NSB024 Case Scenario: Pathophysiology, Hypovolemia

Hypovolemia
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Hypovolemia
Hypovolemia is a condition that leads to a shortage of fluid in one’s body. The disease can mainly be attributed to the reduction of fluid intake, extreme loss of blood, and finally, a fluid loss which subsequently leads to the reduction of extracellular fluid volume. Loss of blood or body fluids is often as a result of internal bleeding, external injuries, or some obstetric emergencies. According to Lloyd (2013), hypovolemic shocks occur when one has lost a fifth of their blood. It is hence essential to ensure that external injuries are treated fast and to have body checkups after accidents to prevent internal bleeding at later dates. The basis of this article is on a case scenario of Mr. Jensen who fractured his right tibia and fibula. A pathophysiology of Mr. Jensen’s post-operative hypovolemia, his priority problems, the nursing goals for his care, and finally, the nursing intervention mechanisms and rationales will be examined in this paper.
Pathophysiology of Mr. Jensen’s Post-Operative Hypovolemia
As already stated, post-operative hypovolemia often results from excessive loss of blood or body fluids. In Mr. Jensen’s case, it is apparent that he has lost a lot of blood as well as body fluids from his external injury and the subsequent surgery. All the above suggest or heightens the risks of him experiencing hypovolemic shock. When one loses blood or body fluids, the body often responds by trying to compensate for the loss so as to maintain cardiac output. Essentially, the body responds by making the heart beat faster and judging by the patient’s post-operative BPM of 107; the obvious conclusion is that his body was re-adjusting. Blood vessel constriction is also another way that a person’s body responds to blood and fluid losses and from the blood pressure measurements, Mr. Jensen’s BP has indeed fallen (from 155/100 to 104/55 mmHg).
According to the American Heart Association (AHA) (2016), if one’s systolic reading is between 140 and 159 and the diastolic reading is between 90 and 99 then such an individual is a Stage 1 case of high blood pressure. AHA went further and gave the readings for hypotension and as per their information, people with a systolic reading that is lower than 90 mmHG and a diastolic reading that is less than 60 mmHG are experiencing hypotension. Mr. Jensen’s readings pre and post-operation indicate that he initially was in the range of stage 1 hypertension, and currently, he is in the hypotension range. When one observes the patient’s blood pressure difference, the obvious conclusion is that he lost a lot of blood. The above is indeed reminiscent of the hypovolemic shock state, and this means that it is indeed of the essence that his body resumes normal functionalities and evens out the vital signs.
Initially, doctors used only to observe the changes in blood pressure to determine whether a patient is experiencing hypovolemic shock or not. However, according to Mistovich (2009), “a patient could be in a true shock state and not initially present with a dramatic decrease in blood pressure or increase in heart rate.” The above statement is indeed imperative to even Mr. Jensen’s case because a deeper assessment of his problem is indeed needed. The blood pressure reading is indeed important and necessary as well, but Mistovich explains that for a complete assessment, it is crucial also to take the patient's pulse and respiratory rate.
The medical history of a patient as well as his lifestyle also needs to be considered. In most occasions, patients tend to worsen their states and to make it hard for doctors to help them. Mr. Jensen is a diabetes patient, and this means that his healing duration will be stretched further than usual. At 65 years, Mr. Jensen should not be working at the rate that he is due to his frailness. Having had the kind of accident that he had, the patient is in need of rest and needs help with chores as well as therapy to help propel the healing process. However, for the patient at hand, there are no close friends and family who can be of aid to him, and this will lengthen the healing process. Loneliness has been, on more occasions than one, thought to be a factor that influences one’s mental and physical health. Tiwari (2013) reports that loneliness is more dangerous than smoking and thus with his condition, Mr. Jensen is likely to take more time to heal.
In addition to his condition, Mr. Jensen also has a fractured tibia and fibula. Essentially, this is the injury that led to the hypovolemic shock and thus cannot be ignored when looking into the challenges of dealing with his condition. This injury is painful indeed and as per the assessment data, the pain level is 7 on a scale of 1- 10. The universal truth is, pain is subjective, but 7 is relatively painful and thus patient management measures will indeed be affected. According to the Australian Pain Management Association (2016), pain has psychological effects on a patient such as depression and anxiety. APMA continues to explain that pain can also reduce one’s quality of life, and if it is as a result of a secondary illness/condition/injury, it can “influence the development of persistent problems and the outcome of treatment” (Linton and Shaw, 2011).
Elderly patients are vulnerable and fragile, and this is indeed true because most of them are obviously relatively less active than they were. Depending on the depth, extent or seriousness of Mr. Jensen’s injury, damage on his leg could have extended to the neurovascular. The main danger here is the fact that being an obese elderly man who has noticeably lost a lot of blood and with diabetes, maintaining the patient’s blood pressure will indeed a big problem. It is crucial that the vital signs be monitored at all times and the patient be advised to change his lifestyle for the sake of his health. Mr. Jensen is surrounded by numerous factors that could negatively influence his health but to avoid the risk of a high/low post-operative blood pressure, then the possibility of him experiencing the hypovolemic shocks need to be curtailed.
Mr. Jensen’s Actual Priority Problems
Mr. Jensen’s main priority problem is the heart’s increased activity, a decrease of blood that is reaching the vital organs as well as the blood pressure. Increased heart activity increases the chances of Mr. Jensen getting a stroke, and when vital organs do not get enough blood then the body’s ability to fight is reduced, and these will influence the outcome of the entire treatment. Blood pressure changes increase the patient’s chances of experiencing the hypovolemic shocks. Maas, et al. (2013) advised that it is crucial to place the patient under continuous observation for the purpose of detecting changes once one has been subjected to medication. For a patient like Mr. Jensen, the risks are indeed high because he is a loner and loneliness has been touted as one of the issues that negatively impact one’s health (Tiwari, 2013).
Diabetes is the other priority problem for Mr. Jensen. People who fracture their bones take 8 – 12 weeks to heal depending on the severity of the injury. However, diabetic patients often take longer to heal regardless of an injury’s severity. According to a September 22, 2016, article in the New York Times, “Diabetes doubles the risk for depression” and this will negatively impact the patient’s health and subsequently the entire treatment. As per the assessment data, Mr. Jensen’s glucose level was 17 mmol/LTR, and this value is relatively high. This means that if not managed well his diabetic condition could jeopardize the entire healing process. Craft, Gordon, and Tiziani (2010) attribute reduction of risks as well as unexpected complications to sufficient management of one’s health and thus if not maintained well, Mr. Jensen’s diabetic condition could influence healing.
One's doctor best identifies a patient's priority problems, but the universal truth is that pain is almost everyone’s concern and a priority problem. Pain can switch focus from one’s primary illness or condition to itself. According to Brown and Edwards (2013), it is crucial that medical practitioners determine a patient’s type of pain. Mr. Jensen fractured his r...