Hypovolemic Shock Lecture

Overview

• Hypovolemic Shock: Decrease in circulating volume, divided into hemorrhagic and non-hemorrhagic causes.

Hemorrhagic Causes

• Postpartum Hemorrhage: Common complication after childbirth.
• Upper GI Bleed: E.g., esophageal varices, peptic ulcer disease.
• Trauma: Puncture wounds, crush injuries, lacerations.
• Aneurysm: Ruptured aneurysm in the head or abdomen.

Non-Hemorrhagic Causes

• Vomiting & Diarrhea: Loss of fluid through these means.
• Diuresis & Sweating: Excessive urination or sweating leads to fluid loss.
• Burn Patients: Loss of interstitial fluid.
• Third Spacing: Fluid shifting into interstitial spaces, e.g., edema, ascites.

Pathophysiology

• Decrease in Intravascular Fluids:
  • Leads to a decrease in preload to the heart.
  • Resulting in decreased stroke volume and cardiac output.
  • Causes decreased blood pressure (hypotension).
  • Leading to decreased perfusion, reduced oxygen/nutrient delivery, and potential organ ischemia.

Signs & Symptoms

• General Signs:
  • Hypotension (low blood pressure).
  • Tachycardia (rapid heart rate) to compensate for hypotension.
  • Tachypnea (increased respiratory rate) to meet oxygen demand.
  • Oliguria: Low urine output, indicating poor kidney perfusion.
  • Altered Mental Status: Due to decreased cerebral perfusion.
• Specific Signs for Hemorrhagic Patients:
  • Pale skin, lips, gums.
  • Sweaty or clammy skin.
  • Anxiety and restlessness due to decreased oxygen.

Diagnosis

• Blood Work: Check CBC levels, stool occult test for blood.
• Assessment: Vital signs, neurostatus, skin color, capillary refill time.

Management

Hemorrhagic Shock

• Blood Transfusion:
  • RBCs, fresh frozen plasma, platelets.
  • O negative blood if cross-matching is unavailable.
  • Two-nurse verification required for transfusion.
• Identify and Treat Cause:
  • Surgical repair if necessary.
  • Address GI bleeds or traumatic causes promptly.

Non-Hemorrhagic Shock

• Fluid Replacement:
  • Normal saline or lactated ringers.
• Vasopressors:
  • To increase blood pressure by vasoconstriction.
• Nursing Interventions:
  • Monitor intake and output: 30 ml/hr urine output is the goal.
  • Urinary catheters may be needed.
  • Frequent monitoring of vital signs and neurostatus.
  • Positioning: Elevate legs or use Trendelenburg position.

Summary

• Key differences between hemorrhagic and non-hemorrhagic shock.
• Both may require fluids and vasopressors, and management of underlying causes is crucial.
• Ensure thorough monitoring and appropriate nursing interventions for stabilization.