Here are independent, dependent, and collaborative nursing interventions for the nursing diagnosis of

Ineffective Tissue Perfusion related to inadequate circulating volume and reduced oxygen-carrying
capacity of the blood secondary to hypovolemic shock and severe anemia:

**Independent Nursing Interventions:**

1. **Monitor Vital Signs:** Continuously assess the patient's vital signs, including blood pressure, heart
rate, respiratory rate, and oxygen saturation, to detect changes in perfusion status.

2. **Positioning:** Elevate the patient's legs to promote venous return and improve perfusion to vital
organs.

3. **Administer Oxygen Therapy:** Provide supplemental oxygen via nasal cannula or mask to improve
tissue oxygenation.

4. **Fluid Resuscitation:** Initiate intravenous fluid therapy as prescribed to restore circulating volume
and improve tissue perfusion. Monitor for signs of fluid overload.

5. **Blood Transfusion:** Administer blood products, such as packed red blood cells, to correct severe
anemia and improve oxygen-carrying capacity.

6. **Pain Management:** Address pain promptly to reduce sympathetic response and improve tissue
perfusion. Use non-pharmacological interventions, such as positioning and relaxation techniques, in
addition to administering analgesics as prescribed.

**Dependent Nursing Interventions:**

1. **Medication Administration:** Administer medications prescribed by the physician, such as

vasopressors (e.g., dopamine, norepinephrine) to support blood pressure and improve perfusion to vital
organs.

2. **Blood Product Administration:** Coordinate with the healthcare team to obtain and administer
blood products, such as packed red blood cells and fresh frozen plasma, as indicated to correct anemia
and coagulopathy.
**Collaborative Nursing Interventions:**

1. **Consult with Healthcare Team:** Collaborate with physicians, pharmacists, and other healthcare
team members to develop and implement a comprehensive treatment plan for managing hypovolemic
shock and severe anemia.

2. **Surgical Intervention:** Coordinate with the surgical team to arrange for emergent interventions,
such as endoscopy or surgery, to address the underlying cause of bleeding, such as bleeding peptic ulcer
disease.

3. **Continuous Monitoring:** Collaborate with other healthcare providers to continuously monitor the
patient's response to interventions, including laboratory values, hemodynamic parameters, and signs of
tissue perfusion. Adjust the plan of care as needed based on the patient's condition and response to
treatment.