What should a CNA do if a resident is in shock?

According to medical professionals, timely recognition and response to shock can dramatically improve outcomes for elderly residents. Knowing exactly what should a CNA do if a resident is in shock is not just a best practice—it's a critical safety measure that protects a vulnerable population.

Quick Summary

CNAs must immediately call for emergency assistance, safely position the resident to maximize blood flow (elevating the legs if no head or abdominal injury is present), keep them warm with a blanket, and closely monitor their vital signs until the nurse or medical team arrives. Swift action is non-negotiable.

Key Points

• Call for help immediately: Your top priority is to activate your facility's emergency response system by notifying the charge nurse or calling 911.

• Position resident correctly: Lay the resident down and elevate their legs unless you suspect a head, neck, or abdominal injury.

• Keep resident warm: Prevent hypothermia by covering the resident with a blanket to help maintain their body temperature.

• Monitor and observe: Continuously watch for changes in the resident's breathing, pulse, and mental state until professional medical help arrives.

• Do not give food or drink: Never attempt to give a resident in shock anything to eat or drink, as this can cause choking or interfere with treatment.

• Stay with the resident: Never leave the resident unattended, even for a moment, as their condition can change rapidly.

Recognizing the Signs of Shock in Seniors

Shock is a life-threatening condition where the body is not getting enough blood flow. For certified nursing assistants, recognizing the signs promptly is the first and most critical step. The elderly are particularly susceptible, and their symptoms may be less obvious.

Common signs of shock include:

• Rapid, weak pulse
• Low blood pressure
• Rapid, shallow breathing
• Pale, cool, clammy skin
• Confusion or altered mental state
• Dizziness or feeling faint
• Anxiety and agitation
• Nausea
• Unconsciousness

It is important to remember that not all symptoms will be present, and changes in mental status can be particularly telling in older adults.

The Critical C-A-R-E Protocol for CNAs

When you suspect a resident is in shock, your immediate, calm, and correct response is crucial. Follow this systematic C-A-R-E protocol to ensure you take all necessary steps.

Step 1: Call for Help Immediately

1. Activate Emergency Response: Immediately notify your charge nurse, supervisor, or call 911, depending on your facility's specific emergency protocol. Every second counts.
2. Provide Key Information: Give a clear, concise report. State the resident's name, room number, and what you have observed, such as “Resident Jane Doe in Room 205 appears to be in shock; she is pale, clammy, and disoriented.”

Step 2: Assess and Position the Resident Safely

1. Lay the Resident Down: Help the resident lie down on their back on a flat surface. This helps keep them stable.
2. Elevate the Legs: If there is no suspected head, neck, spinal, or abdominal injury, and they are not having difficulty breathing, carefully and gently elevate their legs about 12 inches. Use pillows, a chair, or rolled-up blankets to prop them up. This helps direct blood flow back toward the heart and brain.
3. Position on Side: If the resident is unconscious or vomiting, and you do not suspect a spinal injury, gently turn them onto their side to prevent choking.

Step 3: Respond with Comfort and Warmth

1. Maintain Body Temperature: Cover the resident with a blanket or coat to prevent a drop in body temperature. Shock can cause the body's internal thermostat to malfunction, leading to chilling.
2. Loosen Restrictive Clothing: Undo any tight clothing, such as a belt or collar, to reduce pressure and help with circulation.

Step 4: Evaluate and Monitor Vital Signs

1. Check ABCs: Continuously monitor the resident's Airway, Breathing, and Circulation. Note any changes and report them to the nurse.
2. Do Not Give Food or Drink: Never give a resident in shock anything to eat or drink. They may not be able to swallow properly, which could cause choking, or it could interfere with potential medical treatment.
3. Stay with the Resident: Do not leave the resident unattended. Provide reassurance and stay with them until a nurse or emergency medical services arrive to take over.

