Hypovolemic Shock

Question 1

Define hypovolemic shock

Answer 1

loss of intravascular volume of 15% or more

Question 2

what are the symptoms of hypovolemic shock?

Answer 2

tachycardia, cool pale skin, tachypnoea, oliguria, increased capillary refill time, confusion anxiety or agitation, HOTN

Question 3

explain why tachycardia and HOTN can manifest in hypovolemic shock

Answer 3

low intravascular volume causes difficulties maintaining BP where heart rate increases as a compensatory mechanism to increase CO

Question 4

list the symptoms in hypovolemic shock associated with low perfusion

Answer 4

oliguria, increased capillary refill time, confusion, anxiety or agitation, cool pale skin

Question 5

explain why tachypnoea can occur in hypovolemic shock

Answer 5

low cardiac output leads to low perfusion and oxygenation which stimulates the SNS compensatory mechanisms including increase RR as a means to reduce PaCO2 in the blood and increase O2

Question 6

explain why skin may become cool and pale in hypovolemic shock

Answer 6

due to low blood volume, the body increases peripheral vasoconstriction to prioritise blood flow to vital organs eg heart and brain therefore limited blood flow to skin= reducing temp and colour

Question 7

identify 3 nursing interventions appropriate for a patient with hypovolemic shock and provide a rationale for each

Answer 7

1) elevate lower limbs with horizontal trunk and head just above to increase venous return and cardiac output
2) initiate O2 therapy to maintain SpO2 >92%, support tissue oxygenation and cellular function
3) administer prescribed IV fluids to increase intravascular volume and support tissue perfusion

Question 8

explain how you would evaluate the change of position and provide a rationale for this

Answer 8

monitor BP for improvement or maintenance, improved skin colour and decreased heart rate as position should increase venous return which will increase SV and CO increasing BP, decreasing HR, and decreasing need for compensatory mechanisms such as peripheral vasoconstriction

Question 9

explain how you would evaluate the O2 therapy and provide a rationale for this

Answer 9

Monitor O2 sats to ensure they maintain levels of 92%, assess for improved skin colour and maintained or normal resp rate as oxygen therapy should support tissue perfusion and decrease need for compensation from respiratory rate

Question 10

describe the flow chart of hypovolemic shock

Answer 10

initial loss of intravascular volume-> decreased venous return -> decreased preload -> decreased CO (tachycardia) -> HOTN (increased peripheral vasoconstriction) -> Perfusion failure and tissue hypoxia -> organ dysfunction -> multi organ failure

Question 11

Explain why abdomen pain may occur after bowel resection surgery in the context of hypovolemic shock

Answer 11

abdomen pain may occur after surgery with symptoms of hypovolemic shock caused by haemorrhage from the surgery, the pain is caused by blood irritating the abdomen lining

Question 12

explain why patient may have oliguria in HVS

Answer 12

oliguria can occur as body tries to increase intravascular volume and therefore reabsorbs fluid instead of creating urine, additionally can be due to low perfusion of the kidney resulting in impaired function

Question 13

what causes increased capillary refill time in HVS

Answer 13

low perfusion and increased peripheral vasoconstriction

Question 14

fill in the blanks for evaluating the elevation of lower limbs
Monitor BP for improvement/maintenance, slowed ___ and improved __________ as position should increase venous return which will increase ___ and CO=increase ______ and decreasing need for CM increased _______ and increasing ___________

Answer 14

HR, skin colour, SV, BP, heart rate, perfusion of skin

Question 15

fill in the blanks for evaluating O2 therapy
Monitor O2 sats to ensure they maintain levels of 92%, assess for improved _______ and maintained or normal ______ as oxygen therapy should support _______ and decrease need for _______ from ___________

Answer 15

skin colour, RR, tissue perfusion, compensation, respiratory rate

Question 16

explain how you would evaluate IV fluids and provide a rationale for this

Answer 16

Monitor skin colour, capillary refill time, BP, HR and SpO2 as increased intravascular volume should improve perfusion of skin, increase SV and CO which would increase BP and reduce need for CM increased HR