Cardiovascular: occur with dec MAP leading to compensatory responses. Assess the central and peripheral pulses for rate and quality. In the initial stage, HR inc (first manifestation). Stroke vol is dec, peripheral pulses are difficult to palpate (as shock progresses may become absent). When assessing BP, compare to baseline. Systolic pressure dec. as shock progresses and CO dec. leading to dec. pulse pressure. At this stage, BP is difficult to hear. O2 sats are 90-95% during the nonprogressive stage of shock and between 75-80% with the progressive stage.
Respiratory: Assess rate, depth, and ease of respirations. RR inc. during hypovolemic shock. When shock progresses to the stage at which lactic acidosis is present, the rr depth also inc.
Kidney/Urinary: Assess urine for volume, color, specific gravity, and the presence of blood or protein. Measure urine output every hour. (dec urine output is a sensitive indicator of early shock). Kidney can tolerate anoxia for up to 1 hr.
Skin: Assess for temp, color, and moisture (cool, cold, moist). Observe oral mucosa. As shock progresses, skin becomes mottled. Evaluate capillary refill. With shock, may be slow or absent.
CNS: Assess LOC and orientation. Pt may be restless, agitated or anxious. As hypoxia progresses, leads to lethargy and loss of consciousness.
Skeletal: Muscle weakness and pain in response to tissue hypoxia. Deep tendon reflexes are decreased or absent. Assess muscle strength. Assess deep tendon reflexes.