哪些評估結果是急性低血容性休克早期階段的預期表現？（選所有適合的）
Which assessment findings are expected in a client experiencing early stages of acute hypovolemic shock? (Select all that apply.)
- ATachycardia✓ 正解心搏過速
- BCool, clammy skin✓ 正解皮膚冰冷、濕冷
- CIncreased urinary output尿量增加
- DRestlessness or anxiety✓ 正解煩躁不安或焦慮
- EHypotension低血壓
低血容性休克早期，身體啟動代償機制以維持心輸出量。交感神經興奮導致心跳加速（Tachycardia）與血管收縮引起皮膚冰冷濕冷（Cool, clammy skin），腦部灌流變化則導致不安感（Restlessness）。尿量減少是腎臟灌流不足的結果，而非增加；低血壓則是晚期代償失調的表現，早期血壓通常可維持正常。
In early hypovolemic shock, the body activates compensatory mechanisms to maintain cardiac output. Sympathetic stimulation causes tachycardia, and vasoconstriction produces cool, clammy skin; altered cerebral perfusion leads to restlessness. Decreased urine output results from inadequate renal perfusion rather than an increase, and hypotension is a manifestation of decompensation in the late stage — blood pressure can usually be maintained within normal limits during the early phase.
台美臨床對於休克早期辨識皆強調代償機制，但美國護理師常依據 EWS (Early Warning Score) 進行早期偵測。