Hypovolemic Shock

Shock, medical surgical, med surg

Video Transcript 

Hi friends in today's video. We're going to talk about hypovolemic shock. If you enjoy this video in these discussions, make sure to give this video a thumbs up and subscribe to the channel. We release a bunch of different nursing educational content to help you guys pass nursing school and pass and NCLEX to become a nurse

all right, let's get into it. So what is hypovolemic shock? So it is a reduction in intervascular, blood volume, which causes circulatory dysfunction and inadequate tissue perfusion. So vascular fluid loss causes extreme tissue hypoperfusion. So let's look at the pathophysiology of hypovolemic shock. So you have some type of fluid loss.

This can be either internal or external, which leads to a compensatory mechanisms. So the results, the resulting drop in arterial, blood pressure activates the body's compensatory mechanism in an attempt to increase the body's intravascular volume which then leads to diminished venous return as a result of a decrease in arterial blood pressure.

And the preload or the filling pressure of the heart becomes reduced. And the stroke volume is decreased. The cardiac output is decreased because of a decrease in stroke volume. There is a reduced mean arterial pressure. Which follows as the cardiac output gradually decreases. And there's a compromise of cell nutrients because as tissue profusion decreases the delivery of nutrients and oxygen to the cells also decreases which would ultimately lead to multiple organ dysfunction syndrome.

So you have this hypovolemia due to a fluid loss, which decreases the venous return that's and decreases the preload decreases cardiac output, which leads to hypotension. Then you have perfusion failure and tissue hypoxia, which leads to that organ dysfunction. And then multiorgan failure. As you can see in this diagram.

So the causes of hypovolemic shock is acute blood loss that is around one fifth of the total volume and internal fluid loss. This can result from hemorrhage or third space fluid shifting also external fluid loss, which results from severe bleeding, severe diarrhea diarrhesis or vomiting in adequate vascular volume, which leads to decreased venous return and cardiac output.

So the manifestations that we're going to see clinically include hypotension because the hypovolemic shock is reducing the amount of fluid. So you're going to have that decrease in blood pressure with a narrowed pulse pressure cognitively the patient is going to experience some mental status changes.

You might see some tachycardia to compensate for the decreased cardiac output. It was just going to lead to the heart pumping faster than normal. And you may see some rapid, shallow respirations due to a decrease in oxygen delivery and around the body systems. The respiratory system is compensating by having rapid, shallow respirations.

You may see. olguria or decreased urine output less than 25 milliliters an hour. And you may see some clammy skin that is cool and pale. So to prevent this one of the most important things nursing can do is early detection and recognizing patients with conditions that may reduce blood volume and those at risk, we can also maintain accurate I and O's so we can estimate the fluid loss and replacement as necessary to prevent the hypovolemic shock.

So there's different complications that can occur when patients are having a hypovolemic shock. So the first one is acute respiratory distress. And this occurs when fluid builds up in the tiny elastic air SACS in the lungs can also have acute tubular necrosis. It's a kidney disorder that involves damage to the tubular cells of the kidney, which leads to acute kidney failure.

You can have disseminated intravascular coagulation. This is a process characterized by widespread activation of the clotting cascade, that results in the formation of blood clots in tiny blood vessels. And you can have multiorgan dysfunction syndrome which is the end result of hypovolemic shock. So different assessment and diagnosing findings that we might see are going to include laboratory findings, such as an elevated potassium serum, lactase and blood urea nitrogen level.

We may see different urine characteristics such as an increased in urine specific gravity and osmolarity. We may also see a decrease in blood pH partial pressure of oxygen and an increase of partial pressure of carbon dioxide. So the medical management of patients that are currently experiencing hypovolemic shock.

So emergency treatment and measures must include prompt and adequate fluid and blood replacement to restore intervascular volume and raise the blood pressure. So we can do this by volume expansion using a saline solution or lactated to bring your solution. Then possibly also some plasma proteins or other plasma expanders.

This will help to produce adequate blood volume expansion until the whole blood can be matched. Because again, if a patient comes in with a hypovolemic shock due to severe blood loss, to a trauma, these are things we can use until we know their blood type and things like that to get them actual replacement with blood.

