Nursing Assignment: Hypovolemic Shock and Nursing Interventions

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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Justification of Nursing Problem Statement
Hypovolemic shock is a severe lethal condition that is caused by the severe blood loss
and fluid loss after a surgery. Patients suffering from hypovolemia have decreased peripheral
perfusion and if it is let untreated, it can develop ischemic injury of the vital organs, causing
multi-organ failure (Gutierrez, Reines & Wulf-Gutierrez, 2014). Hypovolemic shock commonly
occurs in critical care units. This situation is of particular risk for Darren, as considerable loss of
the intravascular volume might lead to hemodynamic instability, reduced perfusion of the tissue,
cellular damage, cellular hypoxia, damaged of the organs and death (Dellinger et al., 2013).
Class I hypovolemic shock is a preterminal complications that requires immediate therapy.
It is evident from the case study Darren Roberts that he had undergone an open
cholecystectomy surgery and is at a risk of developing hypovolemic shock due to the excessive
blood loss. The skin of the patient looks cool and clammy. Patients often feel sluggish and the
skin becomes pale and clammy due to the inadequate pumping of the heart (Noel-Morgan, &
Muir, 2018). The patient also feels sluggishness and sleepiness and confusion because of the
lack of blood flow in to the vital organs. The estimated blood loss is again complicated by many
factors like the renal impairment and the development of tissue edema.
Hypovolemic shock due to the loss of the extracellular fluid can be caused due to the
etiologies like gastrointestinal loss, where the gastrointestinal tract secretes 3-6 liters in a day.
Volume depletion might occur if the fluid from the GI tract are not observed (Noel-Morgan, &
Muir, 2018). The hypovolemic shock occurs due to the reduction of the intravascular volume,
which can be due to extracellular blood loss or loss of fluid from the body. It should be noted in

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this context, that the body tries to compensate with the augmented sympathetic tone causing a
rise in the heart rate, augmented cardiac contractility and peripheral vasoconstriction. In case of a
hypovolemic shock there is an increase in the blood pressure with a narrowed pulse pressure. As
the volume status decreases, the systolic blood pressure drops (Noel-Morgan, & Muir, 2018).
Hence the oxygen delivery in the vital organ reduces resulting in the switching to anaerobic
metabolism to aerobic metabolism leading to lactic acid metabolism. With the increase of the
sympathetic drive, the flow of the blood is diverted from other organs for preserving the blood
flow to the brain and heart. This helps in the progression of the tissue ischemia and worsens the
occurrence of lactic acidosis. This condition is specifically important to treat for Darren Roberts,
as such situations can worsen the hemodynamic compromise and can bring about mortality.
Again, it can be seen from the case study that Darren Roberts had met the anesthesia
prior to the surgery. Depression of the cardiac performance associated with anesthesia and
arterial vasodilation have a well-recognized hostile effects. The venous circulation, containing
65-70% of the entire volume of the blood, that is a crucial contributor to the stroke volume and
the cardiac output. Vasodilation is the main cause of relative hypovolemia produced by the
anesthetic drugs (Noel-Morgan & Muir, 2018). Impairment of Anesthetic drug is a deceptive and
an appreciated cause of relative hypotension in the patient. It is evident from the case study of
the patients that the patient had mild hypotension, which can be worsened anesthesia related
hypotension.
Patient centered SMART goal
The client will be able to maintain appropriate cardiac output, evidences by strong
peripheral pulses, with a systolic blood pressure within the range 20mm Hg of the baseline, with

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a heart rate of 60 to 100 beats per minute with a normal rhythm, urinary output 30 ml/hr or more
than that, warm and dry skin and normal level of consciousness.
Nursing interventions
Nursing interventions Rationale
1. Electrolyte replacement can be prescribed
(Sharkawy, Sahota, Maughan, & Lobo,
2014). Hartmann’s solution is a balanced
crystalloid solution that can be
administered intravenously.
Imbalance of the electrolytes might cause
dysrhythmias or the other pathological
conditions. Operative trauma imposes a great
impact on the physiology of the fluid and the
electrolytes within the body that is greater
than the changes linked with simple lack of
alimentation (Sharkawy, Sahota, Maughan, &
Lobo, 2014). Crystalloid solutions containing
low molecular weight electrolytes can pass
freely across semi-permeable membrane
(between the intra in water and pass Dextrose
solution are given within 4 hours after the
surgery, because they are metabolized rapidly
(Sweeney, McKendry & Bedi, 2013). Another
reason of giving dextrose, instead of free
water is due to the fact that the administration
of even a small volume of water might cause
intravascular hypotonicity causing hemolysis
of the red blood cells owing to the influx of