shock [Fr, choc] , an abnormal condition of inadequate blood flow to the body’s tissues, with life-threatening cellular dysfunction. The condition is usually associated with inadequate cardiac output, hypotension, oliguria, changes in peripheral blood flow resistance and distribution, and tissue damage. Causal factors include hemorrhage, vomiting, diarrhea, inadequate fluid intake, or excessive fluid loss, resulting in hypovolemia. Kinds include anaphylactic shock, cardiogenic shock, hypovolemic shock, neurogenic shock, septic shock. ▪ OBSERVATIONS: Hypovolemic shock is the most common kind of shock. There is decreased blood flow with a resulting reduction in the delivery of oxygen, nutrients, hormones, and electrolytes to the body’s tissues and a concomitant decreased removal of metabolic wastes. Pulse and respirations are increased. Blood pressure may decline after an initial slight increase. The patient often shows signs of restlessness and anxiety, an effect related to decreased blood flow to the brain. There also may be weakness, lethargy, pallor, and cool, moist skin. As shock progresses, the body temperature falls, respirations become rapid and shallow, and the pulse pressure (the difference between systolic and diastolic blood pressures) narrows as compensatory vasoconstriction causes the diastolic pressure to be elevated or maintained in the face of a falling systolic blood pressure. Urinary output is reduced. Hemorrhage may be apparent or concealed, although other factors, such as vomiting or diarrhea, may account for the deficiency of body fluids. ▪ INTERVENTIONS: Fluid volume must be restored quickly so that there can be a rapid return of oxygenated blood to the perfusion-deprived tissues. Supplemental oxygen should be administered. Blood volume is expanded with IV fluids, such as a lactated Ringer’s solution or a 5% dextrose in normal saline solution. Packed red blood cells, plasma, and plasma substitutes are also given for shock of hemorrhagic origin. Metabolic acidosis may result from anaerobic metabolism. ▪ PATIENT CARE CONSIDERATIONS: After vital functions are restored and diagnosis has been made, the patient in shock must be monitored continuously until recovery is assured. The patient should remain flat in bed, but the lower extremities can be raised to improve venous return (modified Trendelenburg’s position). The Trendelenburg position should be avoided because it tends to push the abdominal organs against the diaphragm and increases the work of breathing. Position changes should be made slowly. Vasoactive drugs may be ordered when the blood volume is adequate. The patient’s skin color, temperature, vital signs, intake and output, pulse oximetry, and level of consciousness should be monitored closely.
