ShockComparisonWK7
Pathophysiology Clinical Manifestations Medical Management Nursing Management
Hypovolemic Shock Hypovolemic shock can be caused by
... [Show More] external fluid losses, as in traumatic blood loss, or by internal fluid shifts, as in severe dehydration, severe edema, or ascites (see Chart 14-3). Intravascular volume can be reduced by both fluid loss and fluid shifting between the intravascular and interstitial compartments.
. The sequence of events in hypovolemic shock begins with a decrease in the intravascular volume. This results in decreased venous return of blood to the heart and subsequent decreased ventricular filling. Decreased ventricular filling results in decreased stroke volume (amount of blood ejected from the heart) and decreased cardiac output.
When cardiac output drops, BP drops and tissues cannot be adequately perfused
• Anxiety or agitation.
• Cool, clammy skin.
• Confusion.
• Decreased or no urine output.
• Generalized weakness.
• Pale skin color Major goals in the treatment of hypovolemic shock are to restore intravascular volume to reverse the sequence of events leading to inadequate tissue perfusion, to redistribute fluid volume, and to correct the underlying cause of the fluid loss as quickly as possible.
Depending on the severity of shock and the patient’s condition, often all three goals are addressed simultaneously.
Treatment of the Underlying Cause
If the patient is hemorrhaging, efforts are made to stop the bleeding. This may involve applying pressure to the bleeding site or surgical interventions to stop internal bleeding. If the Primary prevention of shock is an essential focus of nursing care. Hypovolemic shock can be prevented in some instances by closely monitoring patients who are at risk for fluid deficits and assisting with fluid replacement before intravascular volume is depleted. In other circumstances, nursing care focuses on assisting with treatment targeted at the cause of the shock and restoring intravascular volume.
General nursing measures include ensuring safe administration of prescribed fluids and medications and documenting their administration and effects. Volumetric IV pumps should be used to administer vasopressor medications, if prescribed.
Another important nursing role is monitoring for complications [Show Less]