Which finding will the nurse expect when caring for a client who is in hypovolemic shock?
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Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working. Show
Losing about one fifth or more of the normal amount of blood in your body causes hypovolemic shock. Blood loss can be due to:
The amount of circulating blood in your body also may drop when you lose too much body fluid from other causes. This can be due to:
A physical exam will show signs of shock, including:
Tests that may be done include:
In some cases, other tests may be done as well. Get medical help right away. In the meantime, follow these steps:
The goal of hospital treatment is to replace blood and fluids. An intravenous (IV) line will be put into the person's arm to allow blood, blood products, or fluids to be given. Medicines such as epinephrine or norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output). Symptoms and outcomes can vary, depending on:
In general, people with milder degrees of shock tend to do better than those with more severe shock. Severe hypovolemic shock may lead to death, even with immediate medical attention. Older adults are more likely to have poor outcomes from shock. Complications may include:
Hypovolemic shock is a medical emergency. Call the local emergency number (such as 911) or take the person to the emergency room. Preventing shock is easier than trying to treat it once it happens. Quickly treating the cause will reduce the risk of developing severe shock. Early first aid can help control shock. Angus DC. Approach to the patient with shock. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 98. Dries DJ. Hypovolemia and traumatic shock: nonsurgical management. In: Parrillo JE, Dellinger RP, eds. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 26. Maiden MJ, Peake SL. Overview of shock. In: Bersten AD, Handy JM, eds. Oh's Intensive Care Manual. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 15. Puskarich MA, Jones AE. Shock. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 6. Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Hypovolemic shock typically refers to a severe drop in blood volume that leads to further complications in a person’s health. The heart cannot pump blood around the body unless a certain volume of blood is present. Blood volume describes the total amount of blood in the body. If a person’s blood volume drops significantly, then a person can go into hypovolemic shock. Many health problems can lead to hypovolemic shock. A doctor will diagnose a patient with the issue once an individual loses 20% or more of their blood volume. Hypovolemic shock is a medical emergency that is difficult to diagnose and treat. It can result in organ failure. In a study, more than 82% of patients who died from hypovolemic shock died within the first 24 hours. There are approximately three stages of hypovolemic shock based on the level of blood volume loss. All the stages require fast treatment. The earlier doctors can recognize the stage of shock a person is in, the faster they can give the patient the appropriate treatment. MildDuring the earliest stage of hypovolemic shock, a person loses less than 20% of their blood volume. This stage can be difficult to diagnose because blood pressure and breathing will still be normal. The most noticeable symptom at this stage is skin that appears pale. The person may also experience sudden anxiety. ModerateIn the second stage, the body loses 20-40% of blood. The individual may experience increased heart and breathing rates. Blood pressure may still be within normal range. However, the diastolic pressure, or bottom number, of their blood pressure may be high. The person may begin sweating, as well as feeling more anxious and restless. SevereBy stage 3, a person with hypovolemic shock will have lost more than 40% of their blood. The systolic pressure, or top number, of their blood pressure, will be 100 millimeters of mercury (mm Hg) or lower. Their heart rate will increase to over 120 beats per minute (bpm). They will also have a rapid breathing rate of more than 30 breaths per minute. They will begin to experience mental distress, including anxiety and agitation. Their skin will be pale and cold, and they will begin sweating. They will have a weak pulse but an extremely rapid heart rate. Breathing will become be very fast and difficult. Systolic blood pressure will be under 70 mm/Hg. They may experience the following symptoms:
A major cause of hypovolemic shock can be acute blood loss. The term hemorrhagic shock refers specifically to this type of hypovolemic shock. This can occur as a result of an acute tissue injury or because of conditions like internal bleeding or illness. But, hypovolemic shock can also refer to any major loss of bodily fluid that also results in significant blood loss. Blood plasma is the liquid part of blood that holds red blood cells, white blood cells, and blood platelets. Water makes up 92% of plasma. If a person loses a significant volume of fluid, the plasma part of blood will deplete too. For this reason, many conditions that are not acute blood loss can lead to a critical reduction in blood volume. Severe burns, persistent diarrhea, vomiting, and even excessive sweating could all be potential causes of hypovolemic shock. Doctors can identify hypovolemic shock more easily when they can see significant blood loss from an external wound. However, hypovolemic shock often develops as a complication of an underlying medical condition. Internal bleeding may not be obvious from observation and is