Hypovolaemic Shock

Mid complexity — Circulation

Goals

  1. Recognise the symptoms of hypovolaemic shock and apply nursing interventions accordingly.
  2. Recognise and describe the compensatory mechanisms in hypovolaemic shock.
  3. Provide treatment recommendations.

Anamnese

  • Name: Mr Bolstra
  • Age: 68 years
  • Family: Married
  • Occupation: Off-licence owner
  • Cultural: Not known

AMPLE

A: Unknown

M: Dabigatran and metoprolol tartrate

P: Hypertension and atrial fibrillation

L: Bread meal 1 hour ago

E: Abdominal complaints and general muscle weakness

SBAR

S: Mr Bolstra is admitted to your ward for observation of abdominal complaints. He has had significant abdominal pain since this morning. He says he has just been to the toilet but feels he needs to go again. He just feels too weak.

B: Mr Bolstra is 68 years old. His history includes hypertension and atrial fibrillation. He uses dabigatran as an anticoagulant and also metoprolol.

A: See ABCDE

R: Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

A: Clear, appears fatigued.

B: RR 24 breaths/min, symmetrical thoracic excursions, normal work of breathing, not using accessory breathing muscles, normal jugular veins, normal breath sounds, saturation 92%.

C: Pale colour, CRT 3 sec, HR 115 bpm, weak regular pulse, peripherally cold and clammy, BP 86/48 mmHg.

D: Alert on AVPU, fatigued, glucose 7.4, pupils PEARL.

E: Temp 36.3°C, pale skin, no active blood loss visible. No oedema in legs. Urine output: spontaneous 150 ml 6 hours ago.

Situation at the end of scenario

A: Clear, reduced consciousness, eyes closed.

B: RR 28 breaths/min, symmetrical thoracic excursions, normal work of breathing, not using accessory breathing muscles, normal jugular veins, normal breath sounds, saturation 92%.

C: Increasingly pale colour, CRT 5 sec, HR 138 bpm, weak regular pulse, peripherally cold and clammy, BP 73/33 mmHg.

D: Voice on AVPU, glucose 7.4 mmol/l, pupils PEARL.

E: Temp 36.3°C, pale skin, active blood loss visible between legs (rectal). No oedema in legs.

Recommendations

  • Administer blood products