foreign Engineers nerds in this video today we're going to be talking about hypovolemic shock so if you like this video make sure you give it a thumbs up and comment down below and don't forget to subscribe and then head over to ninja.org that's where we have all of our notes and illustrations for all the lectures that we put up here on YouTube but let's get started here with hypovolemic shock so what are we going to be talking about with hypovolemic shock you should already be thinking this is a decrease in circulating volume meaning the amount of volume that we have in our body is going to be depleted and it can be broken into two different categories what we're looking at here is hemorrhagic or non-hemorrhagic or a loss of blood for one of the causes or a loss of fluid for one of the causes so what we're going to be talking about here is what are some potential hemorrhagic causes that we can experience hypovolemic shock well one of those right away when we think about hemorrhagic we can think about right here this lady being pregnant and we can think about post partum all right so postpartum Hemorrhage so a patient goes in they go into have their baby and then all of a sudden some complications occur it's one of the more common things with pregnancy when you go to give birth you can have postpartum Hemorrhage another one that we're going to be looking up here is our upper GI bleed so we have a patient that maybe has esophageal varices or they have peptic ulcer disease and they are prone to possibly having a hemorrhagic episode right what are some other areas what are some things you can think about with a patient that would come in and have some type of hemorrhage let's think about the next one which would be any type of trauma right so a patient that is going to have some type of potential puncture wound they're going to have some type of crush injury or they are have multiple lacerations they could also have a tendency to have a hemorrhagic episode or go into hypovolemic shock and then there's one more we're going to talk about and that is and your rhythm right so if patient has an aneurysm in their head and neighbors aneurysm in their abdomen and they go and they have a ruptured aneurysm that can also cause them to have Hammer Hemorrhage or have a hypovolemic shock situation on the other end of this we were going to talk about ones that are non-hemorrhagic somebody that's not necessarily bleeding out but they're having some other issues with their fluid right so they're having a depletion in their fluid so easy one to think about right away is it's a patient that is vomiting a lot or a patient that's having diarrhea right they're losing a lot of fluid that way on the same scale of this you can also think somebody's having an issue with peeing or diuresync so they're peeing a lot or also sweating a lot right so all these would be ways that patients are losing fluid that it's not blood is they're losing all types of fluid from their body what's another one we can think about patients that are in the Burn Unit or burn centers when they're losing a lot of that fluid that they would need in their interstitial fluid so they're losing that they're having a fluid deficit and the last one we want to think about is where patients have third spacing of fluid so they're having lots of Edema maybe ascites and the the fluid that should be intravascular is now interstitial in a place that it shouldn't be so when we think about hypovolemic shock we need to think about how this is going to occur within the body so either they're going to have hemorrhage which is a decrease in the blood volume or of a patient that is decreasing in their fluid volume all right so we need to think of this pathophysiology and what we're looking at really here is a decrease in the intra vascular fluids right so we have a decrease in this intravascular fluid so because of this we're going to have a decrease in our preload to the heart and then thus a decrease in our stroke volume because if you remember or if you forgot we have cardiac output is equal to heart rate times stroke volume and we want to remember that our stroke volume can be broken into preload after load and our contractility okay so if we have a decrease in our preload right here we're going to decrease in our stroke volume and if we have a decrease in our stroke volume the next sequence and this would be our decrease in our cardiac output right so now our heart isn't going to be pumping out as much as we want right so because of that we have hypovolemic shock so we should be thinking decrease cardiac output because of this hypovolemia this decrease in volume we're going to be seeing that manifest as a decrease in our blood pressure right and if we think all the way back to basic anatomy physiology when we have that decrease in blood pressure what are we thinking about we're thinking about decreasing perfusion well what's perfusion it's bringing our nutrients and our oxygen to all those vital organs and when we're having a decrease in that perfusion we're having a decrease in getting that oxygen there which is causing possibly ischemia and we have ischemia we have damage to those potential organs so let's move into now that we understand what the pathophysiology is with that decrease in the fluids causing a decrease in the preload and stroke volume causing and decrease in that cardiac output and then causing our decrease in our blood pressure or our hypotension what are some of the signs and symptoms that our patients May exhibit if they are having hypovolemic shock or going into it all right energy talk about the signs and symptoms and when we talk about them today we're going to be talking generally about hypovolemic shock but in a separate video I will go over all the different stages of hypovolemic where it's a little more in depth but for the purposes on the NCLEX you don't necessarily have to know all the stages you just need to see hypovolemic shock as it's whole but as we go into talk about the signs and symptoms we want to initially start with our biggest one right our patient is losing blood or is losing fluid or maybe they're losing both both of those will manifest like we talked about that decrease in blood pressure which is what we call hypotension right so if we remember back to anatomy and physiology when we have a patient who was low blood pressure or hypotension at some point they typically want to compensate and have tachycardia oops tacky cardia right their heart rate is going to pick up in order to try to help out with that hypotension because we want to keep trying to perfuse and keep trying to bring blood and oxygen to where it needs to be that hypotension is occurring because we're having that deficit and our fluid or our volume we have tachycardia because we're going to pick up that heart rate to try to increase the cardiac output what else is going to incur if we're having an issue delivering oxygen and our body notices that what is our body going to do it's going to say breathe breathe more for me please breathe for me so now we're going to have maybe tachypnea this patient's now going to have an increase in their respiratory rate so they're going to have this breathing that's occurring right it's going a lot faster heart rate's going a lot faster and because of all this there's some other things that are be going on with our patient right one of the things is we know that they have this decrease in fluid right this decrease