Hypovolemic Shock

Question 1

What is shock?

Answer 1

Systemic abnormal cellular metabolism occurring when tissue oxygenation does not meet the needs to maintain cellular function
- Supply does not equal demand

Question 2

4 types of shock

Answer 2

• Hypovolemic (volume loss)
• Cardiogenic
• Distributive
• Obstructive

Question 3

What are the two main components of cardiac output?

Answer 3

Heart rate and stroke volume

Question 4

What are the three components of stroke volume?

Answer 4

Preload (volume of blood within ventricle)
Afterload (resistance)
Contractility (ejection)

Question 5

Risk factors for hypovolemic shock

Answer 5

• Burns
• GI loss: vomiting, diarrhea
• Excessive sweating
• Bleeding: injury, bleeding disorders, physiologic bleeding

Question 6

Class I Hemorrhage

Answer 6

• Up to 15% of blood vol
• No change in vitals
• Fluid resuscitation not necessary

Question 7

Class II Hemorrhage

Answer 7

• 15-30% of total blood vol
• Tachycardic
• Narrowing pulse pressure
• Peripheral vasoconstriction
• Pale/cool skin
• Slight changes in behavior
• Volume resuscitation w crystalloids
• Blood transfusion not required

Question 8

Class III Hemorrhage

Answer 8

• Loss of 30-40% blood volume
• BP drops
• HR increases
• Peripheral hypoperfusion
• Diminished cap refill
• Mental status worsens
• Fluid resuscitation with crystalloid and blood transfusion

Question 9

Class IV Hemorrhage

Answer 9

• Loss of more than 40% circulating blood volume
• Limit of body’s compensation is reached
• Need aggressive resuscitation

Question 10

Assessment of Hemorrhage

Answer 10

• Mottled/purple skin
• Cyanotic muscus membranes
• Thready pulse
• Increased HR
• Increased RR
• Oliguria
• Pale/cool/clammy skin
• Cognition changes
• BP Changes
• Diminshed cap refill

Question 11

Compensatory Mechanisms for Hemorrhage

Answer 11

• Fluid retention: aldosterone, ADH, RAA

- Shunting: diversion of blood, attempt to maintain organ perfusion

Question 12

Shock Interventions

Answer 12

Ventilation
Infusion
Pharm

Question 13

Ventilation Interventions

Answer 13

• Give O2
• Maintain open airway
• Semi-fowlers position
• Pulmonary toilet (turn, cough, deep breathe)
• Prevent shivering and promote rest

Question 14

Infusion Interventions

Answer 14

• Assess GI tract for PO fluids
• Consider IV fluids
• Optimize position

Question 15

Pharm Interventions

Answer 15

• Avoid IM injections (usually IV meds)
• O2 admin
• Stop bleeding
• Vasoactive medes

Question 16

Effectiveness of Interventions

Answer 16

• Skin: warm, dry, 2+ pulses, cap refill less than 3 sec
• HR: 60-100 bpm, regular rhythm, stable BP
• RR: 12-20, clear lung sounds
• LOC: calm, A and O x4
• Kidneys: increased urinary output over 30 mL/hr
• GI: peristalsis