Shock is a clinical syndrome that is a result of inadequate tissue perfusion that creates imbalance between the delivery of and the requirements for oxygen that support cell health. Signs and symptoms of excess fluid volume or inadequate tissue perfusion characterize heart failure. Address the Following:  Describe the differences in the nursing management for hypovolemic shock, cardiogenic shock, and heart failure. Hypovolemic shock, the most common type of shock, is decreased intravascular volume because of fluid loss. It can be the result of external fluid loss as might occur with a major trauma or from internal shifts of fluid such as dehydration, ascites or extensive edema. Treatment of hypovolemic shock is focused on reestablishing the intravascular volume and reversing the initial cause of fluid loss. As fluid loss advances the heart rate increases and becomes weak resulting in a weak thread pulse and orthostatic hypotension. If fluid loss continues water is drawn from the interstitial spaces and causes decreased skin turgor, decreased urine output, dry skin and mucous membranes, and flat neck veins. Nursing management of shock includes an assessment of the patient’s history which can aid in determining possible causes of the shock and determining the type of work up a patient might require, vital signs and careful monitoring of trends in vitals, and for trauma patient’s determination of mechanism of injury. Nurses should utilize oxygen and safe administration of fluids and medications as prescribed as well as monitoring and documenting the patient’s response to treatments. The nurse must also formulate a diagnosis with the most common being deficient fluid volume, ineffective tissue perfusion and self-care deficit. The main goals for hypovolemic patients includes maintenance of fluid volume at an efficient level, continuous blood pressure, pulse and temperature within normal limits, maintenance of moist mucous membranes and tongue, elastic skin turgor, and orientation to person place time and event. Also, the patient should demonstrate an awareness of the contributing factors to deficient fluid volume. Nursing interventions are focused on aiding with treatments that pursue the cause of shock and reestablishing intravascular volume (Hinkle & Cheever, 2014). Cardiogenic shock indicates a failure of the “pump” or heart to produce the pressure needed to circulate oxygenated blood and perfuse the body. It is most often caused by MI (myocardial infarction), but can also be caused by pericardial tamponade, pulmonary embolus, myocarditis (inflammation of cardiac