NURS 4700 NURSING CONCEPTS AND INTERVENTIONS FOR THE CARE OF OLDER ADULTS II (Shock) CASE STUDIES MARQUETTE UNIVERSITY

Adult II-Theory
Shock Case Studies
CAS E 1:
A 41 yo is involved in an auto accident and suffers from a lacerated spleen with bleeding through an
open wound. The patient is taken to the OR and 1,500 ml blood loss is replaced.
Post-operative assessment finds the following:
T-99.0 F, HR-102, R-22, BP-108/60
Lethargic, oriented x 3
Skin pale, cool and clammy
Mucous membrane dry, lt pink
NPO, NG output 50 cc greenish
IV-NS @ 125cc/hr
Does this patient initially have actual or relative hypovolemia?
• The patient has absolute hypovolemia which is fluid loss outside the body.
What should initial treatment include?
• Fluid replacement, blood product replacement, oxygen therapy
You continue to assess and three hours later determine treatment has been effective. What do you
suspect you observed?
• Moist mucus membranes, alert and oriented, skin warm, vs within patient’s normal values,
active bowel sounds.
CASE 2:
A 51 yo male with chronic hepatitis from blood transfusions presents with jaundice and ascites. He is
thirsty and refusing a liquid diet. Upon assessment you find the following:
o T-98.4, HR-110, R-28, BP 112/70
o ABD distended, hard tight
o Pitting edema-3+ sacral, thighs
o Skin-cool, dry
o Alert, O x 2, not time, restless
o D5.45 @ 75 cc/hr
Does this patient initially have actual or relative hypovolemia?
• This patient has relative hypovolemia which is when fluid shifts in the body. For this particular
patient, the ascites.
You discover in his history that the last bp in his doctor’s office 186/92. During the evening you note
what signs that cause you to suspect he is in early hypovolemic shock?
• Decrease in his BP (previously 186/92 112/70), elevated HR, cool skin, increased RR, and
restlessness.
What treatment do you anticipate for this patient?
• Warm and reposition the patient, replace fluids by using Collids to draw fluid back into the
vessels, monitor vital signs.