Clinical skills: assessing and treating shock: a nursing perspective

This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Nursing copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see http://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2004.13.12.13260 This article outlines the pathophysiology associated with hypovolaemic, cardiogenic and distributive shock, and discusses how each of these might present clinically in the patient. Nursing assessment of a patient in shock is explored, and the use of tools such as the pulse oximeter are examined. The evidence base for a variety of interprofessional interventions is analysed, including fluid therapies such as blood transfusion, the use of crystalloids and colloids, and drug therapies such as the use of inotropic and vasoactive agents. The nursing role in managing the patient in shock is considered throughout. The importance of recognizing the clinical presentation of shock is highlighted, with an emphasis on understanding the pathophysiology and potential systemic effects. Treatment is discussed and covers: providing optimal oxygen therapy, appropriate patient monitoring and location of care, using effective communication skills, assisting with activities of living, psychological support, and working collaboratively to maximize the overall quality of patient care delivered.