An elderly patient with a five-day history of diarrhea and vomiting is brought to the emergency room (ER). The patient is diagnosed with hypovolemic shock. The nurse recognizes which signs as advanced shock?

Cool, clammy skin
Metabolic acidosis
Obtundation

Explanation

• Shock is a physiologic state characterized by a significant reduction of systemic tissue perfusion, resulting in decreased oxygen delivery to the tissues.

Shock from dehydration causes low blood pressure and tachycardia as a compensatory mechanism. Early cerebral signs of dehydration include apprehension, restlessness, and headache.

• Obtundation is a greatly reduced level of consciousness, often occurring before coma. As fluid deficit progresses, some cerebral signs can occur such as hallucinations, maniacal behavior, and obtundation followed by coma.

• As hypovolemic shock progresses, inadequate fluid volume and tissue perfusion results in an inability of the body to meet metabolic demands. The body increases anaerobic metabolism through glycolysis, resulting in the formation of large amounts of lactic acid. This causes metabolic acidosis. 

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