Care of the COVID-19 Patient


Inflammatory Process

The classic signs of inflammation include redness, heat, swelling and pain. As irritants injure or irritate cells, these cells release histamine and other substances. These substances, such as histamine, prostaglandins and leukotrienes, cause the blood vessels to dilate bringing more blood to the area. This increased blood flow results in redness and heat. Histamine also causes the walls of the blood vessels to leak fluid and other substances into the tissues, which results in swelling. Accumulation of fluid and substances stimulates pain receptors; and the affected person experiences pain.

Another important point to consider is that increased blood flow brings glucose, oxygen and white blood cells to the injured site. As white blood cells do their job, many do not survive the process and these dead cells add to the accumulation of fluid, injured tissue cells and other substances. This material is known as pus or exudate. Clotting factors present in the blood stream also work to contain the area of inflammation and repair the tissue. If excessive fluid and substances collect in the area, blood flow may become impaired, which could lead to further damage of the tissue.

Upon completion of this section, you will be able to:

  1. Identify clinical signs and symptoms of shock
  2. Discuss appropriate primary nursing interventions, nursing care and management of patients with shock in IMCU


Shock is much more than a low blood pressure and/or cool, clammy skin. Rice (1999) defines shock as “a complex syndrome of decreased blood flow to body tissues resulting in cellular dysfunction and eventual organ failure” (p.1). The common denominator in all shock states is decreased cellular perfusion. If this altered cellular perfusion is not corrected the results are tissue injury (inflammatory response) and cell death. Critical care nurses are in a key position to improve clients’ survival rates from shock. Accurate, ongoing client assessment provides the opportunity for early detection of the warning signs essential to the diagnosis and management of the shock state.

Review the following video on types of shock:

Shock, Pathology of Different Types

Alila Medical Media, 2018.

Sepsis is now defined as a “life threatening organ dysfunction caused by a dysregulated host response to infection shock is a complex condition that results from an infectious process” (Singer et al, 2016, p. 804). It is the leading cause of in-hospital deaths (Urden et al., 2018). Sepsis is an intense bloodstream infection that can easily progress to multi-organ failure and death. The body’s systemic inflammatory response to the severe infection results in altered circulation, coagulation processes and impaired tissue perfusion. Septic shock, is now defined as “a subset of sepsis in which underlying circulatory and metabolism abnormalities are profound enough to substantially increase mortality” (Singer et al., 2016, p. 806). Septic shock carries a 23% to 50% mortality rate (Urden et al., 2018).

Septic shock, often begins subtly, progresses rapidly, and results in death if not recognized and aggressively treated in its early stages. Although both gram- negative and gram- positive can both cause sepsis, over the last two decades it has been shown that gram-positive bacteria are the most common cause of sepsis (Urden et al., 2018). Septic shock actually occurs as a result of the body’s attempt to destroy these invading organisms and not as a direct result of the bacteria per se. Just like neurogenic and anaphylactic shock, septic shock is characterized by massive vasodilation, decreased tissue perfusion and a loss of cellular energy.

Review the following video on sepsis: