NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00205 |
|---|---|
| Label | Risk for shock |
| Spanish label | Riesgo de shock |
| Domain | 11. Safety / protection |
| Class | 2. Physical injury |
| Type | Risk |
| Status | Current |
What it means
The patient is at risk of blood flow to the tissues dropping below what the organs need, with organ damage that can become life-threatening. Shock is not present yet: the goal is close monitoring and correcting whatever could trigger it before it happens.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Infection with signs of a systemic response: fever, tachycardia, tachypnea, confusion.
- Active or recent bleeding, even if blood pressure is still normal.
- Acute pancreatitis, bowel obstruction or burns with large fluid losses.
- After major surgery with high drain output.
- Patients with MI or heart failure who are starting to run borderline low blood pressures.
- An ongoing allergic reaction after a medication or food.
What to assess
- Mean arterial pressure (MAP): below 65 mmHg means perfusion is compromised.
- Heart rate and shock index (HR divided by systolic BP): a value above 0.9 is a red flag even when the BP looks normal.
- Respiratory rate: 22 breaths/min or higher is an early sign of severity.
- Mental status: new restlessness, confusion or drowsiness.
- Skin: capillary refill over 2 seconds, coolness, pallor or mottling over the knees.
- Hourly urine output: less than 0.5 mL/kg/h for two hours in a row.
- Serum lactate if available: 2 mmol/L or higher indicates hypoperfusion.
- Temperature, drain output or bleeding, and fluid balance.
Risk factors
What makes the problem more likely, and what nursing can monitor or modify.
- Insufficient or delayed fluid replacement for known losses.
- Fluid or blood losses that are not being measured.
- Vital signs and urine output checked at intervals too long for the patient's acuity.
- Delays in drawing cultures or giving prescribed antimicrobials.
- Uncontrolled fever or hypothermia.
- Poor fluid intake over the previous days.
- Patient or family unable to recognize warning signs.
- External bleeding not controlled with local measures.
At-risk populations
- Older adults, who may not mount a fever or tachycardia.
- Immunocompromised patients: chemotherapy, transplant, long-term corticosteroids.
- Patients after major surgery.
- Patients with multiple trauma or extensive burns.
- Postpartum patients with heavy bleeding.
Associated conditions
- Sepsis and other severe infections.
- GI, obstetric or traumatic hemorrhage.
- Severe acute pancreatitis.
- Acute myocardial infarction and decompensated heart failure.
- Anaphylaxis.
- Severe dehydration and extensive burns.
Risk factors are what nursing can monitor and correct: fluid replacement, how often you reassess, fever, early detection. Sepsis, hemorrhage or MI are associated conditions: they explain the risk, but treating them is up to the medical team. If your program requires it, write them as "in a patient with...".
How to write it (PES)
Risk for shock related to poor fluid intake over the previous three days and uncontrolled hyperthermia, in a patient with urosepsis (associated condition).
This is a risk diagnosis, so there is no "as evidenced by." If the patient already has hypotension that does not respond to fluids, shock is established: the care plan shifts to the actual problems (inadequate fluid volume, ineffective perfusion) and to collaborative care with the medical team.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Maintains a MAP of 65 mmHg or higher throughout monitoring.
- Maintains urine output of at least 0.5 mL/kg/h every hour during the first 24 hours.
- Lactate drops below 2 mmol/L within the first 6 to 12 hours if it was elevated.
- Remains at baseline level of consciousness with capillary refill under 2 seconds.
- Patient and family know to report dizziness, confusion, cold skin or decreased urine.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Take vital signs with MAP every 15 to 30 minutes at first, then space them out as the patient stabilizes. | Catching a drop in pressure within minutes changes the outcome. |
| Calculate the shock index and use your facility's early warning score. | Both help you recognize deterioration before hypotension shows up. |
| Secure two large-bore peripheral IVs and give the prescribed fluids at the ordered rate. | Timely fluid replacement is the first step in supporting perfusion. |
| If sepsis is suspected, draw the ordered cultures before the first antimicrobial dose, then give it without delay. | Every hour of delay in antimicrobial therapy worsens the outcome. |
| Measure urine output hourly and keep strict intake and output. | Urine output reflects renal perfusion and responds quickly to fluid replacement. |
| Monitor for crackles, dyspnea and SpO2 while fluids are running. | Some patients cannot tolerate large volumes and develop pulmonary edema. |
| Control fever with cooling measures and the prescribed antipyretic. | Fever increases oxygen consumption and fluid losses. |
| Notify the provider immediately if MAP drops below 65 mmHg, lactate rises or new confusion appears. | These are signs of progression to shock that need urgent medical treatment. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0418Shock Severity: Cardiogenic
- 0419Shock Severity: Hypovolemic
- 0421Shock Severity: Septic
NIC interventions
- 4260Shock Prevention
- 4180Hypovolemia Management
- 4140Fluid Resuscitation
- 6680Vital Signs Monitoring
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Urosepsis in an older woman
Patient. 72-year-old woman, 60 kg, arrives at the ED with fever and right flank pain for three days. Her daughter says she has barely been drinking and seems more drowsy today.
Assessment
- Temperature 38.9 °C (102 °F), HR 112 bpm, BP 104/62 mmHg (MAP 76 mmHg), RR 23 breaths/min.
- Shock index of 1.08.
- Drowsy but oriented, GCS 14.
- Urine output of 25 mL in the last hour (0.4 mL/kg/h), cloudy urine.
- Capillary refill of 3 seconds and dry mucous membranes.
- Lactate 2.6 mmol/L; elevated WBC count.
Nursing diagnosis
Risk for shock related to poor fluid intake over the previous three days and uncontrolled hyperthermia, in a patient with urosepsis (associated condition).
Goal
Maintains a MAP of 65 mmHg or higher and urine output of at least 30 mL/h (0.5 mL/kg/h) during the first 24 hours.
Interventions
- Start two peripheral IVs and give the prescribed crystalloids.
- Draw blood and urine cultures, then give the prescribed antimicrobial right away.
- Vital signs with MAP every 15 minutes for the first hour, then hourly.
- Insert an indwelling urinary catheter per order and measure hourly urine output.
- Cooling measures and prescribed antipyretic; repeat lactate as ordered.
- Auscultate lungs every 2 hours and notify the provider if MAP drops below 65 mmHg.
Evaluation
At 6 hours, MAP is 78 mmHg, HR 96 bpm and urine output 35-45 mL/h; lactate is down to 1.6 mmol/L. At 24 hours she is afebrile and alert. The diagnosis is kept for another 24 hours with checks every 2 hours and resolved if she stays stable.
How it differs from similar diagnoses
- Inadequate fluid volume (00421): Inadequate fluid volume is an actual problem that is already present: tachycardia, oliguria, dry mucous membranes. It can coexist with risk for shock.
- Risk for excessive bleeding (00374): Risk for excessive bleeding focuses on preventing hemorrhage. If the patient is already bleeding and perfusion is threatened, the focus moves to risk for shock.
- Risk for decreased cardiac output (00240): Risk for decreased cardiac output focuses on the heart's pumping function, not on every cause of hypoperfusion.
- Risk for infection (00004): Risk for infection is used when there is no infection yet. Once there is an infection with systemic signs, the focus is risk for shock.
Common mistakes
- Keeping risk for shock when the patient is already hypotensive and on vasopressors: shock is already present.
- Listing only medical conditions as factors ("related to sepsis") with nothing nursing can change.
- Waiting for the blood pressure to drop before acting: tachycardia, tachypnea, confusion and oliguria come first.
- Relying on systolic pressure alone in a hypertensive patient, for whom 110 mmHg may already be a significant drop.
Used in these conditions
Other diagnoses in the Physical injury class
Domain 11, Safety / protection. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for risk for shock?
00205. It belongs to Domain 11 (Safety/protection), Class 2 (Physical injury), and remains current in the 2024-2026 edition.
Does risk for shock have an "as evidenced by" part?
No. It is a risk diagnosis, so you only write the risk factors.
What signs show that the risk is turning into actual shock?
MAP below 65 mmHg, lactate of 2 mmol/L or higher, urine output under 0.5 mL/kg/h, mottled skin, slow capillary refill and new confusion.
Can I use risk for shock for a patient with sepsis?
Yes, as long as perfusion is maintained. It is one of the most common uses. If the patient progresses to persistent hypotension, shock is established and the diagnoses change.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Risk for shock (00205) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1. Reviewed November 2, 2026.