It has been noted that shock in children can be easily managed if early recognition of the condition is achieved and if timely intervention and treatment is initiated. Nurses have a big role in such through proper patient assessment, family education, and proper management.

Assessment

It is crucial for the health team to come up with the most detailed and frequent assessment of a child with shock. It is in this stage that the prognosis and survival can be projected to either a positive or a negative outcome.

Parameters that greatly matters in assessing a child with shock are the following:

• Pulses (proximal and peripheral pulses)
• Perfusion
• Skin color
• Skin temperature
• Vital signs
• Urine output
• Level of consciousness
• Respiratory functions

Ongoing assessment is also critical; therefore as the disease progresses or improves, indicators to predict survival have been noted:

• Heart rate
• Arterial blood pressure
• Serum lactate levels
• Degree of acidosis

Nursing Diagnosis

• Decreased cardiac output related to inadequate intravascular volume
  • As evidenced by:
    • Hypotension
    • Deprived perfusion
    • Lethargy
    • Increased Cardiac rate
    • Deficient urine output
    • Ineffective peripheral tissue perfusion related to vasodilation and coagulopathy
      • As evidenced by:
        • Decreased urine output
        • Metabolic acidosis
        • Altered neurologic status
        • Decreased cardiac output related to decreased cardiac function
          • As evidenced by:
            • Decreased blood pressure
            • Poor perfusion
            • Lethargy
            • Tachycardia
            • Lesser urine output

Outcome Identification

• Patient will be able to restore normal volume status, heart rate, urine output, blood pressure, and level of consciousness within twenty four to forty eight (24 – 48) hours.
• Patient will be able to exhibit restoration of normal vascular tone (septic – induced distributive shock).
• Patient will be able to obtain normal blood cultures and without indication of any bleeding alterations and disorders.
• Patient will be able to obtain blood cultures negative of sepsis.

Planning and Implementation

• Vital signs monitoring
• Perfusion assessment and monitoring
• Carrying out orders for administration of both intravenous fluids and medications (such as inotropics and antibiotics)
• Strict monitoring of intake and output (diarrhea, vomiting, etc.)
• Respiratory status monitoring (includes assessment, oxygen supplementation and if indicated, endotracheal intubation)
• On-going neurological assessment noting consciousness and lethargic episodes (airway support should be ready at hand)
• If coagulopathies are present, blood transfusions (fresh frozen plasmas) might be indicated, or Vitamin K is administered as ordered.
• Antibiotics are given as ordered foe septic induced shocks.
• Febrile episodes may be common which can be treated with antipyretics.

Evaluation

• After proper and adequate interventions, the child will be stable with good respiratory, circulatory, cardiac and neurologic functions.
• There will be no more evidence of sepsis and coagulopathies, all laboratory works will be normal.
• Fever will subside and white blood count will be within normal limits.