WEEK 10

Question 1

there are two types of hypovolemic shock

Answer 1

External (haemorrhage/severe diarrhoea/vomiting/massive urination)
Internal (fluid shift into extravascular/interstitial space/third spacing – peritonitis/burns/ascites)

Question 2

Management of Hypovolemic ShockMedical management

Answer 2

Treat underlying cause
Fluid/blood replacement
Redistribution of fluid
Pharmacologic therapy

Question 3

Management of Hypovolemic

Nursing management

Answer 3

Haemodynamic monitoring
Maintaining arterial/venous lines/equipment
Patient assessment/vital signs/fluid balance
Oxygen
Safety/comfort/reassurance

Question 4

General Management Strategies in Shock

Answer 4

Airway support
-Maximal oxygenation/ventilatory support

Vasoactive medication therapy

• Restore vasomotor/improve cardiac function
• Adrenaline/vasopressin/dopamine

Fluid replacement
-Restore intravascular volume
Nutritional support
-To match metabolic requirements

Question 5

Fluid Replacement

Answer 5

Crystalloids: (electrolyte solutions) - 0.9% saline (normal saline)/ Hartmans (CSL)
Colloids: (plasma proteins) – albumin/gelofusine/haemaccel
Blood components (primarily for hypovolaemic shock)
Large bore cannulae x 2 (16g) at ~ 1000ml/5 mins each via hand pump/pressure bag driven/rapid infusors
CVC/intraosseus

Complications of fluid replacement include fluid overload/ pulmonary oedema/anaphylaxis (colloids)

Question 6

Nutritional Therapy

Answer 6

Nutritional support needed to meet increased metabolic, energy requirements prevent further catabolism, due to depletion of glycogen
Support with parenteral or enteral nutrition

Administration of glutamine
Amino acid essential in injury/burns/trauma

Question 7

What Is Shock?

Answer 7

Shock is a syndrome characterised by tissue ischemia from decreased perfusion and impaired cellular metabolism’

Question 8

Signs and symptoms of shock

Answer 8

Increased pulse rate may be only early sign
Pallor / sweat
Increased Resp rate
Reduced urine output (<30ml/hr)
Reduced concious level

Question 9

Types of Shock

Hypovolaemic

Answer 9

Cardiogenic
Anaphylactic
Septic
Spinal

Question 10

Hypovolaemic shock
Low Volume of Blood’
Can be any fluid.
Caused by :

Answer 10

Bleeding – internal/external
Diarrhoea / vomiting
Dehydration

Question 11

Hypovolaemic shock Treatment:

Answer 11

Oxygen
Fluid replacement
Stop further loss

Question 12

Identify Improved Organ Function

Answer 12

CNS: Improved level of consciousness
 Renal:  urinary output
 Skin: Warm, capillary refill
 Respirations: Improved rate and depth
 Vital signs: Return to normal

Question 13

What is the patient’s response? Related to volume or persistence of hemorrhage

Answer 13

Rapid responder
Transient responder
Nonresponder