Hypovolemic Shock Flashcards
How does hypovolemic shock occur?
It occurs from inadequate fluid volume in the intravascular space to support adequate perfusion
Volume loss may be either _____ or _____
Absolute or Relative
Absolute hypovolemia
Results when fluid loss is lost through a hemorrhage, GI loss, fistula drainage, diabetes insipidus, or diuresis
Relative hypovolemia
Fluid volume moves out of intravascular space into the extravascular space (intracavity space) a.k.a “third spacing”
List some examples of relative hypovolemia
-Internal bleeding
-Third-spacing of fluid; severe burns due to increased capillary permeability
-Long bone fractures
-Damage to organs like the pancreas
-Massive vasodilation…..sepsis
List some examples of absolute hypovolemia
-Massive bleeding from surgery or injury
-Excessive fluid loss: Vomiting, diarrhea, urination, sweating
What is the volume percentage a person must lose for signs and symptoms of shock to occur?
> 15% (750ml)
How much blood does an average adult have?
5L
Reduced intravascular volume results in ____
-Decreased venous return to the heart
-Decreased preload
-Decreased stroke volume
-Decreased cardiac output
What are the hallmark signs of shock?
Decreased tissue perfusion and impaired cellular metabolism
What factors does a patients response to acute volume loss depend on?
-Extent of injury
-Age
-General state of health
A patient may compensate for loss of up to ___ of the total blood volume
15%
Further loss of volume (15-30%) results in a _____
Sympathetic Nervous System (SNS) mediated response
SNS mediated response results in _____
-Increased HR
-Increased cardiac output
-Increased RR and depth
Patient may appear _____ and urine output begins to _____ if they loose 15%-30% of fluid volume
-Anxious
-Decrease
If volume loss is greater than 30%, compensatory mechanisms may _____ and immediate replacement with ______ should be started
-Fail
-Blood products
What are common lab studies and assessments done for patients with hypovolemic shock?
Serial measurements of Hgb & Hct levels, electrolytes, lactate, blood gases, mixed central venous O2 saturation (SvO2), and hourly urine outputs
Define Preload
Amount ventricles stretch at the end of diastole
Define Stroke Volume
Amount of blood the left ventricle pumps each beat (50-100mL)
Define Cardiac Output
Amount of blood the heart pumps per minute (4-8L)
How many classes/stages of hypovolemic shock are there? What are the volume percentages?
4
-Class I: <15% (750mL)
-Class II: 15%-30% (750mL - 1,500mL)
-Class III: 30%-40% (1,500mL - 2,000mL)
-Class IV: >40% (>2,000mL)
Signs and symptoms of stage 1
Asymptomatic
-HR, BP, RR, mental status – w/in normal range
-Skin: warm
-Capillary refill: < 2 sec.
-UOP: >30cc/hr
Signs and symptoms of stage 2
-HR: Increased (mild tachycardia)
-BP: Slightly decreased
-RR: Mild Increase
-UOP: 20-30cc/hr
-Skin: Cool & clammy
-Capillary refill: < 2 sec.
-Peripheral pulses: Diminished
-Mental status: Mild anxiety
Signs and symptoms of stage 3
-HR: >120 (tachycardic)
-BP: Severe hypotension
-RR: Increased (resp. failure)
-UOP: < 30cc/hr (oliguria)
-Skin: Cool, clammy, mottled
-Pulses: Poor
-Mental status: Confusion, agitation
Signs and symptoms of stage 4
Vital signs are significantly abnormal (near death)
-Major tachycardia (>140)
-Severe hypotension
-Major respiratory failure
-Anuria
-Mental status: lifeless, in a coma
What factors should we look at when coming up with goals and interventions for patients with hypovolemic shock?
Circulation, perfusion, and oxygenation
What are the treatments for hypovolemic shock?
Replace fluids and correct the underlying cause
What are signs of adequate perfusion?
-Skin: warm to touch
-Mental status: normal
-HR, BP, RR: normal
-UOP: >30cc/hr
-Capillary refill: < 2 sec.
List nursing interventions for patients with hypovolemic shock
-Give patients fluids as ordered
-Monitor patient for fluid overload
-Obtain IV access STAT
-Give the patient oxygen or put on mechanical ventilation
-If patient is bleeding, hold firm direct pressure on wound and call rapid response
-Monitor for signs of adequate perfusion
-May need to start Foley catheter
-Central line and Hemodynamic monitoring
-Position patient in modified Tredenlenburg
-Keep patient warm, but not to the point of sweating
-Monitor for fluid overload
-Monitor for blood transfusion reactions if patient is given blood
How many IV sites should a patient have?
At least 2
What size should the cannula be?
Large cannula; > 18 G
How is the patient positioned in the modified Tredelenburg position?
Supine with legs/feet elevated at 45 degrees
What types of fluids can you give to the patient?
Crystalloids, colloids, blood, and blood products (Packed RBCs, Platelets, FFP)
Crystalloids and colloids are two types of _____ used for hypovolemic shock
Volume expanders
What are two examples of crystalloids?
Normal saline & Lactated Ringers
How do crystalloids work?
They add more fluid into the intravascular system, which increases preload, SV, and CO
What should watch for when administering fluids?
Fluid overload
What are the differences between crystalloids and colloids?
-Crystalloids are able to diffuse through the capillary wall so less fluid remains in the intravascular space
-Colloids consist of large molecules so more fluid stays in the intravascular space longer
What is the 3:1 rule?
For every 1mL of approximate blood loss, 3mL of crystalloid solution is given
What are 2 examples of colloids?
Albumin & Hetastarch
Patients can have what kind of reaction when colloids are used for fluid replacement?
Anaphylactic shock
T/F: Colloids more expensive than crystalloids
True
When giving large amounts of fluid, what should the nurse do?
Warm the fluid to prevent hypothermia
Packed RBCs help ____
Replace fluid and provides the patient with Hgb
When can you give packed RBCs?
When the patient is not responding to crystalloid fluids, experienced severe bleeding/severe hypovolemic shock
What are platelets used for?
Uncontrolled bleeding to help with thrombocytopenia
What are FFP used for?
When patient needs clotting factors
What should you monitor for when giving blood and blood products?
Transfusion reactions
