Chapter 34: Hypovolemic Shock

The nurse is planning care for a patient receiving phenylephrine to treat hypovolemic shock. Which parameter would the nurse assess to prevent complications? Select all that apply. One, some, or all responses may be correct.

1) Headaches 2) Hourly urine output 3) Presence of chest pain 4) IV site every 30 minutes 5) Blood pressure every 15 minutes The nurse would assess the patient for headaches as they can be a sign of drug toxicity. Hourly urine output would be monitored as the medication can decrease urinary output because of its effect on kidney perfusion. Chest pain is a sign of myocardial vasoconstriction, so the nurse would assess for this adverse effect. The nurse will monitor the IV site for extravasation as this medication can cause tissue necrosis if it leaks into the surrounding tissues. The nurse should check the blood pressure every 15 minutes for signs of drug excess.

Which condition is associated with hypovolemic shock?

Dehydration Dehydration is a symptom of hypovolemic shock. This is because in hypovolemic shock there is a decrease in the total body fluids. Pulmonary embolus is a result of direct pump failure, which indicates cardiogenic shock. Myocardial infarction occurs because of decreased cardiac function, which causes obstructive shock. Chemical-induced sepsis is caused by fluid shift from the central vascular space. This results in distributive shock.

Which condition is a risk factor for HYPOvolemic shock? Select all that apply. One, some, or all responses may be correct.

1) Hemophilia (bleed very easily) 2) Dehydration 3) Diuretic therapy Specific risk factors for hypovolemic shock include hemophilia, dehydration, and diuretic therapy. Hypovolemia can be caused by impaired clotting in patients with hemophilia. Dehydration leads to decreased blood volume. Excessive diuresis as a result of diuretic therapy can also cause reduction in blood volume. In patients with myocardial infarction, cardiac function is impaired, which causes cardiogenic shock. Patients with spinal cord injury have distributive shock in which the total blood volume is not reduced, but fluid shifts from the central vascular space.

Which symptom occurs in the compensatory *PHASE* of shock? Select all that apply. One, some, or all responses may be correct.

1) Restlessness 2) Decreased urine output 3) Decreased tissue perfusion 4) Increased respiratory rate Signs and symptoms of the compensatory stage of shock include changes resulting from decreased tissue perfusion. Objective changes include restlessness, tachycardia, increased respiratory rate, decreased urine output, falling systolic blood pressure, rising diastolic blood pressure, narrowing (not widening) pulse pressure, cool extremities, and a decrease in oxygen saturation.

Which sign or symptom occurs in the compensatory *STAGE* of shock? Select all that apply. One, some, or all responses may be correct.

1) Restlessness 2) Increased respiratory rate 3) Decreased urine output 4) Tachycardia Signs and symptoms of the compensatory stage of shock include changes resulting from decreased tissue perfusion. Objective changes include restlessness, increased respiratory rate, decreased urine output, and tachycardia. Cyanosis appears later, in the progressive stage of hypovolemic shock.

In which location are the baroreceptors found?

Aortic Arch The baroreceptors responsible for detecting pressure changes in the arterial system are located in the aortic arch and carotid sinus. There are no baroreceptors located in the radial sinus, brachial arch, or femoral sinus

Which stage of hypovolemic shock is indicated by a pulse oximetry value of 93%?

Compensatory In the compensatory stage of hypovolemic shock, the pulse oximetry value ranges from 90% to 95%. If the value is above 95%, it indicates the initial stage of hypovolemic shock. Any value below 70% indicates the refractory stage. In the progressive stage, the value lies between 75% and 80%

Which abnormality would the nurse expect to see when reviewing the arterial blood gas results for a patient with hypovolemic shock?

Elevated lactic acid The nurse would expect to find an elevated lactic acid level in a patient with hypovolemic shock. Other findings would include a decreased pH and Pao2 and an increased Paco2.

Which type of shock may result if hemorrhage in a patient is not treated in time?

Hypovolemic Hemorrhage can result in hypovolemic shock, which occurs when the mean arterial pressure decreases because of loss of blood from the vascular space, resulting in inadequate total body perfusion and oxygenation. A loss of blood does not result in distributive, obstructive, and cardiogenic shock; therefore these are not associated with hemorrhage.

Which organ is responsible for releasing myocardial depressant factor that leads to heart damage as a result of multiple organ dysfunction syndrome (MODS)?

Pancreas Myocardial depressant factor is secreted from the ischemic pancreas and is responsible for causing profound damage to the heart in MODS

IV colloid solutions contain which component that helps manage hypovolemic shock?

Starches Colloid solutions are mainly composed of larger molecules like starches and proteins. These molecules help maintain the oncotic pressure of the intravascular fluid and prevent fluid loss. Salts, sugars, and minerals are components of crystalloids, not colloids.

Which condition represents an early symptom of hypovolemic shock?

Tachycardia Heart and respiratory rates increased from the patient's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock. Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal. Early in shock, the patient displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock; they are related to lack of oxygen to the heart

Which change in a patient with hypovolemic shock indicates to the nurse that the fluid resuscitation therapy is effective?

Urine output increase from 5 mL/hr to 35 mL/hr During shock, the kidneys and baroreceptors sense an ongoing decrease in mean arterial pressure and trigger the release of renin, antidiuretic hormone (ADH), aldosterone, epinephrine, and norepinephrine to start kidney compensation, which is very sensitive to changes in fluid volume. Renin, secreted by the kidney, causes decreased urine output. ADH increases water reabsorption in the kidney, further reducing urine output. These actions compensate for shock by attempting to prevent further fluid loss. This response is so sensitive that urine output is a very good indicator of fluid resuscitation adequacy. If the therapy is not effective, urine output does not increase. An increase in respiratory rate, increase in heart rate, and a decrease in core body temperature are not expected findings of successful fluid resuscitation.