often hard to control without surgery. Medical professionals and first responders are trained to recognize the signs of blood loss. However, people should educate themselves on its signs so that they can get help for themselves and others as quickly as possible. Hypovolemic shock usually occurs as a result of either an illness, injury, or other medical condition. As a result, doctors may find it hard to predetermine specific risk factors. Any risk factors would be the risk of getting a condition that can cause the shock, such as the risk of being severely injured in a car crash or having an aneurysm rupture. When a person is dehydrated, they lose a significant amount of water volume. People who are dehydrated can become hypovolemic if they are also losing salt, which can lead to a loss in blood volume. For this reason, people who are dehydrated, or at risk of becoming dehydrated, should continue to drink fluids, especially if their illness is causing them to experience vomiting or diarrhea. These can lead to further loss of fluids. A person may not be able to prevent the injuries or illnesses that cause hypovolemic shock. However, a person may be able to prevent further complications by rehydrating. The easiest way for a medical professional to diagnose hypovolemic shock is through observation and examination. A physical exam will show whether the person has low blood pressure, increased heart and breathing rates, and a low body temperature. Doctors can use blood tests to help support this diagnosis. A blood chemistry test can give some additional clues about the level of salt and electrolytes in the body as well as how the kidneys and liver are functioning. A complete blood count (CBC) can tell how much blood a person has lost. The following tests or devices can help determine the underlying cause of the hypovolemia or locate a source of internal bleeding:
Treating hypovolemic shock means treating the underlying medical cause. Physicians first will try to stop fluid loss and stabilize blood volume levels before more complications develop. Doctors usually replace lost blood volume with intravenous (IV) fluids called crystalloids. These are liquids with a thin consistency, such as a saline solution. The doctor may also use thicker solutions called colloids. In the most severe cases, the remaining blood becomes diluted. This can result in low levels of platelets and other blood components that help form clots that stop bleeding. The medical team will replace these components when necessary, especially if the person is still bleeding, through plasma or red blood cell (RBC) transfusions. After the shock is under control and the blood volume stabilizes, the doctor can treat the underlying illness or injury. Hypovolemic shock is a life-threatening emergency. A person’s outlook depends heavily on which complications develop while a person is in shock. This can include damage to the kidneys or brain. It is critical that an emergency doctor increases the person’s blood volume quickly to restore blood supply to all organs. The amount of time it takes to increase the blood volume can depend on:
Hypovolemic shock and older adultsOlder adults are particularly at risk of getting hypovolemic shock because they can be more susceptible to dehydration, which can trigger hypovolemia. They also do not tolerate having a low blood volume well. The risk of complications increases with age, especially if other conditions have already caused organ damage such as kidney failure or a heart attack. It is especially important that older adults receive prompt treatment as soon as they, or individuals near them, recognize any signs of hypovolemic shock. Hypovolemic shock is a medical emergency in which blood volume drops to a dangerous level. It occurs when the body loses excessive amounts of water and salt. The condition has four stages. By the fourth stage, a person’s condition becomes critical. Treatment for this type of shock involves replacing fluids in the body, usually with a saline solution. However, treatment is difficult and the condition usually carries a high risk of death. The best way to stabilize the condition is to spot symptoms as early as possible and to seek prompt medical treatment. Which finding will the nurse expect when caring for a client who is in hypovolemic shock quizlet?Which finding would the nurse expect when assessing a client diagnosed with hypovolemic shock? Urine output decreases to less than 20 to 30 mL/hr (oliguria) because of decreased renal perfusion secondary to a decreased circulating blood volume.
Which of the following indicates hypovolemic shock in a client who has had a 15% blood loss?The answer is D. During stage 2 or class II of hypovolemic shock, the cardiac output is falling even more due to volume loss. This is when the patient has lost 15-30% of volume.
Which conditions can cause hypovolemic shock select all that apply?What causes hypovolemic shock?. excessive or prolonged diarrhea.. severe burns.. protracted, or excessive vomiting.. excessive sweating.. bleeding from serious cuts or wounds.. bleeding from blunt traumatic injuries due to accidents.. internal bleeding from abdominal organs or ruptured ectopic pregnancy.. Which action would the nurse take first when caring for a client with hypothermia?Monitor breathing. A person with severe hypothermia may appear unconscious, with no apparent signs of a pulse or breathing. If the person's breathing has stopped or appears dangerously low or shallow, begin CPR immediately if you're trained. Provide warm beverages.
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