Pathophysiology and Nursing Goals for Post-Operative Hypovolemia in Acute Care

Running head: ACUTE CARE
ACUTE CARE
Name of the Student
Name of the university
Author’s note

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Pathophysiology of Eleanor’s post-operative hypovolemia
Hypovolemia is a clinical condition in which a rapid loss of the body fluid takes place,
which might cause a multiple organ failure due to the inadequate circulating volume and
subsequent inadequate perfusion. Hypovolemia can be referred to as decrease in the volume of
the blood relative to a normal sized vascular compartment (Gann & Drucker, 2013).
Hemorrhagic shock can also occur due to acute internal blood loss in the thoracic or the
abdominal cavity. Furthermore, Eleanor has undergone resection of the tumor under anesthesia.
It has to be mentioned that anesthesia related vasodilation can be the primary cause of relative
hypovolemia (Noel-Morgan & Muir, 2018). Hence prolonged effect of anesthesia might have
caused hypovolemia in the patient. Vasodilation associated with hypovolemia is associated with
the increased venous compliance, decreased venous return and a reduced response to the
vasoactive substances. Depending upon the status of the patient the hypovolemia might remain
clinically undetected with the impending consequences due to the impaired oxygen delivery and
the tissue perfusion (Gann & Drucker, 2013). The hematocrit count and the low concentration
of the hemoglobin indicates towards hemorrhagic shock that might have occurred. Isovolemic
anemia can also occur if the blood transfusion is not available, which is characterized by a
decreased hemoglobin content. Hypovolemia causes a lowered cardiac output and hypotension
by decreasing the preload, which can be related to the low blood pressure obtained in the
subjective values of the Eleanor- BP 90/54. Again, the heart rate in hypovolemic shock increases
which can be observed form the vital signs of this patient. Low urinary sodium is found in the
hypovolemic patients because the kidney attempts for the conservation of the sodium and water
for the expansion of the extracellular volume.

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Trauma can be associated with the hypovolemia, with the profuse attendant blood loss.
Blood loss has been associated with the traumatic fracture or resection of malignant tumors.
How does the body compensate it physiologically
The body compensates with the increased sympathetic tone causing an increased heart
rate, increased cardiac contractility, and peripheral vasoconstriction. The initial changes that can
be seen in the vital signs is the increased diastolic pressure along with a narrowed pulse pressure
(Taghavi & Askar 2018). A volume status continues to decrease and the systolic blood pressure
drops. Again there are some other compensatory mechanism that a body employs to deal with the
hypovolemic shock. The mechanisms includes the baroreceptor reflexes, the chemoreceptor
reflexes, the circulating vasoconstrictors, the renal absorption of the sodium and water ,
activation of the thirst mechanism and the reabsorption of the tissue fluids (Gulati, 2016).
A body can quickly sense a reduction of the arterial blood pressures by the help of the
arterial and the cardiopulmonary baroreceptors and then activates the sympathetic adrenergic
system for stimulating the heart (increase the contractility and the heart rate) and the constriction
of the blood vessels. This causes an increase in the systemic vascular resistance and the arterial
pressure. Hence the cardiac output is redistributed from the less important organ to the brain
(Gulati, 2016). The reduced blood flow caused due to the vasoconstriction and the reduced
arterial pressure causes systematic acidosis that is normally sensed by the chemoreceptors.
The combined effect of the arterial hypotension and the sympathetic activation causes the
activation of the humoral compensatory mechanism. The sympathetic stimulation of the adrenal
glands stimulates the release of the catecholamines in to the blood that reinforces the impacts of
sympathetic activation of the vasculature and the heart (Gulati, 2016). The kidney releases more

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renin after the hemorrhage. It leads to an increased circulating level of the angiostenin II and
aldosterone. It causes vascular contraction, increased sympathetic activity and stimulation of the
release of vasopressin.
Hypotension, combined with the contraction of the precapillary resistance vessels causes
a fall in the capillary hydrostatic pressure (Lonjaret, Lairez, Minville & Geeraerts, 2014). This
pressure normally facilitates the filtration of the fluid from the blood across the capillary
endothelium and in to the interstitial space (Thomovsky & Johnson, 2013). As the capillary
hydrostatic pressure is reduced, less amount of fluids leaves the capillaries. When the pressure
falls sufficiently low , net absorption of the fluid can occur from the tissue interstitium back in to
the capillary plasma (Thomovsky & Johnson, 2013). The blood plasma volume is increased,
causing the hemodilution of the blood and therefore the hematocrit falls in response to the fluid
shift. This can be related to fact that the Haematocrit (HCT) range was 0.36 , which slightly less
than the standard value.
Identification of the priority problems in Eleanor
Eleanor has returned to the ward after a right hemicolectomy for a poorly differentiated
adenocarcinoma of the ascending colon. The four clinical priorities for Eleanor has been stated
below:-
 Low blood pressure – The assessment data of Eleanor in the post-operative period clearly
indicates he incidence of hypotension in the patient. Hypotension in Eleanor might have been
caused due to hypovolemia occurred after the patient had returned from the surgery.
Hypovolemia has been found to be causing a low cardiac output and hypotension, which can
occur due to the loss of the circulating blood volume after the hemorrhage. Hypotension