HYPOVOLEMIC SHOCK

By: Precious D. Colita

Hypovolemic Shock
- occurs when too little circulating blood volume causes a MAP decrease so that the body s total need for oxygen is not meet. - most common type. - is caused by decreased in intravascular volume of 15% or more (porth 2002). - the venous blood returning to the heart decreases and ventricular filling drops. - may result SV, CO and BP decrease.

Causes:
Hemorrhage (internal or external hemorrhage) Inadequate clotting
Hemophilia liver disease , malnutrition, bone marrow suppression, cancer, anticoagulation therapy

Dehydration

(vomiting, diarrhea, heavy diaphoresis, diuretic therapy, diabetes insipidus)

Physiologic Event
Initial Stage -decreased in MAP of 5-10 mmHg -increased in sympathetic stimulation >mild vasoconstriction > increased in HR S/S: BP: normal to slightly decreased Pulse: slightly increased RR: normal Skin cool, pale (in pheripery), moist Mental status: alert and oriented UO: slight decrease Other: thirst, decreased CRT

Nonprogressive Stage -decreased in MAP of 10-15 mmHg -continued sympathetic stimulation >moderate vasoconstriction >increased heart rate >decreased PP

S/S: BP: hypotension Pulse: rapid, thready RR: increased Skin : cool,pale(trunk), poor turgor with fluid loss , edematous with fluid shift

chemical compensation >renin, aldosterone & ADH secretion >increased vasoconstriction >decreased urine output >stimulation of thirst reflex -some anaerobic metabolism in non vital organs >moderate acidosis >moderate hyperkalemia

Mental status: restless, anxious, confused or agitated . UO: oliguria Other: marked thirst,acidos,hyperkalemia, decreased CRT, absent pheriperal pulses

Progressive Stage

-decrease in MAP >20 mmHg -anoxia in nonvital organs - hypoxia in vital organs -overall metabolism in anaerobic >moderate acidosis >moderate hyperkalemia >tissue ischemia

>hypoxia

>anoxia > ischemia Lifethreatening!

Refractory Stage
-Severe tissue hypoxia with ischemia and necrosis -release of myocardial depressant factor the pancreas -build up of toxic metabolites -multiple organ dysfunction syndrome(MODS) -DEATH

S/S: BP: severe hypotension Pulse: very rapid, weak RR: rapid ,shallow breathing, crackles and wheezes Skin : cool, pale, mottled with cyanosis Mental status: disoriented,lethargic, comatose UO: anuria Other: loss of reflexes, decrease of pheriperal pulses
>DEATH!

Diagnostics test:
Blood hemoglobin and hematocrit test

Arterial blood gas

Serum electrolytes Blood urea nitrogen,serum creatinine levels

,urine specific gravity and osmolity Central venous catheter

Medications:
Diuretics Sodium bicarbonate Calcium Antiarrhythmic agent Vasoconstrictors >dopamine >epinephrine >phenylephrines Agents Enhancing Contractility >milrinone >atropine sulphate >dobutamine hydrochloride Agent Enhancing Myocardial Perfusion >sodium nitroprusside

Therapy:
IV THERAPY:

>Colloids help restore osmotic pressure and fluid volume >Crystalloids help maintain a adequate fluid and electrolyte balance OXYGEN THERAPY:

Surgical Intervention
Vascular repair

Surgical hemostasis
Closure of bleeding and chemical scarring

varicosities

Nursing Management
Monitor for signs and symptoms of persistent

bleeding Monitor the client closely for hemorrhage Prevent blood volume loss (e.g. apply pressure to the site of bleeding Administer IV fluids as appropriate. Note hemoglubin /hematocrit level before and after blood loss as indicated. Administer blood products as appropriate PT, PTT, Fibrinogen, fibrin degrading /split products, and platelet counts, as appropriate

Immediate Nursing Interventions:

Immediate Nursing Interventions: Ensure a patent airway. Start an IV catheter or maintain an established

catheter. Administer oxygen. Elevate the clients feet ,keeping his or her head flat or elevated to 30 degree angle Examine the client for overt bleeding. If overt bleeding is present, apply direct pressure to the site. Administer medication as prescribe. Increase the rate of IV fluid delivery Do not leave the client