Nursing Case Study Hypovolemic Shock

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Mr George Jensen is experiencing post-operative hypovolaemia from a right tibia and fibula surgery, as a result of falling off the roof cleaning the gutters. It is therefore important to get an understanding of what hypovolaemia is and the pathophysiology behind this condition before treating the condition. According to Kettley and Marsh (2016), hypovolaemia is defined as inadequate filling of blood or fluids within the body’s circulatory system. Approximately one-third of the total body fluid is distributed in the extracellular compartment, of which one-quarter resides within the vasculature. Hypovolaemia can be divided into two separate categories, of which include absolute hypovolaemia, and relative hypovolaemia. Absolute hypovolaemia is usually caused by excessive fluid loss, such as blood loss from trauma or surgery, plasma loss from burns, or ECF loss from diarrhoea and vomiting. Relative hypovolaemia occurs in sepsis and anaphylaxis, where total body fluid content is high but the intravascular compartment is deplete (Kettley & Marsh, 2016). In relation to this, Mr George Jensen would be suffering from absolute hypovolaemia, due to an open reduction and external fixation of his fractures post surgery.

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55). According to Wen-Chih et al. (2010, p.11), ageing patients are susceptible to blood loss since they have limited physiological replacement. Thus, considering the age and the surgical procedure the patient is at high risk of hypovolemia. If the loss of blood progresses and the body is unable to compensate, the patient will be at risk for hypovolemic shock (D’Angelo, M., Dutton, R., 2009, p. 279). Hypovolemic shock means deficit in flowing blood causing to ineffectively filing the intravascular space. Mamaril, M., Child, S., & Sortman, S., 2007, p. 191. Kolecki, P., & Menckhoff, C. (2014) emphasizes that there are four (4) classification of hypovolemic shock. Class 1 is when there is 0-15% of blood loss with only slight change in heart rate. If the patient heart rate becomes more than 100 beats per minute and they experience tachypnoea and has cool clammy skin, the patient is in the class 2 of hypovolemic shock. Class 3 and 4 is when the patient will manifest the severe sympathetic response of the body due to the inability of compensate with the blood loss. Thus, considering the age and the surgical procedure the patient is at high risk of hypovolemia or even the more severe

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Cardiogenic shock is a frequently fatal complication that occurs when the heart cannot pump an adequate amount of blood in order to perfuse tissues. This hypoperfusion causes multiple organ dysfunction and damage which classifies cardiogenic shock a medical emergency. In the past, cardiogenic shock had a poor prognosis. However, currently approximately half of the people that go into cardiogenic shock survive (National Heart, Lung, and Blood Institute [NHLBI], 2011).