Académique Documents
Professionnel Documents
Culture Documents
haemorrhage
Submitted to: submitted by:
Mrs. rajbir kaur pooja rani
Lecturer m.sc (n)2 year
nd
Submitted on:
SPECIFIC OBJECTIVES
At the end of the class student will able to provide the comprehensives care to the patient with hemorrhage.
CONTRIBUTORY OBJECTIVES:
2. 2min Define hemorrhage. Hemorrhage is defined as a loss of blood What is the Loss of blood from PPT Define
from the body is called hemorrhage. definition of the body is called hemorrhage.
hemorrhage? hemorrhage.
3. 2min Explain how the Blood in the fluid form because the balance
hemorrhage occurs. between clotting and fibrinolysis.
4. 4min Describe the factor FACTORS AFFECTING CLOTTING What are the factor Prothrombin and PPT Enlist the
affecting the ARE- affect the clotting? fibrinogen. factors
clotting. 1. Calcium affecting blood
2. Prothrombin clotting.
3. Fibrinogen
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
1. CALCIUM-
Calcium helps in clotting of
blood.
This calcium is displaced
from the body by 3.8%
solution of sodium citrate etc.
2. PROTHROMBIN-
It is formed from vit. K, a fat
soluble vitamin absorbed
from the small intestine.
Its help in the clotting factors.
3. FIBRINOGEN-
In the absence of fibrinogen
severe bleeding may occur.
Its help in the phenomenon
known as fibrinolysis by
dissolving the fibrin
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
5. 3min Enlist the types of A.ACCORDING TO THE VESSELS What are the types These are of three PPT What are the
hemorrhage. INVOLVE- of hemorrhage? types arterial, types of
a) Arterial hemorrhage capillary and hemorrhage?
b) Capillary hemorrhage venous
c) Venous hemorrhage hemorrhage.
a) ARTERIAL HEMORRHAGE-
Blood loss from the artery is
known as arterial
hemorrhage.
The blood is bright red.
Blood loss is more rapid from
a vessel of corresponding.
b) CAPILLARY HEMORRHAGE-
The blood oozes over the
surface of capillary and is
dark in color.
c) VENOUS HEMORRHAGE-
The blood is los from vein is
known as venous
hemorrhage.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
The blood dark in color.
The rate of loss is much
severe than arterial
hemorrhage.
a) PRIMARY HEMORRHAGE-
It is immediate hemorrhage which
occurs when there is damage to any
blood vessels and bleeding occurs
immediately.
b) REACTINARY OR
INTERMEDIATE HEMORRHAGE-
It most occurs in first 24 after
operation.
The major operation which
may leads to hemorrhage are
kidney operation, thyroid and
breast operation.
c) SECONDARY HEMORRHAGE-
It is due to sloughing off the
wall of blood vessels.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
The common cause of bacterial
infection.
In this type the thinnest vessels
burst first and blood may be found
on the body.
A) REVEALED OR EXTERNAL-
It is a type when bleeding can be seen
externally.
B) CONCEALED HEMORRHAGE-
It is the type when bleeding cannot
be seen externally.
These bleeding occur into one of
the body cavities such as the
abdomen, into the lumen of hollow
organ such as intestine or into the
tissues.
It is later become obvious. E.g. By
being vomited or per rectum.
6. 3min Write down the CLINICAL MANIFESTATION What is the It can be early and PPT List out the
clinical 1. EARLY clinical late pallor, feeling clinical
manifestation of 2. LATE manifestation of faint etc. menifestations
hemorrhage. hemorrhage? of
hemorrhage.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
EARLY CLINICAL MANIFESTATION-
Restlessness and anxiety
Feeling faint
Coldness Slightly increase pulse
Pallor
Patient feel thirsty
04. 10min Write down the STAGES OF SHOCK: What are the Stages of shock Chart Explain in
stage of shock. stages involve in are- Initial, detail about
1. Initial stage shock? compensatory, stages of
2. Compensatory stage progressive, shock.
3. Progressive or decompensate refractory stage
4. Refractory or Irreversible
1. INITIAL STAGE-
During this stage Inadequate perfusion
CLINICAL MANIFESTATION-
Confusion
Dilated, sluggish pupil
Thirst rapid shallow breathing
Tachycardia
Cool moist skin
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
Slow capillary refill
Muscle weakness
Hypotension
4. REFRACTORY ( IRREVERSIBLE )
At this stage the vital organs have failed and
the shock can no longer be reversed.
