 Hi, welcome to Nursing School Explained in this video on hypovolemic shock. Now, hypovolemic shock is basically a loss of intravascular volume, and that can be a loss of volume, so basically the fluid, or it can be loss of blood, or it can be a combination of the two. So, if we're just using losing fluid, this can be due to vomiting or diarrhea, or maybe a heat stroke, extreme dehydration, and so forth. But we can also lose blood, or blood components, from let's say a GI bleed, or any kind of massive hemorrhage from a trauma or any kind of other injury. Now those are fluid losses to the outside, they completely leave the body. But then there's also third spacing, such as in burns, or maybe even patients with asides, who have third spacing in their abdomen. And that would basically be loss to the extravascular space, where the fluids may still remain inside the body, but they are now out of the intravascular space. And whenever we think about loss of intravascular space, we have to talk about cardiac output and stroke volume. So pathophysiologically, if we now have decreased volume, we're going to have decreased stroke volume, which then leads to decreased cardiac output, which decreases the blood pressure, which means that our organs are not being profused, the body is going to hold on to every drop of fluid, and therefore we have decreased urine output, and then eventually we'll have impaired cellular metabolism. And hyperbolic shock occurs in three different stages. So first stage is compensatory, and remember that we have these beautiful mechanisms built into our bodies that help us maintain our blood pressure. So we have our sympathetic nervous system that helps us to increase the blood pressure by increasing the heart rate, therefore it raises the cardiac output, and also we increase our respiratory rate to get more oxygen to the cells that so desperately needed. And then we have the renin angiotensin and aldosterone system that when it detects a drop in blood pressure, it causes vasoconstriction and retains more sodium and water and brings up the blood pressure. Now a patient in a compensatory stage of hyperbolic shock might show increased heart rate, respiratory rate, and then they might be restless because now their brain is maybe being deprived of oxygen, but a lot of times the sympathetic nervous system and the rest will be able to compensate. Now if these fluid loss progresses, we are in the progressive stage, and then now we don't have enough volume anymore to hydrate or to provide the cells with what they need to have normal metabolism, and so the cells change to anaerobic metabolism, which leads to the buildup of lactic acid and results in metabolic acidosis. Furthermore, remember that anaerobic metabolism does not generate as much energy as aerobic metabolism, and therefore it leads to tissue hypoxia, which then causes vasodilation and an increase in capillary permeability, which increases the patient's risk for DIC or disseminated intravascular coagulopathy. Signs and symptoms in the patient in a progressive stage of hyperbolic shock are low blood pressure. Now we can't compensate anymore. There might be a narrowed pulse pressure and the stroke volume will be down as well. And then if we don't catch this and the patient switches to this anaerobic metabolism and all these cellular changes occur, we actually end up in this irreversible cause or stage of hyperbolic shock where there's permanent cell damage that eventually will lead to death. The patient eventually will become unconscious, they will be severely hypotensive, and they might have slower chained stokes respirations until their death occurs. So there are basically stages and so when we know that the patient is at risk for hyperbolic shock by any of these conditions that cause the fluid to shift out of that intravascular space, we need to be extra aware of these possible complications and monitor the patient very carefully for these things over here so that we can intervene appropriately and in a timely manner. Now diagnostic tests we might need for patient hyperbolic shock, CBC, we will not check their hemoglobin and hematocryp as well as the platelets because we know that they are for a risk for coagulation issues. We also want to check all their electrolytes because depending on the underlying cause, their electrolytes might be out of balance as well. We want to check their kidney function because if there's impertisodial metabolism and we are producing lactic acid and we are laser constricted and holding onto sodium and water, we might not be perfusing the kidneys appropriately. Again we have coagulation studies here and any stress can cause alterations in blood sugar so we want to check the blood sugars very carefully as well as their arterial blood gases if we're suspecting they're heading towards metabolic acidosis as well as urine-specific gravity to see how the hydration status is doing and we might need heart studies such as EKG and echocardiogram to determine what's going on with the heart and are the electrolytes affected or is the heart affected by the hypovolemia. And then the treatment is treating the underlying cause. If the patient is dehydrated they're going to need crystalline solutions. If the patient is bleeding they're going to need blood. If they start spacing they're going to need a lot of other things so watch my separate video on that. Certainly we're going to need to be watching ABCs and the patient might need to be intubated if they're heading towards this progressive stage where they're going to need a lot of interventions to prevent or to help correct this metabolic acidosis and keep them from developing DIC. And then again we need to replace whatever we've lost so crystalloids to help with the increased intravascular volume, normal saline or lactated ringers, colloids such as albumin to help with the oncotic pressure and actually keep the fluid in the intravascular space or blood as in red blood cells if there's hemorrhage or massive blood loss. For nursing care we want to make sure again we monitor ABCs very carefully, frequent monitoring of bioscience and then the patient might require hemodynamic monitoring because now we're dealing with very low blood pressure and an invasive arterial line for example might help us determine their blood pressure on a more minute-to-minute basis and also maybe we need a central venous pressure to see how their fluid volume is doing without as we're replacing it. We definitely want to make sure the patient has a urine output of greater than 30 ml per hour to ensure perfusion to the kidneys and we want to frequently reassess them and particularly here we want to reassess their lungs as always when we're replacing fluids we have to consider that the fluid might go to their lungs so this is why we have to frequently reassess as well as their skin signs because if we lose intravascular volume the patient might be shunting a blood away from the surface from their skin into that intravascular space so the first signs might be cool cool skin or maybe they're cool to the touch or maybe they're turning a little bit pale so don't remember don't forget to assess those very basic things to hopefully keep the patient from developing this progressive stage of hypovolemic shock. Thanks for watching this video I'll see you soon right here on nursing school explained.