Hypovolemic Shock: Causes, Symptoms, and Nursing Interventions

This article discusses the causes, symptoms, and nursing interventions for hypovolemic shock. It emphasizes the importance of early diagnosis and treatment to improve patient outcomes. The article also highlights the role of nurses in assessing and managing patients with hypovolemic shock.

Running Head: Case Study 1
Case Study
According to case study one, the condition from which patient presents is the
Hypovolemic shock. This shock arises when the circulation volume considerably drops. In this
type of the shock, systemic decrease of tissue perfusion results in reduced oxygen delivery. If the
primary process is inverted, prolong oxygen deficiency can lead to cellular hypoxia as well as
accumulation of metabolic waste, causing multiple system organ failure leading to death (Piras,
2017). Providentially, initial identification of the hypovolemic in addition proper treatment can
significantly recover patient symptoms. The most common form of hypovolemic shock is blood
loss. Hypovolemic shock is considered as a significant reason of the morbidity as well as
mortality. Quick diagnosis related with the instant and suitable treatment is critical to existence.
Timely hemodynamic stability is foundation of the initial management.
The first and foremost symptom of the hypovolemic shock is low diastolic blood
pressure. Mr. Bradman was having 98/48mmHg blood pressure on assessment, which is major
complication. In hypovolemic shock there is decrease in preload (a decrease in left ventricular
blood volume at diastole). As the preload drops, the cardiac output also drops (Edla et al., 2015).
When interstitial fluid moved to intravascular space and the liver as well as spleen discharge
stored red blood cells (RBC), the blood volume increases. These variations stimulate the renin-
angiotensin-aldosterone system, it encourages the retention of sodium as well as water to
increase systolic blood pressure. The renal system counteracts the lack of blood supply by
starting a compensation path to counter the physiological effects of massive blood loss (Boyd &
Smart, 2018).
Second most prominent symptom of hypovolemic shock is impaired electrolyte balance
and cellular metabolism due to fluid loss. It leads to weakened muscle contraction, amplified risk

Running Head: Case Study 2
of the arrhythmia, fatigue as well as weakness. There is decrease in myocardial contractility due
to electrolyte imbalance (Gunnerson 2015). An increase in hydrogen ion production due to lactic
acidosis results in an increase in activity of buffer system, and an increase in carbon dioxide
production in an exertion to prevent pH changes. This carbon dioxide is emitted through the
lungs, which can be demonstrated by increasing the respiratory rate and depth. However, as
elongated as the kidneys are able to redevelop bicarbonate, this activity will continue. (Galvagno
2013). An increase in respiratory rate is a display of imminent clinical deterioration. Renin is
secreted due to decrease in circulating blood volume, resulting in an increase in plasma levels of
angiotensin II that secretes vasopressin which function to stops additional fluid loss (Corrêa et
al., 2015).
The pathophysiology of Bradman's hypovolemic shock is intensified by the presence of
alcohol in the blood. Alcohol intake leads to a lack of fibrinogen and coagulation factors and
reduces platelet function. Therefore, despite the fact of rapidly losing blood and experiencing
from the hypovolemic shock, patient’s body do not compensate by coagulation or platelet
aggregation to damaged area because of disproportionate intake of the alcohol. Previous history
of per rectum bleed and currently present per rectum bleed results in a large amount of blood
loss. The goal of treating hypovolemic shock, in this case is holistic with the goal of enhancing
the cardiac output through cycling volume replacement as well as reversing shock. Nurses must
be able to properly assess patients and identify signs and symptoms of exacerbations and
deterioration. In addition, nurses need to fully understand the patient's medical history and the
underlying causes of insufficient blood volume (Bench, 2014).
Fluid loss is priority problem to be managed by nursing interventions because several
electrolyte imbalances occur in hypovolemic shock due to fluid loss. Beginning of hyperkalemia

Running Head: Case Study 3
may leads to substantial arrhythmias. It have an adverse effect on the prognosis related to
circulatory failure by releasing potassium into the extracellular fluid (Uyehara and Sarkar 2013).
In case of Mr. Bradman breathing is also labored as SpO2 is 91% which should be monitored.
Nurses must monitor the fluid balance diagrams of the inputs and outputs which can help
determine if additional fluid are needed (Supandji et al., 2015). Maintaining the fluid balance
map is an important intervention as well as an important device for evaluating a patient's state
and reaction to treatment (Gallimore, 2015). The occurrence of the coagulopathy as well as
hypothermia increases the danger of death and ineffective fluid resuscitation (Spahn et al., 2013).
The first nursing intervention for fluid maintenance is administration of proper fluid. The
most frequent intravenous fluids used to replace as well as restore fluid volume are crystalline
and colloidal. The crystal solution should be given in the large quantities, including 0.9 percent
of sodium chloride and solution of Ringer's lactate. A great amount of crystal fluid cause
pulmonary edema, electrolyte imbalance, the tissue edema, and congestive heart arrest leading to
respiratory distress as well as coagulopathy. Thus, care must be taken by nurses under the
through guidance of the medical professional appointed for continuous assessment of the
patient's clinical complaint.
Second most important nursing intervention is monitoring and selection of the fluids to
be given to the patients in order to prevent further complications. The Colloidal solution
comprises of albumin, plasma dilator, succinylated gelatin as well as 10 percent of glucose. That
are suitable for early treatment of hypovolemic shock and are extensively practiced too (Redhi,
2013). The role of the colloid is to flow blood from the extravascular space into the blood vessels
to reinstate body’s fluid volume; they need less to accomplish this goal, which will be valuable
for patients having a history of heart disease to avoid fluid overload as illustrated by (Bouglé et

