Hypovolemic Shock Case Study (OB sim) (60 min)
Included In This Lesson
Study Tools For Hypovolemic Shock Case Study (OB sim) (60 min)
Outline
Mrs. Stewart, a 27-year old female, presents to the Emergency Department (ED) two days postpartum. She is complaining of severe abdominal pain and reports some vaginal bleeding. She reports an uncomplicated pregnancy and a normal vaginal delivery. She and her husband both appear very anxious.
What initial nursing assessments need to be performed for Mrs. Stewart?
Upon further assessment, Mrs. Stewart is pale and weak. Pulses are 1+ bilaterally in radial and pedal arteries. The UAP obtained vital signs and assisted Mrs. Stewart to the bathroom and noted a sanitary pad saturated with bright red blood.
Her vital signs were as follows:
- BP 116/72 mmHg
- Urine Dark yellow and clear
- HR 92 bpm and regular
- Ht 158 cm
- RR 22 bpm
- Wt 71 kg
- Temp 36.6°C
- SpO2 96% on Room Air
What do you believe may be going on with Mrs. Stewart?
What actions should you take at this time for Mrs. Stewart? Why?
The ED provider has called the obstetrics team to assess Mrs. Stewart, he tells you they will be down shortly, but to go ahead and start two large-bore IVs, just in case. You notice Mrs. Stewart is more diaphoretic than before, and she is slower to respond to you when you try to wake her up. She is still oriented x 3, just drowsy. You take another set of vital signs and note the following:
- BP 108/68 mmHg
- HR 108 bpm and regular
- RR 28 bpm
- Temp 36.4°C
- SpO2 94% on Room Air
Describe what is happening to Mrs. Stewart physiologically.
What orders do you expect to receive from the provider?
You notice Mrs. Stewart has already saturated another sanitary pad and is bleeding through her patient gown. You immediately notify the ED provider that you believe Mrs. Stewart is decompensating due to hemorrhage.
You receive the following orders for Mrs. Stewart from the ED provider:
-
Give 1,000mL Lactated Ringers IV, rapid bolus, now
-
Administer Oxygen via nasal cannula to keep SpO2 > 92%
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Type and Crossmatch
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Transfuse 2 units Packed Red Blood Cells
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Give Morphine 2 mg IV push, q4h, PRN moderate pain
Which order should you implement first? Why
Mrs. Stewart responds well to the first liter of fluids, but is still bleeding profusely. The Obstetrics team arrives and tells you to obtain 2 units of emergency release blood instead of waiting for a type and crossmatch. You also receive orders to transfuse a 2nd liter of LR, which you initiate. After examining the patient, the Obstetrics team determines that this patient may need to go to the OR, but they want to monitor her in ICU first. The ED physician places an arterial line and a central line while you initiate the first two units of packed red blood cells. Mrs. Stewart’s hemodynamic readings are as follows:
- Art. Line BP 90/58 mmHg
- MAP 66 mmHg
- HR 122 bpm and regular
- CVP 4 mmHg
- RR 32 bpm
- SpO2 90% on Room Air
You note she is extremely pale, sweating bullets, very drowsy and confused.
What should be your immediate course of action?
The Obstetrics team returns and agrees that Mrs. Stewart is too unstable to be transferred. They agree to take her to the OR right away. In the OR, Mrs. Stewart is found to have a uterine wall tear, which is repaired successfully. She spends 1 night in the ICU and 2 nights recovering on the post-partum unit before being transferred home to be with her new baby.
What, if anything, might you have done differently in this situation? Why?
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
- Anxiety Disorders
- Depressive Disorders
- Trauma-Stress Disorders
- Substance Abuse Disorders
- Bipolar Disorders
- Psychotic Disorders
- Concepts of Mental Health
- Eating Disorders
- Personality Disorders
- Health & Stress
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Note Taking
- Concepts of Population Health
- Basics of Human Biology