CASE STUDY

Case study

Case study

Question 1

Hypovolemic shock is a crisis status in which critical body-fluid and blood decrease makes the heart incapable to propel sufficient body-fluid to the body. This kind of shock can cause many vital organs to fail and cause significant damage and in some cases death(Spaniol et al 2007 152-156).

Diagnosis

Hypovolemia can be identified by increased pulse, weakened body-fluid force, and the nonattendance of perfusion as considered by skin indications (skin rotating pale) and/or capillary refill on forehead, lips and fastener beds. The persevering may seem dizzy, unclear, nauseated, or very thirsty. These indications are furthermore attribute of most kinds of shock. John has Stage 1 Hypovolemia.

In Stage I of shock, when reduced body-fluid flow (perfusion) is first noticed, several schemes are triggered in alignment to maintain/restore perfusion. The outcome is that the heart beats much quicker, the body-fluid vessels all through the body become somewhat lesser in diameter, and the kidney works to keep fluid in the circulatory system. All this serves to maximize body-fluid flow to the most significant body components and schemes in the body. The persevering in this stage of shock has very couple of symptoms, and remedy can absolutely stop any progression.

 

Skin pallor

John's skin is discovered to be cold  and clammy

Capillary refill

A hold up in capillary refill of longer than 3 seconds corresponds to a capacity decrease of roughly 10%.

In johns case it is 5 seconds.

Urine output

Decreased urine yield is characterised as making less than 500 milliliters of urine in 24 hours. In john's case it should be not less than 20 ml per hour. Observation discloses that it is only 15 ml.

Normal Vitals

Normal heart rate, body-fluid force and respiration rate along with the overhead three facts present an perfect case of stage 1 Hypovolemia.

Question 2

Three goals are vital in the management of John who is suffering from stage one of Hypovolemic shock. It has been decided that he undergoes another surgery to manage the root cause of the hypovolmic shock(Tarrant Ryan Hamilton Bejaminov 2008 252-257).

The following three areas need to be taken care by the medical staff post John's surgery.

(1) maximize oxygen consignment - accomplished by double-checking adequacy of ventilation, expanding oxygen saturation of the body-fluid, and refurbishing body-fluid flow, (2) command farther body-fluid decrease, and (3) fluid resuscitation. Also, the John's disposition should be quickly and appropriately determined(Cottingham 2006 317-326).

Maximizing oxygen delivery

Nurses should double-check that the John's airway should be considered directly upon appearance and stabilized if necessary. The deepness and rate of respirations, as well as wind noise, should be assessed. If pathology (eg, pneumothorax, hemothorax, flail chest) that hinders with respiring is discovered, it should be addressed immediately. High-flow supplemental oxygen should be administered to all patients, and ventilatory support should be granted(Tarrant Ryan Hamilton Bejaminov 2008 252-257), if needed. Excessive positive-pressure ventilation can be detrimental for John pain Hypovolemic shock and should be avoided.

Nurses can start two large-bore IV lines. The Poiseuille regulation states that flow is inversely associated to the extent of the IV ...