10 NURSING. :. NURSING. Nursing. Name of the Student. N

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Answer: 1
Pathophysiology of hypovolemia
The signs of the post-operative hypovolemia in Eleanor Wilson is evident from her
low blood pressure (90/54; normal units: 120/80mmHg) and marginally low level of oxygen
saturation (95%; normal: 96 to 100%), high heart rate (106 beats per minutes; normal 100
beats per minute) and slightly reduced body temperature (36.9°C Axilla; normal: 37°C).
According to Braid (2015) hypovolemia is a process of decrease volume of the body fluid.
The reduction in the volume of the body fluid reduces the overall blood returning to the heart
and thereby decreasing the preload. In order to compensate for the reduced preload in the
cardiac muscles or reduced cardiac output, the heart rate increases as in case of Eleanor
Wilson. The increase in heart rate helps to increase the cardiac output and thus increasing the
pressure of tissue perfusion (Vincent et al., 2016). Alternatively, Siebenmann et al. (2016)
have reported that induction of hypovolemia within an organism triggers off numerous
closely associated processes where the equilibrium of the individual's spatial and temporal
interactions is hampered. The primary response towards the hypovolemia includes reduction
in the transport of the oxygen and cardio-dioxide molecules. The reduction in the transport of
the oxygen and carbon-dioxide is the reason behind Eleanor Wilson’s high heart rate (106
beats per minutes). Siebenmann et al. (2016) also reported that hypovolemia is associated
with decreased capillary flow as a consequence of the resulting hypotension. The decrease in
the body fluid within the body changes the pattern of the capillary perfusion. This decreases
the overall flow of the fluid within the arteries and veins and thus leading to generation of the
low blood pressure or condition similar to hypotension. Hypotension is evident in Eleanor
Wilson (90/54; normal units: 120/80mmHg). According to Høiseth, Hisdal, Hoff, Hagen,
Landsverk and Kirkebøen (2015) hypovolemic shock is the main cause of mortality among

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the trauma patients. Lower body negative pressure (LBNP) is defined as the central model of
hypovolemia. LBNP as present in Eleanor Wilson has caused decrease rate of oxygen
saturation and thus she is on fraction of inspired oxygen (FiO2) supply externally at a rate of
2 liters of oxygen (O2) through nasal prongs).
Post-operative data leading to hypovolemic shock
Reason for the occurrence of hypovolemia in case of Eleanor Wilson include high rate
of hourly urine output of 15 to 20 ml per hour (normal parameter include 1 to 2 ml/kg/hour)
from the indwelling catheter (IDC) measurement. Brotfain et al. (2017) stated that urine output is
an important parameter of renal function and status of the blood volume in the ciritically ill
post surgical patients. The blood volume status and renal function of post-operative patients,
with multiple trauma, changes rapidly during the first 24 hours after the surgery. In case of
Eleanor Wilson, the uncontrolled high level of urine output is the reason behind
hypovolemia. Brotfain et al. (2017) also reported that trauma-associated acute haemorrhage is
another leading cause of intravascular volume depletion leading to the generation of
hypovolemia. The vacuum wound drain (Bellovac) in-situ fitted to Eleanor Wilson might be a
reason behind hypovolemia. Bellovac is a low vacuum wound drainage system that consists
of a drain, vacuum bellows and a drainage bags for the collection of the tissue fluids, blood
and other body secretion coming from the wound. The drainage of the body fluid or blood
through the wound drainage system is thus reducing the total volume of the body fluid
leading to the development of hypovolemia.
Mechanism of body to compensate hypovolemia physiologically
Taghavi and Askari (2018) reported in order to cope with this emergency state of the
body, the initial measures are undertaken by the internal pathological mechanism of the body.
The first step is the restriction of the gastro-intestinal (GI) losses. GI losses occur by different
etiologies. GI tract secretes 3 to 6 litres of fluid per day. The majority of the secreted fluid is

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the reabsorbed and only 100 to 200 ml is excreted through stool. In order to protect the
volume depletion the secretion of GI juices increases along with reduced excretion through
stool. In case of Eleanor Wilson, it can be said that, she is on ranitidine medication (150 mg
BD). The role of this medication is decreased production of the stomach acid and thus
inhibiting GI to restore the fluid balance through increase GI secretion. Fluid loss also occurs
through skin in the form of sweat. The loss of fluid can be as high is 1 to 2 litres per hour
during hot and dry climate. So in order to reduce the loss of fluid through the skin, the over
body temperature is reduced (hypothermia) by signalling through the hypothalamus of the
brain. This decreased body temperature cools the body leading to fluid loss skin in the form
of sweat (Taghavi & Askari, 2018). Eleanor Wilson is on regular dosage of IVI paracetamol,
and thus helping to regulate the body temperature.
Answer 2
Priority One
Control of Hypovolemia as, it might lead to the development of hypovolemic shock.
Hypovolemic shock leads to decreased peripheral perfusion and if left untreated can lead to
the development of ischemic injury of the vital organs leading to multi-organ failure (Taghavi
& Askari, 2018). The hypovolemic state of body of Eleanor Wilson is evident from low
blood pressure, increased heart rate and low level of oxygen saturation within the body.
Moreover, Eleanor Wilson is one PRN IVI/PO Ondansetron. Ondansetron is a medication
used for the effective management of nausea and vomiting. In case of Eleanor Wilson, nausea
and vomiting arising out of adjuvant chemotherapy or as an outcome of the post-operative
condition has lead might have lead to the development of hypovolemia (Taghavi & Askari,
2018).