Question

1. Describe hypovolemic shock. What are causes of hypovolemic shock and what is occurring in each? What are signs and symptoms a patient may be experiencing shock?What nursing interventions would the nurse implement for shock?
2. Describe cardiogenic shock. What are causes of cardiogenic shock?
3. Compare and contrast respiratory acidosis and alkalosis. Include signs and symptoms, treatment, and nursing interventions for each.
4. Compare and contrast metabolic acidosis and alkalosis. Include signs and symptoms, treatment, and nursing interventions for each.
5. How is acid base balance measured? What is the normal ranges for pH, PaO2, PaCO2, HCO3, and BE?

Answer 1

1) Hypovolemic shock is a rapid decrease in intravascular fluid, typically from blood loss. This causes decreased perfusion to tissues and can cause organ failure.

Causes of Hypovolemic shock:-

- Internal/ External hemorrhage due to trauma, severe Gastrointestinal bleeding

- Dehydration due to vomiting , diarrhoea, aquatic therapy

- Loss of plasma due to burns, discharge from lesions.

Stages of Hypovolemic shock:-

1) Initial stage

2) Compensatory stage

3) Progressive stage

4) Refractory stage

In initial stage, their is 15% drop in blood volume causing peripheral constriction. As a result , decreased tissue perfusion leading to cause anaerobic metabolism .

Compensatory stage:-

- Homeostatic mechanism are sufficient to maintain adequate tissue perfusion despite a reduction in CO.

- SNS activation attempts to maintain blood pressure even though CO has fallen.

Progressive stage of shock

-It is marked by hypotension and marked tissues hypoxia.

- Lactate production increases with anaerobic metabolism.

- Lack of ATP leads to cellular swelling, dysfunctions, death.

- Cellular and organ dysfunction result from oxygen free radicals, release of infammatory cytokines and activation of clotting cascade.

Refractory stage involves excessive cell damage and tissue death because tissue perfusion is blocked at this stage due to an excessive decrease in mean arterial pressure.

Signs and symptoms of shock:-

- unconsciousness

- Confusion

- cool skin

- Decrease body temperature

- Decrease blood pressure

- Increase heart rate

- Darked colour urine

- Decrease Hgb and HCT

Nursing Interventions:-

Nursing care focusses mainly to restore intravascular volume.

- Safe administration of blood and regular monitoring.

- Safe administration of fluid and regular monitoring.

- Monitor vital signs such as Blood pressure, Pulse, Temperature.

- Oxygen administration