Brain damage and cell death will occur.
Death of the person will occur immediately.
CLINICAL MANIFESTATION-
Unconsciousness
Absence of reflexes
Dilated sluggish pupil
Severe thirst
Bradycardia
Cyanosis
Absence of bowel sounds
Anuria
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
07. 6min Identify the CLASSIFICATION OF SHOCK- What can be the Classification of PPT What can be
classification of classification of shock are the
shock. 1. HYPOVOLEMIC SHOCK shock? hypovolemic classification
2. CARDIOGENIC SHOCK shock, of shock?
3. CIRCULATORY OR DISTRIBUTIVE cardiogenic
SHOCK shock, circulatory
shock
1. HYPOVOIMIC SHOCK-
This most common type of shock, due
to insufficient circulatory volume.
In this shock there is decreased in
circulatory volume to level that is
inadequate to meet body’s need tissue
oxygenation.
CAUSES ARE: Exercise, fluid loss
from the circulatory system by bleeding,
burns or diarrhea.
PATHOPHYSIOLOGY-
2. CARDIOGENIC SHOCK
It is caused by the failure of heart to
pump an adequate amount of blood to
vital organs.
This leads to reduction in cardiac
output.
It can be result from myocardial
infarction.
CAUSES- Cardiomyopathy, congestive
heart failure.
PATHIPHYSIOLOGY-
3. CIRCULATORY OR DISTRIBUTIVE
SHOCK –
In this there is no loss of blood from body
but this occurs due to dilatation of blood
vessels.
There is no enough blood return to the heart
which leads o inadequate tissue perfusion.
The most common causative organism of
septic shock is gram negative bacteria.
These infection leads to vasodilatation.
Vasodilatation leads to circulatory shock.
It is sub divided into
A. Septic shock
B. Obstructive shock
C. Neurogenic shock
D. Anaphylactic shock
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
a. SEPTIC SHOCK-
Vasodilation
b. OBSTRUCTIVE SHOCK-
Obstruction of blood flow results cardiac
arrest. E.g. Pneumothorax, pulmonary
embolism and aortic stenosis.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
c. NEUROGENIC SHOCK-
It is most often seen in patient who
have had and extensive spinal cord
injuries.
The loss of autonomic and motor
reflexes below levels of injury
results in loss of sympathetic
control.
This leads to dilation and
hypotension, dry skin, Bradycardia.
PATHOPHYSIOLOGY-
Spinal trauma
Venous vasodilation
d. ANAPHYACTIC SHOCK-
Anaphylactic shock is caused by
severe reaction to an allergen,
antigen, drug or foreign body.
PATHOPHYSIOLOGY-
Release of histamine
vasodilation
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
DIAGNOSTIC FINDINDS-
History taking.
Assessment of patient symptoms for
shock.
Conduct head to toe examination
for sig of shock.
Assess the neurological status for
LOC.
Assess for the cardiovascular status.
Check for blood pressure.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
Assess for integumentary status.
Check for skin color, cold and
clammy skin, cyanosis.
Assess for gastro intestinal status.
Hypoactive bowel sounds.
Assess for the metabolic status.
Blood studies reveal acidic blood
PH with low circulatory carbon
dioxide.
08. 6min Explain the MANAGEMENT OF SHOCK- What are the Fluid replacement PPT Explain the
management of management and medication management
shock. 1. PHARMACOLOGICAL strategies for require for the of shock.
MANAGEMENT shock? management for
2. NURSING MANAGEMENT shock.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
1. PHARMACOLOGICAL
INTERVENTION-
a. Hypovolemic shock-
Volume expanders like normal
saline and ringer lactate solution are
used more frequently.
