Shock in the pediatric patient.

Care of the child in shock requires careful and constant assessment of the child's systemic perfusion. In addition, oxygenation and ventilation must be supported. The child's heart rate must be maintained, since pediatric cardiac output often is directly related to heart rate. The goal of treatment of shock of any origin is to ensure that cardiac output is adequate to provide tissue oxygenation and substrate delivery. This goal is accomplished through careful titration of intravenous fluids to optimize ventricular preload and maximization of ventricular function (often with inotropic or vasodilator support). The child should be kept warm, and careful regulation and evaluation of total fluid intake and output is necessary. Parents should be allowed to remain with the child as much as possible, since this will comfort both the child and the parents. The child should be prepared gently for any painful procedures, and realistic but compassionate communication with the entire family is essential. Through constant assessment and evaluation of patient response to therapy, the nurse is in the best position to detect early signs of compromise and to determine effectiveness of therapy. Therefore, it is imperative that the nurse possess a thorough understanding of the pathophysiology and clinical progression of shock in the child, as well as the rationale and potential complications of management.