Risks of Hypovolaemic Shock in Nursing - Essay Example

Running Head: Hypovolumic shock . Hypovolumic shock Name Institution Date Hypovolumic shock is a medical or even surgical condition which is characterized by a rapid loss of fluids by the body that eventually results in failure of multiple organs due to underperfussion.The main causes of hypovolumic shock would range from sever hemorrhage or blood loss, loss of fluids through diarrhea and vomiting, loss of fluids after sustaining burns, and also loss of fluids after trauma (Duane, 2011)In hypovolumic shock there is a decrease in the venous return and this leads to a decrease in the cardiac output and this goes in the long run to cause decreased perfusion of tissues (Mills, 2007). Q1) identify four (4) key pieces of assessment data that Support a diagnosis of hypovolaemic shock. Using current literature, explain the Pathophysiology of each piece of data selected. How the diagnosis of Mr.lee having hypovolumic shock was arrived at: The features which Mr. Lee presented with are those of hypovolumic shock and they this included; Features that were identified at the scene of the accident, secondly those that were identified when primary survey of Mr. Lee was being conducted. First, when the primary survey was conducted for Mr. Lee, it was noted that he had the vital signs which were altered compared to the normal. The blood pressure of Mr. Lee was found to be 74/40mmhg which is lower than the normal ranges .The blood pressures were low because of the reduction in the volume of blood to be pumped around the body as a result of loss of blood. Secondly,Mr. Lee had a respiratory rate which was elevated (35 breaths per minute) and this shows that Mr. Lee was compensating after the excessive loss of blood to maintain perfusion.Thirdly,the pulse rate of Mr. Lee was also noted to be weak and was at 120 beats per minute. The brachial and the radial pulses were also noted not to be palpable with the tachycardia apical beat was also at 120 per minute. The weak pulse is mainly attributed to the loss of blood that occurred after being involved in a road traffic accident (Hazinski, 2010). The forth reason being the body temperatures was at 35.8 degrees Celsius which are lower than the normal ranges (hypothermia). The low body temperatures could be attributed to the low volume of blood hence not all body organs will be supplied with blood and this leads to the drop in the body temperatures (Radiol et al, 2008).The pathophysiology of shock will involve four stages,Mr Lee is in third stage with a blood loss of greater than 30% blood volume, the cardiac out put cannot be maintained due to arterial constriction,Mr Lee hence will have a fall in both the arterial and pulse pressures due to the action of vasoconstrictors which respond to the decreased cardiac output and this goes to activate the rennin angiotensin system which brings about increased arterial and venous tones with an aim of increasing cardiac out put (Hazinski, 2010). Q2) explain the pathophysiology of Mr. Lee’s haemopneumothorax and how the intercostal catheter and underwater sealed drain inserted will help resolve this Problem. The pathophysiology of Mr. Lee’s condition which is pneumohaemothorax can be resolved through the intercostal catheter and underwater sealed drain insertion: Pneumohemothorax is the accumulation of air and blood within the chest cavity. This occurs after a penetrative trauma to the chest wall occurs. The chest wall is punctured and both the air and the blood are now able to enter and occupy the pleural space. The blood and the air rush into the pleural space due to the attempt of equalizing the pressures in the pleural cavity with that of the atmosphere (American College of Surgeons 2004). This makes the pleural fluid that is in the pleural space to be disrupted and the surface tension is limited. This makes the ribs to no longer move with the lungs outwards on inspiration. The continued fluid accumulation thus limits the expansion of the lungs and hence this goes ahead to limit respiration (American Thoracic Society 2011). The chest tube is used in the removal of fluid and air from the pleural space. The chest tube is inserted at the triangle of safety which is demarcated by the 5th intercostals space and the mid auxiliary line (Warriner et al, 2004). The use of the intercostals catheter and underwater seal drainage is to drain the fluid from the pleural space, and also to prevent the returning of the fluid and air back into the pleural space and this will a negative pressure in the pleural space causing the lungs to expand (Fitzgerald, 2009). Q3) Using the primary survey as a framework to prioritize, select two (2) priority Interventions (excluding preoperative preparation and transfer to the operating theatre) implement for Mr. Lee before surgical intervention. Using current literature, justify these Priority interventions. Conducting a primary survey will involve the checking of the airway patency. Mr. Lee’s pulmonary oxygenation will be sustained by giving of oxygen at a high inspired concentration rates (Maier, 2008).Mr. lee has to be inserted a needle to decompress the chest at the second intercostal space and this is aimed at changing the pneumohaemothorax to a simple pneumothorax which could be now easily managed by the underwater seal later on (Maier, 2008). The checking of the circulation will be aimed to ensure that Mr. Lee does not have a compromised circulation. This will involve the checking for the signs of active bleeding or any loss of blood that has occurred after the accident. The active bleeding will be arrested by the application of a tourniquet or by the application of pressure at the site of bleeding. An intravenous access will also be established by the use of a wide bore cannula, during the first insertion 20ml of the blood is withdrawn for the grouping and cross matching purposes and the full hematological studies. The resuscitation will also involve fluid resuscitation mechanisms which will be centered at the giving of plasma expanders to replace the lost amount of fluids. This will be aimed at correcting the hemorrhagic shock (Rizoli, 2003). Plasma expanders such as crystalloids e.g. normal saline or Hartmann’s solution will be used to replace the lost volume. Colloids could also be used to replace the intravascular loss of fluids even though a large amount will be needed to restore the loss of blood back to the normal