HYPOVOLEMIC SHOCK PATHOPHYSIOLOGY

Trauma
(Blood loss of 1600 mL)

Ruptured vessels leak

Large volume Abdomen is firm to
fluid into potential spaces
Hemorrhage third spacing touch
Third spacing
occurs in: Dullness upon
of fluid abdominal percussion
Inflammatory mediators Intra –
↓Intravascular abdominal Abdominal swelling
↑vessel permeability, Absence of bowel
volume GI tract
and fluid leaks out sounds

Loss of circulating blood

volume

HYPOVOLEMIC SHOCK (Stage 3)

↓ Pressure in
venous circulation

↓Jugular vein
pressure

↓Venous return to
heart

Decreased preload
 Decreased cardiac
output

Insufficient organ perfusion

Skin Brain Heart Kidneys In all body tissues

Body preferentially ↓Cerebral Blood pressure prompts Pulseless electrical ↓Blood flow to ↑Lactic acid formation due
vasoconstricts blood flow → compensatory, ↑ heart activity kidneys to inadequate delivery of
extremities to preserve cerebral hypoxia rate, to maintain oxygen
central circulation vital perfusion
organs
↓Myocardial Insufficient
contractility oxygen supply ↓clearance of lactate by the
↓Cerebral liver, kidneys and skeletal
blood flow → P: 136 bpm, apical,
muscle
cerebral hypoxia irregular, rapid
Body preferentially
Weak, thready Renal Ischemia
vasoconstricts
peripheral pulses
extremities to preserve
SaO2 – 86%
central circulation vital Lactic acidosis
R: 38 cpm, irregular; Decreased
organs Half conscious rapid, shallow urinary output ↓GFR
respiration (less than 30 ml
per hour)
Renal failure
 Cold, clammy skin
 Poor skin turgor
 Dry skin and mucous Decreased cardiac output r/t
membranes reduced blood volume secondary to
 Pallor skin blunt trauma as evidenced by
 Nail bed is pale in capillary refill greater than 3
color
seconds, dizziness, cold clammy
 Poor capillary refill as skin, decreased urinary output,
evidenced by color
decreased BP, decreased SaO2,
returned within 3 tachycardia, weak thready pulse
seconds upon release
 Non-pitting edema at
the lower extremities
 Limited ROM
Labs:
 HGB: 10.2 (low)
 HCT: 25.4 (low)
 Neutrophil: 76.4% (high)
 Lymphocytes: 12% (low)
Medical Management
 Administer isotonic crystalloid
solution
 Administer Dobutamine 15
mcg/kg/min IVTT
 Administer Dopamine 15
mcg/kg/min IVTT
 Administer 100% oxygen via nasal
cannula
 Transfuse whole blood for blood
transfusion
Deficient fluid volume related to
reduced blood volume secondary
to blunt trauma as evidenced by
decrease urinary output, capillary
refill greater than 3 seconds, cool
clammy skin, dry mucous
membrane, hypotension,
tachycardia, pale conjunctiva
Labs:
Neutrophil: 76.4% (high)
Lymphocytes: 12% (low)
Segmenters: 88 (high)
Chloride: 112.7 (high)
Sodium: 138.2 (high)
Potassium: 2.63(low)
Medical Management
 Administer isotonic crystalloid
solution
 Administer Dobutamine 15
mcg/kg/min IVTT
 Administer Dopamine 15
mcg/kg/min IVTT
 Administer 100% oxygen via nasal
cannula
 Transfuse whole blood for blood
transfusion
Ineffective Tissue related to
reduced blood volume secondary
to blunt trauma as evidenced by
low BP, decrease SaO2, cool
clammy skin, pallor, dizziness,
shallow respirations, weak
thready pulses, absence of bowel
sounds, firm abdomen
Labs:
 HGB: 10.2 (low)
 HCT: 25.4 (low)
 Chloride: 112.7 (high)
 Sodium: 138.2 (high)
 Potassium: 2.63(low)
Medical Management
 Administer isotonic crystalloid
solution
 Administer Dobutamine 15
mcg/kg/min IVTT
 Administer Dopamine 15
mcg/kg/min IVTT
 Administer 100% oxygen via nasal
cannula
 Transfuse whole blood for blood
transfusion
Nursing Intervention
 Establish IV line
 Monitor blood pressure, pulse
 Monitor urine output through catheter
 Closely monitor fluid intake including IV
lines
 Monitor cardiac rhythm
 Place on cardiac monitor; monitor for
dysrhythmias
 Monitor laboratory tests such as
complete blood count, sodium level, and
serum creatinine.
 Position patient in semi-Fowler’s to high-
Fowler’
 Apply music therapy
 Monitor infusion rate through infusion
pump
Nursing Intervention
 Establish IV line
 Monitor for signs of decreased tissue
perfusion.
 Monitor urine output through catheter
 Monitor for rapid changes or continued
shifts in mental status.
 Monitor capillary refill
 Record BP readings for orthostatic changes
(drop of 20 mm Hg systolic BP or 10 mm Hg
diastolic BP with position changes).
 Use pulse oximetry to monitor oxygen
saturation and pulse rate.
 Monitor laboratory data (ABGs, BUN,
creatinine, electrolytes, international
normalized ratio, and prothrombin time or
partial thromboplastin time) if
anticoagulants are utilized for treatment.
 Assist with position changes.
If left unreated:
Organ dysfunction
Multi organ failure
Death
Nursing Intervention
 Establish IV line
 Monitor urine output through catheter
 Monitor BP and HR for orthostatic
changes
 Monitor the client’s intake and output.
 Monitor for possible sources of fluid loss
 Monitor the CVP, PADP, pulmonary
capillary wedge pressure, and cardiac
output/cardiac index.
 Monitor coagulation studies, including
INR, prothrombin time, partial
thromboplastin time, fibrinogen, fibrin
split products, and platelet count as
ordered.
 Encourage oral fluid intake if able.