Hypovolemic Shock Case Study (OB sim) (60 min)

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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:
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Give 1,000mL Lactated Ringers IV, rapid bolus, now
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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?
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System