CASE STUDY. CASE STUDY. 4. Case Study- The Deterioratin

Running head: CASE STUDY
Case Study- The Deteriorating Patient
(Hypovolemic shock)
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Author Note:
Word Count:1944

1CASE STUDY
The case subject, Kenneth Bradman, is a 67 year old man who has been found to
be admitted to a surgical high dependency unit after a per rectal bleed. In the emergency
department he required a blood transfusion, after which he was transferred to the
Surgical High Dependency Unit for further monitoring of any symptoms of underlying
hypovolemic shock. Hypovolemic shock refers to the severe reduction in the fluid
component of the blood, rendering the heart unable to effectively pump blood to the rest
of the body. This, if not determined and treated at an early stage can be detrimental to
the other organs and gravely affect their functionality (El Ayadi et al., 2016, p.
e0148729). The case subject was kept under observation for any symptoms of atrial
fibrillation as well as the potential incidence of acute kidney failure. Upon neurological
assessment, he was found to be oriented at times and disoriented at other times. His
ECG readings indicated that he was suffering from atrial fibrillation, which was
resolved; however, he was found to show signs of shortness of breath indicated by
mildly elevated respiration rate. He was also observed to have reduced bowel
movements upon abdomen auscultation. The subject was found to have reduced urine
output upon admission, and was administered an indwelling urinary catheter.
The following essay will identify the signs and symptoms of the case subject, determine
the priority medical problem, provide nursing interventions for it and discuss the
psychosocial issue of the case subject.
An individual suffers fromhypovolemic shock when they suddenly lose severe
amounts of blood or other bodily fluids, which reduces the overall volume of the blood
circulating the entire body. This is deemed as a fatal medical complication, as the
organs, from the lack of blood flow through them often suffers from severe hypoxia.
The low oxygen amount in the organs, result in the sudden drop of the overall body

2CASE STUDY
temperature which in turn facilitates the reduction of the functionality of the organs
(Gulati, 2016, p. 182).
Individuals suffering from hypovolemic shock are often seen to portray
increased heart rate, severe fatigue, and shortness of breath, cold skin, and low blood
pressure as well as reduced urinary output (Miller, 2015, p. 9).
The case subject upon admission has been identified to have been suffering from
a severe case of hypovolemic shock. The patient is initially brought to the emergency
dependency unit after suffering from a severe case of per rectum bleed, which resulted
due to the injunction of two bleeding ulcers and an upper gastrointestinal bleed and for
which he required a blood transfusion.
According to the observations documented by the registered nurse, he was seen
to portray a number of symptoms which indicated that he was suffering from a
hypovolemic shock.
The registered nurses assessed that after performing 12 lead ECG upon the
admission of Mr Bradman, he portrayed atrial fibrillation, with a rate of 80-100 beats
per minute.His systolic blood pressure was found to be between the ranges of 105-120
mmHg, after the blood transfusion. Hypovolemic shock results in reduced intravascular
volume which the body compensates with a surge in the sympathetic tone which in turn
facilitates increase upon medically assessing the patient it was found that due to the
sudden loss of blood caused by the severe rectal bleed he suffered, he underwent a
hypovolemic shock. This shock indicates that the individual has lost significant amount
of blood or extracellular fluid, resulting in the reduced blood flow to the heart and other
organs, causing severe hypoxia of the organ cells. in the heart rate and leads to

3CASE STUDY
peripheral vasoconstriction (Gaieski & Mikkelsen, 2016, p. 17). Thus, the first
observable change is the increase in the diastolic blood pressure and the drop in the
systolic pressure of the individual. This results in the increased hypoxia of the organs
which makes the cells switch to anaerobic metabolism causing lactic acidosis.
Prolonged increase in the sympathetic drive results in tissue ischemia and increases the
incidence of lactic acidosis. If the situation is not detected and treated, this can be highly
fatal for the individual. He was also observed to have cold and clammy skin which is
mainly due to the sudden loss of the blood volume leading to vasoconstriction (Miller,
2015, p. 12).
Upon renal assessment, the patient was found to have reduced urinary output of
about 30mls/hr. for 2 hours. This is mainly due to the significant loss of fluid in the
body, which results in the reduced amount of salt and fluid, often leading to renal
failure. The kidneys attempt to help restore the sodium and water in order to increase
the extracellular volume, which produces undue stress on them, impairing their
concentrating ability. Thus, the overall dehydration of the body, results in the reduced
renal perfusion and leads to the failure in body’s mechanisms, during a hypovolemic
shock (Moore,Hsu & Liu, 2018, p. 139). This also contributes to the decreased urine
formation in the patient. The decreased urine output can lead to the deposition of the
salts in the urinary bladder causing urinary tract infections, which would elevate the
white blood cell count. Hence, considering that upon fluid assessment of Mr Bradman,
his white blood cell count was recorded to be 13.5x 109/L whereas the normal range is
4.3-10.8 x 109/L, him contracting UTI, because of the hypovolemic shock, is a
possibility.