Anti diarrheal agents for diarrhea
like lopramide.
b. Carcinogenic shock-
Volume expanders.
Positive cardiac Ionotropic like
dopamine, dobutamine and
epinephrine.
Vasodilators- Nitroglycerine,
sodium nitroprusside etc.
Vasoactive and antiarrythmia
medication- Epinephrine.
c. Distributive shock-
Volume expanders.
Positive cardiac Ionotropic
d. Obstructive shock-
Volume expanders.
e. Septic shock-
Broad spectrum antibiotics like
taxim etc.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
f. Neurogenic shock-
Hypoglycemia- glucose is rapidly
administered.
09. 20min Discuss the NURSING MANAGEMENT- What are the Its include all the PPT What are the
nursing nursing monitoring the nursing
management. Provide supplemental oxygen therapy to the management vital signs of the management
patient. strategies for patient, ABG strategies for
Monitor the ABG value to assess the patient shock? analysis, o2 shock?
response to oxygen therapy. administration is
Continuous monitoring of vital sign should require patient
be done. with the shock.
Check urine output.
Maintain nutritional status of the patient.
Administered prescribed medication to the
patient.
Follow the 6 rights of administrating the
medication.
Evaluate the effectiveness of drugs.
Give psychological support to patient and
relatives.
SL TIME OBJECTIVE CONTENT TEACHING LEARNING A.V. EVALUA
NO ACTIVITY ACTIVITY AIDS TION
NURSING DIAGNOSIS-
1. Fluid volume deficit related to hemorrhage
characterized by oliguria.
Goal: Maintain the normal fluid volume.
Assess for the sign and symptoms
for bleeding.
Check the vital sign of the patient.
Give comfortable position to the
patient.
Monitor intake and output.
Administer oxygen as ordered.
Administered the intravenous fluid
as ordered.
ASSIGNMENT-
Write down the complication of shock?
CONCLUSION-
At the end of my teaching I would like to give
thanks to Mam Mrs.Rajbir, Lecturer for her
guidance throughout the study and my class mates
for their support.
BIBLIOGRAPHY
Bhasker Shebeer P., A concise text book of advanced nursing practice,4th edition,
2012, EMMESS Medical Publisher,Pg. no.230-241
Chintamani, Lewis's Medical Surgical nursing,7 edition, 2011, Published by
Elsevier,Pg no.109-135
Manik Sharon, Lewis Medical Surgical nursing,4th edition, Mosby, 1996, Pg no. 85-
115
M J Black, Medical surgical nursing,5th edition,1998, Harcourt brace and company
Asia Pvt LTD,Pg no. 678
Suddarth’s and Brunner, Text book of medical surgical, 10th edition, 2004,
Lippincott Williams welkin, Pg no. 2153-2154,1392
htt://en.wikipedia.org/wiki/pain
BIBLIOGRAPHY
Bhasker Shebeer P., A concise text book of advanced nursing practice,4th edition,
2012, EMMESS Medical Publisher,Pg. no.230-241
Chintamani, Lewis's Medical Surgical nursing,7 edition, 2011, Published by
Elsevier,Pg no.109-135
Manik Sharon, Lewis Medical Surgical nursing,4th edition, Mosby, 1996, Pg no. 85-
115
M J Black, Medical surgical nursing,5th edition,1998, Harcourt brace and company
Asia Pvt LTD,Pg no. 678
Suddarth’s and Brunner, Text book of medical surgical, 10th edition, 2004,
Lippincott Williams welkin, Pg no. 2153-2154,1392
htt://en.wikipedia.org/wiki/pain
Lesson plan on
shock
Submitted to: submitted by:
Mrs. rajbir kaur pooja rani
Lecturer m.sc (n)2 year
nd
Submitted on:
SPECIFIC OBJECTIVES
At the end of the class student will able to provide the comprehensives care to the patient with shock.
CONTRIBUTORY OBJECTIVES: