Question

Mr. Johnson is a 52-year-old male being treated for hypovolemic shock resulting from bleeding injuries received in a motor vehicle accident. Mr. Johnson has a decrease in his MAP of 12 mm Hg from his baseline reading, increased heart rate, decreased pulse pressure, decreased urine output, increased potassium level, and mild acidosis. He states, “I am so thirsty.” Describe the pathophysiology of sharp Mr. Johnson is presenting. Describe the priority treatments for Mr. Johnson providing explanation of how and why the treatment will benefit the patient.

Answer 1

Pathophysiology of hypovolemic shock due to accident

    * Loss of fluids from the body due to injury result in reduction of intravascular volume.

    * Decreasing fluid volume in the circulatory system result in decreased venous return.

    * Reduction of venous return result in increasing heart rate to compensate circulatory fluid volume.

   * Increased heart rate result in reduction of amount of blood pumped per minute.

   * Pulse pressure decreasing due to reduction amount of blood pumped per minute from the heart.

   * Extracellular and intracelllular fluid shift occurs so increase pottasium level in blood and mild

     acidosis occur .

* Urine output decreased due to reabsorption of water from the renal tubules increase to maintain

    circulatory fluid volume.

* Patient felt thirst because of severe dehydration due to excessive fluid loss.

Medical management of this patient

           * Fluid and blood replacement

                             * Administer fluids and blood to restore fluid volume it include ringer lactate solution,

                                normal saline,colloids and blood products .

          * Postioning the patient

                             * Place the patient properly to assist fluid distribution.Trendelenberg position is

                               recommended to promote return of venous blood.

          * Pharmacological therapy

                              * Along with fluid replacement drugs used to reduce cardiac workload and reverse

                                cause of dehydration.Eg Nitroprussside,Dopamine etc.

* Nurse should monitor for signs of changes in heart rate,diffculty in breathing may occur if pulmonary

   edema is present .

* Check vital signs ,arterial blood gas levels and blood components routinely.