Which physiological response occurs first when a client experiences sudden hypovolemia

Q: Which intervention would the nurse perform when caring for a client in the ED reporting chest pain?

Nurses role. When a patient arrives in the ED and reports chest pain, the nurse should perform an immediate assessment. They also should think of the 12-lead ECG as a sixth vital sign and obtain it within the first 10 minutes of arrival (at the first complaint of chest pain for in-patients).

Q: Which action would a nurse take to prevent a parallax error and ensure accuracy when assessing a clients BP?

The observer should view the manometer in a direct line to avoid parallax error.” Application of the Cuff: Range markings are part of the ADCUFF™ system. Using an inappropriately sized cuff can affect blood pressure readings.

Q: Which fine motor skill would the nurse expect when assessing the development of an infant between 10 to 12 months of age?

By 10 months, the infant should be able to pull up to a standing or sitting position. 10 – 12 mos. Between 10 and 12 months, the infant should be able to stand alone and sit down from standing.

Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

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Symptoms of a heart attack
When to see a doctor
Get the latest heart transplant-related health information from Mayo Clinic.
Risk factors
Complications
Which intervention would the nurse perform when caring for a client in the ED reporting chest pain?
When hypokalemia suspected which diagnostic test will the nurse use to confirm the diagnosis?
Which action would a nurse take to prevent a parallax error and ensure accuracy when assessing a clients BP?
Which fine motor skill would the nurse expect when assessing the development of an infant between 10 to 12 months of age?

Losing about one fifth or more of the normal amount of blood in your body causes hypovolemic shock.

Blood loss can be due to:

Bleeding from cuts
Bleeding from other injuries
Internal bleeding, such as in the gastrointestinal tract

The amount of circulating blood in your body also may drop when you lose too much body fluid from other causes. This can be due to:

Burns
Diarrhea
Excessive perspiration
Vomiting

A physical exam will show signs of shock, including:

Low blood pressure
Low body temperature
Rapid pulse, often weak and thready

Tests that may be done include:

Blood chemistry, including kidney function tests and those tests looking for evidence of heart muscle damage
Complete blood count (CBC)
CT scan, ultrasound, or x-ray of suspected areas
Echocardiogram - sound wave test of heart structure and function
Electrocardiogram
Endoscopy - tube placed in the mouth to the stomach (upper endoscopy) or colonoscopy (tube placed through the anus to the large bowel)
Right heart (Swan-Ganz) catheterization
Urinary catheterization (tube placed into the bladder to measure urine output)

In some cases, other tests may be done as well.

Get medical help right away. In the meantime, follow these steps:

Keep the person comfortable and warm (to avoid hypothermia).
Have the person lie flat with the feet lifted about 12 inches (30 centimeters) to increase circulation. However, if the person has a head, neck, back, or leg injury, do not change the person's position unless they are in immediate danger.
Do not give fluids by mouth.
If person is having an allergic reaction, treat the allergic reaction, if you know how.
If the person must be carried, try to keep them flat, with the head down and feet lifted. Stabilize the head and neck before moving a person with a suspected spinal injury.

The goal of hospital treatment is to replace blood and fluids. An intravenous (IV) line will be put into the person's arm to allow blood, blood products, or fluids to be given.

Medicines such as epinephrine or norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output).

Symptoms and outcomes can vary, depending on:

Amount of blood/fluid volume lost
Rate of blood/fluid loss
Illness or injury causing the loss
Underlying chronic medical conditions, such as diabetes and heart, lung, and kidney disease, or related to injury

In general, people with milder degrees of shock tend to do better than those with more severe shock. Severe hypovolemic shock may lead to death, even with immediate medical attention. Older adults are more likely to have poor outcomes from shock.

Complications may include:

Kidney damage (may require temporary or permanent use of a kidney dialysis machine)
Brain damage
Gangrene of arms or legs, sometimes leading to amputation
Heart attack
Other organ damage
Death

Hypovolemic shock is a medical emergency. Call the local emergency number (such as 911) or take the person to the emergency room.

Preventing shock is easier than trying to treat it once it happens. Quickly treating the cause will reduce the risk of developing severe shock. Early first aid can help control shock.

Angus DC. Approach to the patient with shock. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 98.

Dries DJ. Hypovolemia and traumatic shock: nonsurgical management. In: Parrillo JE, Dellinger RP, eds. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 26.

Maiden MJ, Peake SL. Overview of shock. In: Bersten AD, Handy JM, eds. Oh's Intensive Care Manual. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 15.

Puskarich MA, Jones AE. Shock. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 6.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Overview

Cardiogenic shock is a life-threatening condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock.