Comparison of Shock Types and CNA Actions

While CNAs are not expected to diagnose the specific type of shock, understanding different causes can provide context for the nurse and medical team. The initial CNA response remains largely the same, focusing on immediate stabilization.

Shock Type	Brief Description	CNA-Specific Action	Notes for CNA
Hypovolemic Shock	Caused by severe fluid loss (e.g., from severe bleeding, dehydration).	Control any obvious external bleeding by applying firm pressure with a clean cloth.	Alert the nurse to the potential cause (e.g., resident fell and has a bleeding wound).
Cardiogenic Shock	Occurs when the heart cannot pump enough blood to the body.	Do not elevate legs if breathing is compromised. Sit resident up if it eases breathing.	Observe and report chest pain, irregular pulse, or shortness of breath.
Anaphylactic Shock	A severe allergic reaction.	If an EpiPen is available and facility protocol allows, assist with its use as directed.	Report any known allergies and what might have triggered the reaction (e.g., a new food or medication).
Septic Shock	Caused by a severe infection.	Keep resident warm and monitor for fever, chills, and increased heart rate.	Document and report any signs of infection, such as fever, cough, or foul-smelling urine.

What Not to Do: Avoiding Common Errors

In a stressful emergency situation, it's easy to make mistakes. A CNA should never:

• Attempt to give the resident food or drink.
• Try to move the resident without professional medical instruction, unless they are in immediate danger.
• Leave the resident unattended at any point.
• Guess or withhold information from the emergency response team.
• Try to manage the situation alone without activating the emergency protocol.

Conclusion: The Importance of Preparedness

Properly responding when a resident is in shock is a defining moment in a CNA’s duty of care. By following a clear, structured protocol, CNAs can provide critical, life-saving assistance while awaiting professional medical help. Your preparedness, quick thinking, and adherence to safety procedures are paramount in ensuring the best possible outcome for the resident. Continuing education and drills on emergency response are essential for all healthcare professionals.

For additional first-aid information and general emergency procedures, consult authoritative resources such as the Mayo Clinic guide on shock first aid.

Frequently Asked Questions

What is the very first thing a CNA should do if they suspect a resident is in shock?

The very first action a CNA should take is to call for immediate assistance. This involves notifying the charge nurse or activating the emergency protocol for your facility, such as calling 911.

How should a CNA position a resident who is in shock?

A CNA should lay the resident on their back and, if no head, neck, or abdominal injury is suspected, elevate their legs by about 12 inches. If the resident is unconscious or vomiting, and there is no suspected spinal injury, turn them onto their side to prevent choking.

Why is keeping a resident warm so important during shock?

Keeping the resident warm by covering them with a blanket helps maintain their body temperature. In shock, the body's circulation is compromised, which can lead to a dangerous drop in core temperature. Preventing this chilling is a key part of shock first aid.

Can a CNA give a resident with shock a glass of water?

No, a CNA should never give a resident in shock food or water. Their ability to swallow may be impaired, and providing fluids can interfere with medical treatments that may be required later.

What vital signs should a CNA monitor for a resident in shock?

A CNA should monitor for changes in the resident's breathing rate and pattern, pulse rate and strength, and skin temperature and color. Any change in their level of consciousness or signs of increasing anxiety should also be reported.

What if the resident has a visible injury causing the shock?

If there is obvious bleeding, a CNA should apply direct, firm pressure to the wound with a clean cloth while waiting for the nurse or medical professionals to arrive. This helps control the bleeding while you continue to manage other shock symptoms.

How can a CNA identify the signs of shock in an elderly resident who is confused?

Look for physical signs such as pale, clammy skin, a rapid or weak pulse, and rapid breathing. A change in the resident's baseline mental status, like increased agitation or unusual confusion, can be a significant indicator of shock in the elderly.

Is shock only caused by physical injury?

No, shock can be caused by various medical emergencies besides injury, including severe infections (septic shock), heart attacks (cardiogenic shock), or severe allergic reactions (anaphylactic shock). The CNA's initial response is similar regardless of the cause.