HYPOVOLEMIC SHOCK

Nurses who care for patients in the different stages of shock
must tailor interventions to the type of shock, whether hypovolemic,
cardiogenic, or circulatory shock. Hypovolemic
shock, the most common type of shock, is characterized by
decreased intravascular volume. Body fluid is contained in
the intracellular and extracellular compartments. Intracellular
fluid accounts for about two thirds of the total body
water. The extracellular body fluid is found in one of two
compartments: intravascular (inside blood vessels) or interstitial
(surrounding tissues). The volume of interstitial fluid
is about three to four times that of intravascular fluid. Hypovolemic
shock occurs when there is a reduction in intravascular
volume by 15% to 30%, which represents a loss
of 750 to 1500 mL of blood in a 70-kg (154-lb) person

Medication Desired Action in Shock Disadvantages

Medication                  Desired Action in shock                    Disadvantages

Inotropic Agents

Dobutamine (Dobutrex      Improve contractility, increase stroke             Increase oxygen demand of the heart

Dopamine (Intropin)          volume, increase cardiac output

Epinephrine (Adrenalin)

Milrinone (Primacor)

Vasodilators

Nitroglycerin (Tridil)            Reduce preload and afterload, reduce           hypotension

                                        cause oxygen demand of heart 

Nitroprusside (Nipride)       

Vasopressor Agents

Norepinephrine (Levophed)   Increase blood pressure by vasoconstriction      Increase afterload, thereby                           

Dopamine (Intropin)                                                                                   increasing cardiac   

                                                                                                               workload;compromise perfusion to 

                                                                                                               skin, kidneys, lungs, gastrointestinal 

                                                                                                               tract

Basic Concepts in Nursing

A nurse working in an urgent care clinic that serves an economically

depressed urban area notes a high incidence of elderly patients with

dehydration and heatstroke in the summer months. The nurse verifies

the observations by accessing data about hospital admissions for

dehydration and heatstroke. The nurse determines that many of the

admitted patients live in the area served by the clinic and that

many of the patients live alone and have other chronic illnesses.

The nurse sees the need for a plan that includes a community

response to this problem. The plan includes arranging an

education program about the prevention of dehydration; a community

support buddy system in which neighbors or volunteers call or

visit homebound elders during critical periods in the summer; and

economic support to air condition the senior citizens’ center.