Hypovolemic Shock: Management (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Now, let's talk about the management of hypovolemic shock.

    00:04 Let me caution you, standards and protocols change all the time.

    00:08 I'm going to give you a general overview of the main principles.

    00:12 Now, we're in that Layer Three of the clinical nursing judgment model.

    00:15 This is where we're focusing in.

    00:17 Remember, these are the types of things that you could be tested on.

    00:21 Number one deal in any type of shock is to correct the underlying cause.

    00:26 Now we're talking about hypovolemic shock that was low volume in the intravascular space.

    00:31 Think about what some of those problems were.

    00:34 One was, your hemorrhaging.

    00:36 Well, we would need to stop the hemorrhaging and replace fluid volume.

    00:40 What about a we're in burns, while has some massive fluid shifting.

    00:45 We do some really unbelievable things as far as replacing that volume.

    00:49 But unless we deal with the underlying cause, you're never going to get that patient back to a level of homeostasis.

    00:56 No matter what type of shock it is, and that's why it's important that you recognize what type of shock it is, you're not going to be able to move that patient towards homeostasis, unless you resolve the underlying cause.

    01:08 Now, these are some goals.

    01:09 These are some targets that you be looking for in the respiratory and the cardiovascular system.

    01:14 Theoretically, roughly, you're shooting for an oxygen saturation of 92 to 95%.

    01:21 Each physician, each hospital may have more specific parameters.

    01:25 But in a general guideline, you're looking for an arterial oxygen saturation of 92 to 95%.

    01:32 The patient likely won't be able to do this on their own if they've progressed very far.

    01:36 So they might need some oxygen support.

    01:39 You might be able to do that externally, like with a mask, or the patient may need to be intubated.

    01:45 That's when you place a tube to maintain an open airway, an ET tube.

    01:51 Obviously, with hypovolemic shock, the goal is to restore fluid loss.

    01:55 Some things are easier than others, If they're just intravascular and dehydrated, some IV fluids we can good to go.

    02:01 A burn patient that gets way more complicated.

    02:04 But here's the goal.

    02:06 We want at least two IV sites, right? You always want to have IV access.

    02:11 Most places will use more than two, but you want a minimum of two really good paid in IV sites.

    02:18 You're going to consider packed red blood cells.

    02:20 The healthcare provider will consider if this is appropriate.

    02:23 And what is so fantastic about giving packed red blood cells over giving an IV solution? I hope he said, "IV solutions cannot carry oxygen." And since hypovolemic shock is not enough oxygen being delivered to the cells tissues, that's why giving packed red blood cells might be appropriate.

    02:44 Now we do give IV fluids.

    02:46 You could like IV crystalloids, 0.9% sodium chloride.

    02:50 Might also give norepinephrine or dopamine.

    02:53 Remember, these standards can change.

    02:56 But there's some overview things that might be given to your patient.

    03:01 Now, as a nurse, how do you care for a patient in hypovolemic shock? Well, you're going to watch their O2 saturation closely.

    03:08 So place the SPO2 sensor on the forehead of the client.

    03:13 Why are we putting it on the forehead? Well, think that through.

    03:17 A lot of times we put it on the fingers.

    03:19 What was going on with the fingers in a client with hypovolemic shock? Poor perfusion.

    03:26 So this isn't gonna give you an accurate reading.

    03:28 That's why you want the sensor on the forehead of the client.

    03:32 Now, be very careful if the patient is on a medication like norepinephrine, that you have the next bag ready.

    03:39 Because this particular medication, it doesn't last a long time.

    03:42 And so you don't want a period of time in between taking down the old dried out bag and hanging a new one.

    03:48 So make sure you are ready with that next bag of medication, if this has been prescribed by your healthcare provider.

    03:56 Keep that mean arterial pressure over 65.

    04:00 And if you have the reading, keep the CVP greater than 2.

    04:04 Again, general targets for you to shoot for to see that the patient status is resolving and moving more towards homeostasis.

    04:13 So that wraps up hypovolemic shock.

    04:16 Now, here's the chart we've made for you and you'll be filling that in as we go through our series in shock.

    04:22 Let's take a look at the type of shock that we talked about, hypovolemic shock.

    04:27 So what do you expect to happen to the cardiac output? What do you think? Well, less volume usually equals a lower cardiac output. Right.

    04:37 Heart rate. Well, that's a compensatory response.

    04:40 When the volume is down, the heart rate is going to go up.

    04:43 CVP. Oh, that's an indication of volume.

    04:46 I have less volume. So, I'd anticipate the CVP being lower.

    04:51 Wedge pressure. Same thing.

    04:53 It's going to be on the lower end.

    04:55 Systemic vascular resistance is going to be up. Why? Well, that's a compensatory response.

    05:01 Remember those vessels? They have that vasoconstriction trying to raise that blood pressure caused by low volume in the intravascular space.

    05:11 What happens to your sad? Yeah, it is down.

    05:15 There is less volume in the intravascular space to deliver oxygen to the cells tissues.

    05:21 So that's it. This is one of our series in shock.

    05:25 Thank you for joining me for hypovolemic shock.

    About the Lecture

    The lecture Hypovolemic Shock: Management (Nursing) by Rhonda Lawes, PhD, RN is from the course Shock (Nursing).

    Included Quiz Questions

    1. The nurse makes sure the SpO2 sensor is securely on the client’s finger
    2. The nurse initiates a second intravenous site as ordered
    3. The nurse double-checks the client’s information and the order with another nurse before administering packed red blood cells
    4. The nurse ensures there is no delay in hanging the client’s next norepinephrine bag
    1. Arterial oxygen saturation of 92-95%
    2. Arterial oxygen saturation of 96-100%
    3. Peripheral oxygen saturation of 92-95%
    4. Peripheral oxygen saturation of 96-100%
    1. Treating the underlying cause
    2. Fluid replacement
    3. Preventing kidney failure
    4. Preventing bradypnea

    Author of lecture Hypovolemic Shock: Management (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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