Hypovolemic Shock: Assessment and Manifestations

Hypovolemic shock is quite similar to cardiogenic shock, almost. Both have the same signs and symptoms and are about issues regarding blood volume.

Hypovolemic shock, much like cardiogenic shock, is due to decreased perfusion which results in decreased oxygen transport to the rest of the body. Therefore, the clinical manifestations of hypovolemic shock would be the same with cardiogenic shock.

Hypovolemic Shock Pathophysiology

Though almost similar, there are still a couple of differences between cardiogenic shock and hypovolemic shock; for one, the causes and pathophysiology.

Cardiogenic shock is about decreased cardiac output that results in low pressure and low oxygen pumped around the body. Hypovolemic shock, on the other hand, is having low volume being pushed around the body.

Hemorrhage

Hemorrhage or bleeding, be it external or internal, is the primary reason for hypovolemic shock. Any form of intense bleeding can result in decreased hemoglobin in the body. Hemoglobin is a protein and blood component that is mainly responsible for transporting oxygen throughout the body.

Hemoglobin is like the blood’s oxygen tank for distributing oxygen to the different areas of the body. Without adequate perfusion due to bleeding, there wouldn’t be enough blood to go around; therefore, hemoglobin will be unable to sustain oxygen distribution.

Hemorrhage can be due to a couple of reasons, and some common ones are:

• Trauma
• Car accident
• Gastrointestinal bleeding
• Gunshot wound
• Stabbing

It doesn’t really matter how the bleeding started for as long as the bleeding continues and is not subdued, it will eventually lead to hypovolemic shock.

Clinical Manifestations

Bleeding decreases perfusion which then decreases oxygen in the body leading to hypovolemic shock. If this happens, the body will compensate, and the clinical manifestations will be quite similar to cardiogenic shock.

The primary signs and symptoms of hypovolemic shock are:

1. Increased respiratory rate – breathing hard to get in more oxygen in the lungs and in the bloodstream
2. Increased heart rate – the heart tries its best to transport the limited blood around the body with an increased pace
3. Vasoconstriction due to increased resistance – the blood vessels are trying to bring more blood back to the lungs, heart, and brain
4. Urinary retention – the kidneys will hold on to all the fluid it can hold onto to not lose further blood volume
5. Altered level of consciousness – this is due to decreased oxygen going inside the brain
6. Pale or dusky skin
7. Decreased capillary refill

So, just remember that all of these manifestations happen due to decreased perfusion that leads to low oxygenation. Without oxygen, the body will try its best to compensate, and when that happens, everything will go haywire.

Nursing Interventions

One of the leading nursing interventions that you have to do to prevent hypovolemic shock is to stop the bleeding. So, what are the different things that you should do?

1. Put direct pressure on the affected area to promote the coagulation process and for the bleeding to stop.
2. Give blood transfusion to increase the blood volume; thereby increasing the red blood cells and oxygen going around the body.
3. Give epinephrine to increase peripheral vessel resistance.
4. Provide a dopamine drip to shrink down the vessels in the peripherals.

For our next shock-related lecture, we’ll be delving into anaphylactic shock. Compared to cardiogenic and hypovolemic shock which are both due to blood volume issues, anaphylactic shock is due to decreased resistance. Simply visit our SimpleNursing website and YouTube channel for that discussion.

See you there!