Nursing Care Plan for Hypovolemic Shock

  Causes of shock include:

• Blood loss from:
  • Traumatic injuries
  • Internal bleeding, such as a GI bleed or surgical complication
  • Postpartum hemorrhage
• Fluid loss from:
  • Burns
  • Diarrhea
  • Vomiting

Nurses should assess their patient for the risk of developing hypovolemic shock. The patient may have lost some fluid already, or maybe they’re at risk for bleeding. Either way, the more aware the nurse is of the risk, the more likely it can be prevented or caught early.

Patient may develop tachycardia and tachypnea in the early stages, then hypotension in later stages. It’s important to note these changes in the patient. Monitoring VS could help to prevent hypovolemic shock if caught early, but will also help to determine the patient’s response to treatment.   Level of consciousness should be assessed because it may decrease as the patient loses oxygenation of their brain. Decreasing LOC is a sign of advancing shock. Notify the provider for:

• ↓ blood pressure, not responding to fluids. If the blood pressure continues to drop, the patient will lose perfusion to vital organs.
• ↓ LOC – if the patient is more difficult to arouse or confused, this could be a sign of advancing shock. They may also begin to have difficulty protecting their own airway – the provider needs to be notified

  Hemodynamic measurements will tell us the severity of the shock and how well the patient is responding to treatment.

• MAP = Mean Arterial Pressure – this is the average pressure within the arteries. It can be calculated with a non-invasive blood pressure, but is more accurate when measured by  an Arterial Line. Decompensated shock will show a decreasing MAP below 60 mmHg
• CVP = Central Venous Pressure. This measures Preload. In a patient with hypovolemic shock, it will be low (<4 mmHg). The goal would be to see this number as well as the CO increase with fluid resuscitation
• CO = Cardiac Output. As the patient’s preload decreases, so does their cardiac output. The body will attempt to compensate, so you may see a normal cardiac output for a while – then it will begin to drop as the body’s compensatory mechanisms fail. This is assessed using a FloTrac or PA catheter
• SVR = Systemic Vascular Resistance. This measures afterload. We will expect this to be high because of the body’s attempts to compensate through vasoconstriction. If fluid resuscitation is effective, we will see this number return back down to normal

  Fluids should be given as soon and as fast as possible to restore circulating blood volume.

• Crystalloid – to replace fluid loss from sources other than bleeding/hemorrhage
  • Normal Saline
  • Lactated Ringers
• Colloid to replace lost blood volume from hemorrhage