volume. The colloids will be used when the blood loss is more than one liter. But if the blood loss is massive, there will be need for blood transfusion to be done on Mr. Lee and this will go a long way in maintaining the circulation hence the perfusion of the tissues in the body will resume and bringing to an end the manifestations of hypovolumic shock due to perfusion being enhanced. The transfusions in this case will whole blood in order to maintain the packed cell volume. This will enhance the adequate perfusion of tissues to be maintained (Spaniol et al, 2007). Fluid or volume replacement would also be necessary since the haematocrit concentration is low hence the need to increase the amount of oxygen being supplied to the tissues to enhance perfusion For the intravenous resuscitation, a large bore cannula would be used and the cardiac output measurements being monitored.ressuscitation will aim to maintain a normal flow volume of blood to enable normal perfusion of the tissues and also to provide enough supply of oxygen to be used during respiration (Nolan, 2001). This is because, the low volume resulting from blood loss would end up denying the body the supply of adequate amounts of oxygen to the body and as a result this could lead to underperfussion.The of major organs.underperfussion of major organs will lead to a multi organ failure and this could even result in death due to the low amounts of oxygen within the circulation (Rizoli, 2003). The blood transfusion simply goes ahead to offer more volume unto which the oxygen will be carried and delivered throughout the body. In order to also provide for a good supply of oxygen to the body, the ribs that Mr. Lee fractured would be strapped together as this will encourage the uniform movement of the chest cavity in order to bring about adequate gaseous exchange and hence increased tissue perfusion (Cook, 2001). The second intervention to Mr. Lee will be to ensure that Mr. Lee is not in severe pain. The effect of pain will be reduced by lowering the effect of the catecholamines.This could be achieved by the use of a mixture of 50%nitrous oxide with 50% oxygen (Entonox).this will go ahead to inhibit the secretion of the catecholamines and as a result the pain will be managed.Etonox can also be supplemented with increments of nalbuphine 10mg, morphine 5mg or ketamine 25-50 mg with diazepam 5-10mg or midazolam 5mg.this will often lead to the elimination of the pain. The severe pain will mainly be felt by Mr. Lee during the respiration as a result of the broken ribs. The broken ribs will cause Mr. Lee to have a flail chest and this will bring about considerable pain while breathing. The relieving of pain will involve giving Mr. Lee sedatives for example morphine to be able to reduce the pain that would be experienced while breathing in. The pain will also be eliminated by strapping the broken ribs to ensure that Mr. Lee does not have the pains while breathing in (Rizoli, 2003). Q4) for each intervention you have selected, outline two (2) specific evaluation criteria that would indicate to you that this intervention is having the desired effect. The success of interventions will be termed as a success when Mr. Lee will be able to have the saturation levels of oxygen in the blood will now increase due to increased gaseous exchange. Mr. Lee will also have normal hemoglobin and the respiratory rates, pulse rates and also the blood pressures will begin to normalize as a result of the resuscitation since the lost volume would be returned back into circulation and enhancing the perfusion of the tissues. Mr. Lee will also have no complains about the severe pain as a result of the use is the sedating agents and the strapping of the chest wall. References American College of Surgeons (2004).Committee on Trauma. Advanced Trauma Life Support Course Manual. Chicago, IL: ACSCOT;105:127 American Thoracic Society(2011). Chest Tube Thoracotomy, accessed on 11th April 13, 2011 from http://patients.thoracic.org/information-series/en/resources/chest-tube -thoracostomy.pdf Bollig et al (2011).Scandinavian Effects of first aid training in the kindergarten Journal of Trauma, Resuscitation and Emergency Medicine, Bryden et al(2008).Emergency intubation for acutely ill and injured patients. Cochrane Database Cook (2001). Colloid use for fluid resuscitation: evidence and spin. Ann Intern Med. 2001 Deneuville (2002).Morbidity of percutaneous tube thoracotomy in trauma patients.Eur J Cardiothorac Surg 22(5):673–678. Duane (2011).Types of Shock Part Two in Our Series on Shock, Minnesota health and medical journal accessed on 11th April from http://mnhealthandmedical.com/tchp_shock_series_part_2.pdf Fitzgerald (2009).Prehospital airway management accessedon 11th April from http://emj.bmj.com/content/27/3/172.full.pdf Hazinski (2010).Highlights of the American heart association guidelines for cpr and ecc greenvile, dallas, texas. Hoffman (2004).Road accidents: resuscitation on site, Middlesborough,UK Accessed on 11thApril , 2011 from http://www.sciencedirect.com/science References to hypovolumic Joint Royal Colleges Ambulance Liaison Committee, 2008 JRCALC Airway Management on 11th April 12, 2011 from http://jrcalc.org.uk/airway Maier (2008).Approach to the patient with shock. Harrison’s Principles of Internal Medicine 17th ed. New York, NY:McGraw Hill; 2008: chap 264. Mills (2007). Primary survey Trauma Resuscitation accessed on 11th April from http://www.us.elsevierhealth.com/media/us/samplechapters/9781416028727/Ch pter%2007.pdf Nolan (2001). Fluid resuscitation for the trauma patient, Resuscitation;48(1):57-69. Pettit et al, (2005). The safety and efficacy of prehospital needle and tube thoracotomy by aeromedical personnel.Prehosp Emerg Care: 191–197 Radiol et al (2008) .A pictorial review of hypovolumic shock in adults; 81:252-257. Rawlins et al (2003).Life threatening hemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax. Emerg Med J; 20:383–384 Rizoli (2003).Crystalloids and Colloids in Trauma Resuscitation: A Brief Overview of the Current Debate. J Trauma Spaniol et al (2007). Fluid resuscitation therapy for hemorrhagic shock. J Trauma Nurs; 14:152 --156 Warriner et al (2004). Virtual anatomical three-dimensional fit trial for intra-thoracically implanted medical devices. ASAIO J; 50:354 –359. Warriner et al Virtual anatomical three-dimensional fit trial for intra-thoracically implanted Medical devices ASAIO J; 50:354 –359 Read More