Running Head: Case Study 4
al., 2013). Colloids can encourage rapid and constant plasma expansion, secondary to a large
upsurge in osmotic pressure, promote intravascular fluid volume, and attain circulating
hemodynamic stability in less time; however, they have an allergic reaction.
High risk and hazardous anaphylactic reactions ought to be used with caution. No studies
deliver convincing evidences that colloids are suggestively more expensive as well as more
clinically operative than crystalloids as stated by (Kolecki, 2014) recommends fluid recovery
using Ringer's lactate solution or 0.9 percent of sodium chloride. Due to the hazard of the
electrolyte imbalance when administering huge liquid quantity or the blood elements, electrolyte
intensities, including magnesium, the calcium as well as potassium, must be monitored through
the administration to guarantee that interference is adjusted to prevent additional complications.
Changes in muscle tremors and electrocardiograms of patients should be monitored as a
predecessor to abnormal electrolyte intensities illustrated by (Bouglé et al., 2013). Active fluid
resuscitation might additionally dilute the clotting factor, which may cause blood clots to fall off,
resulting in hypothermia and further dilution of hemoglobin concentration; near monitoring of
the laboratory outcomes and patient conditions by nursing staff is vital stated by (Spahn et al.,
2013).
The most significant nursing intervention above all is the psychological care of patients
and their families. Anxiety (psychosocial issue) management is a key part of Mr. Bradman
because he was former prisoner and might be suffering from psychological distress which further
agitate with illness. Anxiety In this case is linked to the anxiety of death and may be due to side
effects of medication. Info about the patient's ailment and interventions must be provided, along
with it an open, truthful and sympathetic relationship between the nurse and the patient's loved
ones should be established. Nurses who continue to attend with the patient are in a chief position

Running Head: Case Study 5
to ensure that this is to be shunned and the patient's outcome is optimized (Moruzzi & McLeod,
2017). In addition, effective communication with patients, relatives, and other interdisciplinary
teams is critical to ensuring that cooperative practice maximizes the quality of patient care
provided by involving patient in decision making and using patient centered approach.
Management of the shock patients with hypovolemic shock is intricate and challenging.
Hemorrhagic shock could be possibly life-threatening complaint that requires rapid recognition
as well as beginning of the treatment to lessen hazard of the mortality. Hence, it’s crucial to have
the information of the exact indication and symptoms in addition to biological processes
indulged in recognizing the patient coming with hypovolemic shock. Therefore, it can be
concluded that the nurses should frequently locate patients as well as balance sensory stimuli by
enthusiastically promoting a surroundings that stimulate to avoid adversative psychosomatic
consequences. Early comprehensive assessments ensure a smooth, supportive emissions process.
Nurses outside of intensive care also needs to recognize the consequences of shock in order to be
able to initiate early management. Early thorough evaluation by using ABCDE method and
escalation as well as intensive care outreach is vital to avoid complications to reduce cardiac
output, regardless of the cause. For this, it is also essential to determine the root cause of Mr.
Bradman, which means that assessment and drug management are foremost for avoiding similar
situations in the coming future and to safely return to the community.

Running Head: Case Study 6
References
Bench, S. (2014). Clinical skills: assessing and treating shock: a nursing perspective. British
journal of nursing, 13(12), 715-721.
This article uses a case study to present the diagnostic criteria and the medical and nursing
management of a patient with the hypovolemic shock. It helped to better understand the
case better.
Bouglé, A., Harrois, A., & Duranteau, J. (2013). Resuscitative strategies in traumatic
hemorrhagic shock. Annals of intensive care, 3(1), 1.
Boyd, C., & Smart, L. (2018). Hypovolemic Shock. Textbook of Small Animal Emergency
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Corrêa, T. D., Takala, J., & Jakob, S. M. (2015). Angiotensin II in septic shock. Critical care,
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This review briefly discusses the main physiological functions of the renin angiotensin system,
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rate variability better than routine vital signs for prehospital identification of major
hemorrhage? The American journal of emergency medicine, 33(2), 254-261.

Running Head: Case Study 7
Gallimore, E. (2015). Clinical features and management of hemorrhagic shock. Nursing
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This article discusses the clinical features of hemorrhagic shock and the strategies used to
manage the condition, focusing on the presenting symptoms, classifications,
compensatory mechanisms, physiological changes and nursing interventions.
Galvagno, S. M. (2018). Emergency pathophysiology: clinical applications for prehospital care.
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This article focuses on the impact of hypovolemia and current recommendations regarding fluid
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The review article explains the conceptual, physiological, and pathophysiological aspects of
hypovolemic shock. It is an important cause of morbidity and mortality. Rapid diagnosis
associated with immediate appropriate therapy is essential for survival.
Redhi, L. (2013). Fluids: what's new? South African Family Practice, 55(3), S28-S31.

Running Head: Case Study 8
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