Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 480/481L: CRITICAL CARE > Hypovolemic Shock > Flashcards

Hypovolemic Shock Flashcards

1
Q

How does hypovolemic shock occur?

A

It occurs from inadequate fluid volume in the intravascular space to support adequate perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Volume loss may be either _____ or _____

A

Absolute or Relative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Absolute hypovolemia

A

Results when fluid loss is lost through a hemorrhage, GI loss, fistula drainage, diabetes insipidus, or diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Relative hypovolemia

A

Fluid volume moves out of intravascular space into the extravascular space (intracavity space) a.k.a “third spacing”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List some examples of relative hypovolemia

A

-Internal bleeding
-Third-spacing of fluid; severe burns due to increased capillary permeability
-Long bone fractures
-Damage to organs like the pancreas
-Massive vasodilation…..sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List some examples of absolute hypovolemia

A

-Massive bleeding from surgery or injury
-Excessive fluid loss: Vomiting, diarrhea, urination, sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the volume percentage a person must lose for signs and symptoms of shock to occur?

A

> 15% (750ml)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How much blood does an average adult have?

A

5L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Reduced intravascular volume results in ____

A

-Decreased venous return to the heart
-Decreased preload
-Decreased stroke volume
-Decreased cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the hallmark signs of shock?

A

Decreased tissue perfusion and impaired cellular metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What factors does a patients response to acute volume loss depend on?

A

-Extent of injury
-Age
-General state of health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A patient may compensate for loss of up to ___ of the total blood volume

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Further loss of volume (15-30%) results in a _____

A

Sympathetic Nervous System (SNS) mediated response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SNS mediated response results in _____

A

-Increased HR
-Increased cardiac output
-Increased RR and depth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Patient may appear _____ and urine output begins to _____ if they loose 15%-30% of fluid volume

A

-Anxious
-Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If volume loss is greater than 30%, compensatory mechanisms may _____ and immediate replacement with ______ should be started

A

-Fail
-Blood products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are common lab studies and assessments done for patients with hypovolemic shock?

A

Serial measurements of Hgb & Hct levels, electrolytes, lactate, blood gases, mixed central venous O2 saturation (SvO2), and hourly urine outputs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define Preload

A

Amount ventricles stretch at the end of diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define Stroke Volume

A

Amount of blood the left ventricle pumps each beat (50-100mL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define Cardiac Output

A

Amount of blood the heart pumps per minute (4-8L)

21
Q

How many classes/stages of hypovolemic shock are there? What are the volume percentages?

A

4
-Class I: <15% (750mL)
-Class II: 15%-30% (750mL - 1,500mL)
-Class III: 30%-40% (1,500mL - 2,000mL)
-Class IV: >40% (>2,000mL)

22
Q

Signs and symptoms of stage 1

A

Asymptomatic
-HR, BP, RR, mental status – w/in normal range
-Skin: warm
-Capillary refill: < 2 sec.
-UOP: >30cc/hr

23
Q

Signs and symptoms of stage 2

A

-HR: Increased (mild tachycardia)
-BP: Slightly decreased
-RR: Mild Increase
-UOP: 20-30cc/hr
-Skin: Cool & clammy
-Capillary refill: < 2 sec.
-Peripheral pulses: Diminished
-Mental status: Mild anxiety

24
Q

Signs and symptoms of stage 3

A

-HR: >120 (tachycardic)
-BP: Severe hypotension
-RR: Increased (resp. failure)
-UOP: < 30cc/hr (oliguria)
-Skin: Cool, clammy, mottled
-Pulses: Poor
-Mental status: Confusion, agitation

25
Q

Signs and symptoms of stage 4

A

Vital signs are significantly abnormal (near death)
-Major tachycardia (>140)
-Severe hypotension
-Major respiratory failure
-Anuria
-Mental status: lifeless, in a coma

26
Q

What factors should we look at when coming up with goals and interventions for patients with hypovolemic shock?

A

Circulation, perfusion, and oxygenation

27
Q

What are the treatments for hypovolemic shock?

A

Replace fluids and correct the underlying cause

28
Q

What are signs of adequate perfusion?

A

-Skin: warm to touch
-Mental status: normal
-HR, BP, RR: normal
-UOP: >30cc/hr
-Capillary refill: < 2 sec.

29
Q

List nursing interventions for patients with hypovolemic shock

A

-Give patients fluids as ordered
-Monitor patient for fluid overload
-Obtain IV access STAT
-Give the patient oxygen or put on mechanical ventilation
-If patient is bleeding, hold firm direct pressure on wound and call rapid response
-Monitor for signs of adequate perfusion
-May need to start Foley catheter
-Central line and Hemodynamic monitoring
-Position patient in modified Tredenlenburg
-Keep patient warm, but not to the point of sweating
-Monitor for fluid overload
-Monitor for blood transfusion reactions if patient is given blood

30
Q

How many IV sites should a patient have?

A

At least 2

31
Q

What size should the cannula be?

A

Large cannula; > 18 G

32
Q

How is the patient positioned in the modified Tredelenburg position?

A

Supine with legs/feet elevated at 45 degrees

33
Q

What types of fluids can you give to the patient?

A

Crystalloids, colloids, blood, and blood products (Packed RBCs, Platelets, FFP)

34
Q

Crystalloids and colloids are two types of _____ used for hypovolemic shock

A

Volume expanders

35
Q

What are two examples of crystalloids?

A

Normal saline & Lactated Ringers

36
Q

How do crystalloids work?

A

They add more fluid into the intravascular system, which increases preload, SV, and CO

37
Q

What should watch for when administering fluids?

A

Fluid overload

38
Q

What are the differences between crystalloids and colloids?

A

-Crystalloids are able to diffuse through the capillary wall so less fluid remains in the intravascular space
-Colloids consist of large molecules so more fluid stays in the intravascular space longer

39
Q

What is the 3:1 rule?

A

For every 1mL of approximate blood loss, 3mL of crystalloid solution is given

40
Q

What are 2 examples of colloids?

A

Albumin & Hetastarch

41
Q

Patients can have what kind of reaction when colloids are used for fluid replacement?

A

Anaphylactic shock

42
Q

T/F: Colloids more expensive than crystalloids

A

True

43
Q

When giving large amounts of fluid, what should the nurse do?

A

Warm the fluid to prevent hypothermia

44
Q

Packed RBCs help ____

A

Replace fluid and provides the patient with Hgb

45
Q

When can you give packed RBCs?

A

When the patient is not responding to crystalloid fluids, experienced severe bleeding/severe hypovolemic shock

46
Q

What are platelets used for?

A

Uncontrolled bleeding to help with thrombocytopenia

47
Q

What are FFP used for?

A

When patient needs clotting factors

48
Q

What should you monitor for when giving blood and blood products?

A

Transfusion reactions

NURS 480/481L: CRITICAL CARE (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions