A. General information
- Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
- Hypovolemic shock reduces CO and causes inadequate tissue perfusion from loss of circulating blood volume.
- Inadequate tissue perfusion resulting from markedly reduced circulating volume.
- Surgical patient’s are at high risk because of blood loss intraoperatively and trauma from the manipulation of body tissue.
C. Assessment findings
- Systolic blood pressure less than 90 mm Hg or 30 mm Hg less than baseline values
- Rapid weak pulse
- Cool, clammy skin
- Extreme thirst
- Urine output less than 30mL/hr
D. Diagnostic test findings
- Chest X-ray: pulmonary lesions and areas of atelectasis
- ABG measurements: respiratory alkalosis progressing to combined respiratory and metabolic acidosis; hypoxemia
- Serum chemistries: increased BUN, alkaline phosphatase, creatinine, lactate, and potassium levels; decreased HCO3, and albumin levels
- CBC: increased hematocrit (HCT) levels
E. Patient care management goal: restore the circulating blood volume
- Assess and document continuous ECG rhythm; vital signs; mental status; heart, lung, and bowel sounds; urine output; and any signs and symptoms indicating changes in these parameters
- Administer fluids (lactated Ringer’s solution or normal saline solution) to correct fluid deficit
- Obtain ABG measurements and monitor for hypoxemia and acid-base imbalance; monitor SaO2 with a pulse oximeter
- If a pulmonary artery catheter is in place, assess the patient’s fluid volume and document CVP, PAP, PAWP, CO, and SVR as ordered
- Weigh the patient daily, at the same time and on the same scale with patient wearing the same amount of clothing, to evaluate fluid balance
- Administer oxygen at a flow rate based on the patient’s clinical condition to relieve ischemia
- If gas exchange is inadequate, prepare the patient and equipment for intubation