A 70-year-old patient is malnourished, has a history of type 2 DM, and is admitted from the nursing home with pneumonia and tachypnea. For which kind of shock should the nurse closely monitor this patient?

Choice A rationale Septic shock is the most likely risk for this patient because they are elderly, malnourished, and have an active infection. Pneumonia is a common trigger for sepsis in nursing home residents with diabetes. Malnutrition compromises the immune system, making it difficult to fight off the invading pathogens. Tachypnea often indicates a systemic inflammatory response. Normal respiratory rates are 12 to 20 breaths per minute, while tachypnea exceeds this range. Choice B rationale Hypovolemic shock results from a significant loss of body fluids or blood, typically 15 percent or more of the total volume. While malnutrition can involve dehydration, the primary acute threat here is the infectious process of pneumonia. Unless the patient has significant fluid loss from vomiting, diarrhea, or severe hemorrhage, sepsis remains the more immediate concern. Normal fluid intake should support a central venous pressure of 2 to 8 mmHg to prevent hypovolemia. Choice C rationale Obstructive shock occurs when a physical obstruction prevents the heart from filling or ejecting blood effectively, such as a pulmonary embolism or cardiac tamponade. While pneumonia involves the lungs, it does not typically cause a mechanical blockage of the great vessels or heart. This patient lacks specific symptoms of obstruction, such as jugular venous distention or muffled heart sounds. Monitoring for systemic infection is a higher priority given the clinical history of nursing home placement. Choice D rationale Cardiogenic shock happens when the heart fails to pump enough blood to meet metabolic demands, often due to a myocardial infarction or heart failure. This patient has diabetes, which increases the risk of cardiovascular disease, but the primary admission diagnosis is pneumonia. There is no evidence of acute pump failure in the presentation. Normal cardiac index is 2.5 to 4 liters per minute per square meter, which remains stable until cardiac muscle damage occurs.