Cardiogenic shock is rare. It's often deadly if not treated immediately. When treated immediately, about half the people who develop the condition survive.

Symptoms

Cardiogenic shock signs and symptoms include:

Rapid breathing
Severe shortness of breath
Sudden, rapid heartbeat (tachycardia)
Loss of consciousness
Weak pulse
Low blood pressure (hypotension)
Sweating
Pale skin
Cold hands or feet
Urinating less than normal or not at all

Symptoms of a heart attack

Because cardiogenic shock usually occurs in people who are having a severe heart attack, it's important to know the signs and symptoms of a heart attack. These include:

Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
Pain spreading to your shoulder, one or both of your arms, your back, or even your teeth and jaw
Increasing episodes of chest pain
Shortness of breath
Sweating
Lightheadedness or sudden dizziness
Nausea and vomiting

Seek medical attention quickly when having these signs or symptoms to decrease your risk of developing cardiogenic shock.

When to see a doctor

Getting heart attack treatment quickly improves your chance of survival and reduces damage to your heart. If you're having symptoms of a heart attack, call 911 or other emergency medical services for help. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Don't drive yourself.

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Causes

In most cases, a lack of oxygen to your heart, usually from a heart attack, damages its main pumping chamber (left ventricle). Without oxygen-rich blood flowing to that area of your heart, the heart muscle can weaken and go into cardiogenic shock.

Rarely, damage to your heart's right ventricle, which sends blood to your lungs to get oxygen, leads to cardiogenic shock.

Other possible causes of cardiogenic shock include:

Inflammation of the heart muscle (myocarditis)
Infection of the heart valves (endocarditis)
Weakened heart from any cause
Drug overdoses or poisoning with substances that can affect your heart's pumping ability

Risk factors

If you have a heart attack, your risk of developing cardiogenic shock increases if you:

Are older
Have a history of heart failure or heart attack
Have blockages (coronary artery disease) in several of your heart's main arteries
Have diabetes or high blood pressure
Are female

Complications

If not treated immediately, cardiogenic shock can lead to death. Another serious complication is damage to your liver, kidneys or other organs from lack of oxygen, which can be permanent.

Prevention

The best way to prevent cardiogenic shock is to make lifestyle changes to keep your heart healthy and your blood pressure in check.

Don't smoke, and avoid secondhand smoke. If you smoke, the best way to reduce your heart attack risk is to quit.
Maintain a healthy weight. Being overweight contributes to other risk factors for heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease and diabetes. Losing just 10 pounds (4.5 kilograms) can lower blood pressure and improve cholesterol levels.
Eat less cholesterol and saturated fat. Limiting these, especially saturated fat, can reduce your risk of heart disease. Avoid trans fats.
Use less salt. Too much salt (sodium) leads to fluid buildup in the body, which can strain the heart. Aim for less than 2,300 milligrams (mg) a day of sodium. Salt can be found in many canned and processed goods, so it's a good idea to check food labels.
Cut back on sugar. This will help you avoid nutrient-poor calories and help you maintain a healthy weight.
Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
Exercise regularly. Exercise can lower your blood pressure and improve the overall health of your blood vessels and heart. Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. It's recommended to spread out this exercise during the course of a week. Greater amounts of exercise will provide even greater health benefits.

If you have a heart attack, quick action can help prevent cardiogenic shock. Seek emergency medical help if you think you're having a heart attack.

Feb. 09, 2021

Which intervention would the nurse perform when caring for a client in the ED reporting chest pain?

Nurse's role. When a patient arrives in the ED and reports chest pain, the nurse should perform an immediate assessment. They also should think of the 12-lead ECG as a sixth vital sign and obtain it within the first 10 minutes of arrival (at the first complaint of chest pain for in-patients).

When hypokalemia suspected which diagnostic test will the nurse use to confirm the diagnosis?

Diagnosis of Hypokalemia Hypokalemia (serum potassium < 3.5 mEq/L [< 3.5 mmol/L]) may be found during routine serum electrolyte measurement. It should be suspected in patients with typical changes on an ECG or who have muscular symptoms and risk factors and confirmed by blood testing.

Which action would a nurse take to prevent a parallax error and ensure accuracy when assessing a clients BP?

The observer should view the manometer in a direct line to avoid “parallax error.” Application of the Cuff: Range markings are part of the ADCUFF^™ system. Using an inappropriately sized cuff can affect blood pressure readings.

Which fine motor skill would the nurse expect when assessing the development of an infant between 10 to 12 months of age?

By 10 months, the infant should be able to pull up to a standing or sitting position. 10 – 12 mos. Between 10 and 12 months, the infant should be able to stand alone and sit down from standing.