in volume so if they start running out of volume what are some signs and symptoms you might see well they might tell you oh I had diarrhea and vomiting all night now I'm just gagging I'm just having this dry heave over and over again but nothing's coming out another thing that could go on is they could also have oliguria meaning they're not perfusing anymore or they're not creating any more urine they are basically dried up there's nothing else to come out with all this being said they also are having this problem with this perfusion if they are further along than we think they might start having some type of altered mental status right maybe there's something else going on they're not getting perfusion to the brain the family is going to say I don't know they've been acting a little off not quite off too much but like here and there they're saying some weird things or they're answering questions funny so they may have an alternate status and then we're looking at them too if they're losing blood what are some of the things that we look at when we see a patient that maybe we're thinking they're having some decrease in blood right we see the vital signs are going on but looking at the patient just looking at them what are some things that we might see well we might see that they look pale right their Skin's gonna be looking pale the lips or the gums or the eye everything's looking a little more pale we can also think about are they looking sweaty or clammy right what is another sign just looking at a patient that you're like something might be going on I think this patient is going into hypovolemic shock or is getting really really close to being hypovolemic and they might be really anxious again that's that driving force between that decrease in oxygen so we have some general signs and symptoms that we're looking at our patient we're like their blood pressure's low they're acting kind of funny they're looking a little pale but there really is maybe no signs of bleeding and you want to think back to maybe it's something GI related are they having difficulty with stools are the stools been dark and all of a sudden they're not dark questions like that so we move into maybe getting some blood work and we see that there is indications that this patient is losing blood maybe we do a stool cult and check down below and we see that there is positive for blood down there when we are looking at a patient that is indeed having a hemorrhagic type of shock we want to start thinking about what we need to do get those volumes back up so if they lost blood what are we going to do we're going to be giving this patient blood right we're going to transfuse transfuse blood in order to give them blood we want to think about our rbcs our red blood cells they might get fresh frozen plasma and they might even need some platelets okay so what do we need possibly before if it's going to be unmatched on cross and match we're typically giving them O negative but we do want to look into that type and screen right making sure we're checking what their blood type is we're going to be seeing if they're the CBC levels look like so we can get an idea on how this patient is doing we also want to be making sure that we're looking into what's going on with them so we need to make sure that we are talking to our our team and letting them know hey I'm going to be transfusing blood in here I need somebody else with me and we also want to talk to them about what's going on so we need we're going to need that to nurse verification right so now we have two nerves verification for this blood transfusion that's one thing that we can be doing along with other medications but the biggest thing with the hemorrhagic is giving them Blood on the non-hemorrhagic side we're going to be focusing on giving them the fluid back right so our patient is going to get some fluid normal saline or lactated ringers right what else is this patient possibly going to get they are also along with our hemorrhagic might get some vasopressors right to help bring up that blood pressure by constricting there we go the blood vessels what are some other things that we can do for this patient you want to think about what we're going to be looking at for them how do we know that their fluid volume is starting to come back what are some of the other nursing interventions we can be looking at we are going to be doing Ino right so you remember what is the output the patient should be having patients should be having 30 milliliters per hour until we know where our kidneys are working at the way they should so if we're going to be monitoring this what are they going to need for this a urinary Cafe what else do we want to do we want to make sure that we have them with on vasopressors they're going to be getting fluids so what are some other things maybe it is a GI bleed so right now they might have to be on NPO right this patient is going to need vital signs how often maybe Q 15 minutes for a while in order that we're able to keep an eye on what their vital signs are doing and we're going to be doing neurostatuses right checking on that neural status if they were altered in the beginning how are we going to be able to tell that this patient is getting better but when we are doing this we want to start thinking about other things if we're doing vasopressors and we're checking the fluid output because we're giving them fluid or checking their blood pressure what are some other ways that we're going to be able to tell if the vasopressors are working I want you to think about perfusion right if they are perfusing correctly we should be seeing a cap refill that is going to be less than three seconds right we're going to be thinking about what is their neurostatus change look like if they're perfusing correctly what else is going to look better their color right what is their skin looking like so we're able to keep an eye on them and then when we do all this what is the biggest thing we want to think about in nursing like the basics of nursing we're thinking about all the interventions we can do but what's one that's just super easy when they're in bed you want to think about the positioning to the head of bed should be less than 30 degrees we want to think about trendelenberg or elevated legs in order to get that perfusion back to the heart back to the brain okay so I hope this made sense Ninja nerds I hope you're able to focus on what the differences are between the hemorrhagic and the non-hemorrhagic and how even though a patient might be fluid hemorrhagic might be missing blood they also still might need a vasopressor they still also might need fluids as well as getting the blood back so that we're able to keep perfusion correctly up and keep those vital signs stable enough so the patient can recover and then of course with the hemorrhagic the one other thing I forgot to say is where what's the cause we need to find the cause of this bleed so we need to figure out are they having a bleed that we can surgically repair that we need to surgically repair or is there something else going on that we can just do by rest in the GI maybe or is it something that is traumatic and we need to go in and fix it right now without even setting up surgery it is now considered trauma related and we have to do it very very quick so I hope that all made sense into her Ninja nerds I hope that you learned something from this and as always until next time [Music] no no no no no no no