There's also. Pneumatic anti shock garment. So this counteracts bleeding and hypovolemia by slowing or stopping arterial bleeding by forcing any available blood from the lower body to the brain and heart and other vital organs. And by preventing the return of the available circulating blood to the left.

There's also, we can treat the underlying causes. Also importance of the patient is hemorrhaging. We're going to make efforts to stop the bleed, or if the causes from diarrhea or vomiting, we can use some medications to help treat the diarrhea and the vomiting. And redistribution of fluids. So positioning the patient properly assists with fluid redistribution such as a modified Trendelenburg position for hypovolemic shock.

Trendelenburg, you have the feet raised up higher than the person, because again, The blood to go back to the vital organs, which are our brain and our heart and the things located on this side of the body. So pharmacological therapy can be used to reverse hypovolemic shock. And so we can do this with vasoactive drugs that prevent cardiovascular failure.

We can use insulin. If dehydration is secondary to hyperglycemia, We can use desmopressin for diabetes insipidus and we can use antidiarrheal drugs if dehydration is due to diarrhea and we can use antiemetics if the cause is from vomiting. So our nursing assessment is going to include. A patient history to determine the possible causes.

And then we're going to look at some vital signs. So we need to know, what is their blood pressure? What is their heart rate, things like that. And we also want to assess any signs of trauma so we can figure out the mechanism of the injury. Our nursing diagnosis can include. Risk for metabolic acidosis related to decrease in the amount of blood in the capillaries deficient fluid volume related to active fluid loss, ineffective tissue perfusion, self care deficit related to physical weakness and anxiety.

Our nursing care planning goals can include maintaining volume at a functional level report. Understanding of causative factors of fluid, volume deficit, maintain normal blood pressure, temperature, and pulse, and maintain elastic skin turgor, moist tongue and mucus membranes and orientation to person place and time.

So our nursing interventions can include. We want to safely administer blood. It's important to acquire a blood specimen quickly to obtain a baseline CBC and to type and cross match the blood to anticipate for a transfusion. You also want to remember that blood is a high risk meds. Are there certain policies and procedures for running blood.

So you'll remember that you may have to pre-medicate the patient. You want to take a baseline set of vitals before you start. You have to stay with the patient and take vital signs in a very short amount of time while you're monitoring for any reaction. And these are usually based off your hospital's policies and procedures.

You also will have to type and cross-match and check the blood with another nurse before it is given, and also check the patient or double safety check. So you're also went to safely administer fluids. So monitoring the patient closely for cardiovascular overload signs of difficulty breathing, pulmonary edema, jugular, vein, distension, and laboratory.

You want a monitor daily weights for sudden decreases, especially in the presence of decreased urine output or active fluid loss. And you want to monitor vital signs of the patient with a deficient fluid volume every 15 minutes to an hour for an unstable patient and every four hours for a stable patient, an oxygen administration can increase the amount of oxygen carried by the available hemoglobin in the blood.

So our evaluation can include. Maintained fluid volume at a functional level, maintain normal blood pressure, temperature, pulse maintained elastic skin turgor, moist tongue and mucus membranes and orientation to person place and time and report his understanding of causative factors of fluid volume deficit.

And again, these are just some examples. You can have all different evaluations based on how your patient's presenting and how your interventions worked. So documentation is going to include degree of deficit and current sources of fluid intake, availability, and use of community resources, your plan of care and teaching.

I know fluid balance change in weights. Current edema, a urine specific gravity and vital signs. Results of diagnostic studies. Client's response to interventions, teaching and action plan, attainment of progress towards the diet outcomes modification to the plan of care, functional level specifics, and limitations.

And. Needed resources and adaptive devices. All right. So that is the end of the hypovolemic shock. I hope you guys found this helpful if you did make sure to subscribe to the channel and also check out the website links below. There's lots of educational resources and collect study guide that you guys should review before you take an NCLEX and a lot of free PDFs and study a, and so check those out and I'll see you guys next time.