Question

ATI Ch. 37

Active Learning Template: System Disorder

Hemodynamic Shock: Priority Intervention for Hypovolemic Shock

(Fill in the boxes)

NT System Disorder

Alterations in Health (Diagnosis)

Patho related to problem

health promotion & disease prevention

risk factors

expected findings

safety considerations

laboratory test

diagnostic procedure

nursing care

therapeutic procedures

medications

client education

interprofessional care

complications

Answer 1

ALTERATION IN HEALTH- HEMODYNAMIC SHOCK-HYPOVOLEMIC SHOCK)

Shock is defined as a state of cellular and tissue hypoxia due to reduced oxygen delivery or increased oxygen consumption or inadequate oxygen utilization.This is most commonly occurs when there is circulatory failure manifested as hypotension.

Hypovolemic shock can be caused by any disorder that that causes volume depletion of the intravascular space.The patients with hypovolemic shock are initially are able to compensate for the decreased stroke volume with compensatory increase in heart rate and systemic vascular resistance.

PATHOPHYSIOLOGY

The human body responds to a blood loss and hypovolemic state by the following systems

The hematologic system respond by activating coagulation and contracting the bleeding vessels.Platelets are activated and form an immature clot on the bleeding source.The damaged vessels exposes collagen,which cause fibrin deposition and stabilization of clot.

The cardio vascular system initially responds by increasing the heart rate ,myocardial contractility and constricting peripheral blood vessels.This response occur secondary to an increased release of nor epinephrine and decreased baseline vagal tone.It also responds by redistributing blood to the brain,heart and kidneys and away from skin muscles and GI tract.

Renal system responds by stimulating an increase in renin secretion. Renin converts angiotensinogen to angiotensin 1,which is subsequently converted in to angiotensin 2 by lungs and liver.It help to reverse hemorrhagic shock,vasoconstriction of anterior smooth muscles and stimulation of aldosterone secretion .Aldosterone is responsible for active sodium re absorption and subsequent water conservation.

The neuro endocrine system responds by causing an increase in ADH due to low BP and decrease in sodium concentration.ADH indirectly leads to an increased re absorption of water and salt.

These mechanisms effective in maintaining vital organ perfusion in severe blood loss and hypovolemia

HEALTH PROMOTION & DISEASE PREVENTION

For prevention of hypovolemic shock the following must be implemented

• Early detection-Recognize the patients with conditions that reduce blood volume as it risk patients
• Accurate intake out put chart-Estimate he fluid loss and replace,as necessary to prevent hypovolemic shock.

RISK FACTORS

• Dehydration
• Aneurysm upture
• Severe injury and bleeding from wounds
• severe burns

1. excessive vomiting
2. ectopic pregnancy
3. vaginal bleeding
4. EXPECTED FINDINGS
5. MILD SYMPTOMS-headache,fatigue,nausea,profuse sweating,dizziness
6. SEVERE SYMPTOMS-cold clammy skin,rapid shallow breathing,rapid heart rate,deceased urine out put,confusion ,weakness,cynosis,light headedness .loss of consciousness
7. SYMPTOMS OF INTERNAL HEMORRHAGING-abdominal pain,blood in the stool,chest pain,blood in urine,vomiting of blood.

SAFETY CONSIDERATIONS

If you observe a person experiencing shock symptoms

1. Have the person lie on flat with their feet elevated about 12 inches
2. Do not move the person if you suspect head injury
3. keep the person warm to avoid hypothermia
4. do not give the person fluids my mouth

LABORATORY TESTS

• cbc
• electrolytes
• PT ,APTT
• ABG
• urine analysis
• pregnency test

DIAGNOSTIC TESTS

• BLOOD TEST
• CT,ultrasound
• echo
• ECG
• Endoscopy
• Urinary catheterization

MANAGEMENT

• blood transfusion
• platelet transfusion
• IV crystalloids
• Dopamin
• dobutamin
• epinephrin
• non epinephrin
• Antibiotics

NURSING MANAGEMENT

1. assessment of vital signs ,BP,
2. Maintain fluid volume at functional level
3. Safe administration of blood
4. monitor weight and urine out put
5. oxygen administration

COMPLICATIONS

• ARDS
• Acute tubular necrosis
• DIC
• Multiple organ dysfunction