Hypovolemic Shock: Causes, Symptoms, and Nursing Interventions

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