Nursing Care Of Hypovolemic Care Case Study 2022

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Hypovolemic shock can be considered as a life-threatening condition that results
when one-fifth or twenty percent of body’s fluid (blood) has been lost. Loss of extensive fluid
from the body lead to decreased or impaired function of cardiovascular system (Levy et al.,
2018, p. 78). The heart, in hypovolemic state fails to pump the required volume that
consequentially lead to organ failure (Gulati, 2016, p.187). The hypovolemic shock condition
call for a medical emergency (Carlson & Fitzsimmons, 2019, p.474) as it is acute in nature.
Hypovolemic shock affects older adults and young children (Niaudet & Boyer, 2016, p.839)
very much, more than any other age groups. In this case study, a 67 year old patient named
Kenneth Bradman had a large per rectum bleeding. The case study looks into the problem of
rapid patient deterioration due to hypovolemia. The patient has a history of NSAID use on a
prolonged basis that has caused bleeding ulcers (Sostres et al., 2015, p.684). As a measure,
the patient was given packed RBCs, sodium chloride, fresh frozen plasma and
cryoprecipitate.
In the assessment done in the case study, the patient showed atrial fibrillation with
heart beat up to 100 beats per minute. In the cardiovascular assessment, it was found that the
peripheral body temperature was comparatively reduced and the systolic blood pressure
fluctuated between 105 – 120 mmHg. In hypovolemic shock, the heart is forced to pump a
blood volume more than its normal capacity which it eventually fail to produce at one stroke
volume. The afterload keeps on increasing and resultantly, the heart rate increases. There is a
decrease of left ventricular ejection fraction (Meléndez et al., 2017, p.1637) and this lead to
state of tachycardia (that is heart rate of more than 100 beats per volume) (Mar & Raj, 2019,
p.71). Decreased blood volume and intracellular fluid alters the metabolic and hemodynamic
state of the body drastically. In this state, the vital organs that requires a normal perfusion of
oxygen to function properly, fails to meet up with the safe or normal physiological
functioning (Høiseth et al., 2015, p.43). In this case study, Kenneth has exhibited increased

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heart rate that nears tachycardia (tachycardia happens when the heart rate is more than 100
beats per minute). The other vital symptom exhibited by the Kenneth in hypovolemic state, is
the neurological depression which has hampered the patient’s psychological functioning.
Although the patient shows orientation to place and time but require reorientation at times.
The neuropsychological disturbance is associated with reduced level of consciousness which
is a common symptomatic association in hypovolemia. Although the strength in the arms and
legs are mentioned in the case study to be intact – so the nursing diagnosis can assess and
confirm the reduced level of consciousness, is due to neuropsychological depression but
consciousness has to be checked imperatively, in order to relate to the other aspects
(symptoms) of neuropsychological depression. When the patient at checked at 8.25 hours for
an assessment, The patient condition has greatly deteriorated and the symptoms of
hypovolemia were more pronounced – heart rate was 116 beats/ minute (tachycardia), blood
pressure fallen (hypotension), distressed breathing and lowered oxygen saturation along with
overall ‘disorientation’(Phillips, Gavin & Gelfand, 2016, p.433). Tachypnea, pallor and
reduced level of conscious is associated with the hypovolemic condition and these symptoms
were very sound as Kenneth’s deteriorated further. The deterioration can be due to unchecked
bleeding that has resulted in aggravation of the patient’s hypovolemic signs and symptoms.
After doing the nursing assessment and finding the aforementioned symptoms which
is very indicative of further deterioration, the priority problem is the cardiorespiratory
problem. The cardiorespiratory problem has presented with an array of symptoms. The
general, cardiovascular, respiratory and neurological observation assessments has to be
performed. The patient is currently suffering from respiratory distress, resulting due to
underlying pathophysiology of tachypnea and tachycardia (Merlin, Hoy & Rodrigo-Mocholi,
2017, p. e000497). The cardiopulmonary complication is a clinical priority as it is the most
acute and severe symptom presented in Kenneth’s case due to further deterioration and it is of

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utmost importance from the nursing point of view or perspective of clinical care. The labored
breathing which Kenneth is currently suffering from, poses the greatest threat to his clinical
status. Hindrance to respiratory process and further deterioration in the cardiopulmonary
status, would simulate cyanosis and further complication in the hypovolemic status of the
patient. After using the clinical reasoning cycle, a registered nurse can suspect an unchecked
internal bleeding that might have led to this clinical deterioration of patient’s symptoms,
causing further aggravation of patient’s hypovolemic symptomatology. The clinical priority
is to manage the severe cardiopulmonary symptoms associated with the deteriorated
hypovolemic state of the patient. The aggravated clinical presentation of Kenneth is chiefly
due to the worsened cardiovascular function, lowered blood pressure, lowered oxygen
perfusion and disturbed ventilation- perfusion ratio that has led to labored breathing. This has
caused the pallor, peripheral hypothermia and overall disorientation. The clinical priority in
nursing care of Kenneth is to better the cardiovascular and respiratory status of the patient,
otherwise the deterioration might progress to a much irreversible health situation. Prioritizing
the problem is a major clinical challenge as the choice has to be the most complicated
symptoms which affects the condition or progression of the disease in a very adverse way. It
is important to use the clinical reasoning cycle to full effect. In this case, the nurse should use
clinical reasoning cycle, critical thinking in order to prioritize the cardiopulmonary symptoms
above other symptoms and with appropriate nursing care, this problem has to be addressed at
first.
The nursing care of hypovolemic care must manage these three stages (1)
compensated (2) decompensated (3) irreversible (van der Ster et al., 2018, p. e13895). The
trauma care unit or the emergency unit where the patient is admitted, needs to take act fast
with the rehydration and transfusion procedures in order to balance the lost amount of blood
from the body. A series of investigative and diagnostic procedure should follow where blood