures are drawn before antibiotics start so the organism can still be identified, and IV fluids go in early to support blood pressure. Every hour of delay raises the chance the client dies.
A heartbeat that is too fast, too slow or irregular; the LPN reports a new irregular pulse rather than interpreting the rhythm.
An arrhythmia is an abnormal heart rate or rhythm that can range from benign to immediately life-threatening. Pulseless ventricular tachycardia and ventricular fibrillation are shockable and require immediate defibrillation, whereas asystole and pulseless electrical activity are not shocked but treated with CPR and medications. Always correlate the monitor tracing with the client’s actual pulse and level of consciousness — treat the client, not the monitor.
Swelling from fluid trapped in the tissues, graded by pitting depth and tracked with daily weights.
Edema is excess fluid in the interstitial tissues, often a sign of heart failure, renal disease, or fluid overload. Daily weight is the most accurate measure of fluid status, since a 1 kg change roughly equals 1 L of fluid — far more reliable than visible swelling. Weigh the client at the same time, on the same scale, in similar clothing each day for a valid trend.
Too little oxygen reaching the tissues; restlessness is the earliest sign and cyanosis a late one.
Hypoxia is inadequate oxygen delivery at the tissue level, and the brain is the first organ to show it. Restlessness, anxiety, and confusion are early signs, while cyanosis is a late and ominous one — never wait for blue skin to act. Apply oxygen, raise the head of bed, and reposition to optimize ventilation while identifying and treating the underlying cause.
A blood pH under 7.35; new confusion, drowsiness or deep rapid breathing should be reported to the RN.
Acidosis is a blood pH below 7.35 caused by an excess of acid or a loss of base. Distinguishing the cause guides treatment: respiratory acidosis comes from retained CO2 (hypoventilation), while metabolic acidosis comes from acid buildup or bicarbonate loss, as in diabetic ketoacidosis. Deep, rapid Kussmaul respirations are the lungs trying to blow off CO2 to compensate for metabolic acidosis.
Blood flow to tissue that has dropped below what it needs, signalled by pain, pallor and coolness.
Ischemia is reduced blood flow and oxygen delivery to tissue, often from a narrowed or blocked artery. It is reversible if flow is restored quickly, which is why “time is muscle” in a heart attack and “time is brain” in a stroke — rapid reperfusion limits damage. Prolonged ischemia progresses to irreversible tissue death, or infarction.
A sudden burst of abnormal brain activity; the priority is protecting the airway and preventing injury, never restraining the client.
A seizure is abnormal electrical brain activity causing involuntary changes in movement, sensation, or awareness. During one, protect the head, turn the client to the side to keep the airway clear, loosen tight clothing, and never insert anything into the mouth or restrain the limbs. Afterward, maintain the airway during the postictal period and document the onset, duration, and type of activity observed.