nursing profession & the coming wave of healthcare disruption
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21st June 2019
Nursing Department KCMH
Nursing Profession &
The Coming Wave of
Healthcare Disruption
Hypovolemic shock: Assessment,
Treatment & Consequences
Ong-orn JaichaiyaphumCNE,MNS, RN
Nursing Professional Development CenterNursing Department KCMH
Role of ICU nurses to assess
Signs & Symptomps of Shock
Signs and symptoms of hemorrhage by class
Parameter Class I Class II (mild) Class III (moderate) Class IV (severe)
Approximate blood loss (ml) < 15% (< 750) 15-30% (750-1,500) 31-40% (1,500-2,000) > 40% (>2,000)
Heart rate
Blood pressure
Pulse pressure
Respiratory rate
Urine output
Glasgow Coma Scale
Base deficite 0 to -2 mEq/L -2 to -6 mEq/L -6 to -10 mEq/L -10 mEq/L or Less
Need for blood products Monitor Possible Yes MTP
LOC slightly
anxious
mildly
anxious
anxious
confused
confused
lethargic
Hypovolemic
shock assessment
Clinical
parameter
LOC
Urine output
BP
HR
Skin
Hemodynamic
parameter
CO/CI
SVR
SV/SVV
EDV
Perfusion
parameter
SvO2
ScvO2
Base deficit
Lactate
Assessment vs Resuscitation Endpoints
Init
ial A
ss
es
sm
en
t
Resu
scit
ati
on
E
nd
po
ints
Traditional vs. New
Acute vs. Ongoing
Static vs. Dynamic
Global vs. End Organ
• Mentation
• Skin Perfusion
• Pulse
• Blood Pressure
• Pulse Pressure
• Shock Index
• Urine Output
• pH• Serum Lactate• Base Deficit• Arterial Wave Analysis• ScvO2
Arterial Waveform
Static & Dynamic
Measurement
Passive leg raising test
Importance of Occult Hypovolemia
Nursing assessment
Nurses commonly experience
scenarios where hemodynamic
monitoring is focused on
hypovolemia (see case study)
in clinical practice.
Limitation of conventional assessment
Classic sign & symptom of shock
• Changing mentation
• Tachycardia
• Cool, clammy, skin
• Prolonged capillary refill
• Narrowed pulse pressure
• Decreased urine output
• Hypotension
Pulse Contour Analysis
Pulse
Contour
Analysis
Performance of Nursing Care
Assessment
- ABCD Approach
- Clinical Approach
EGDPT
- Minimization of
crystalloid
- 1:1:1 Product
ratio
- Permissive
hypotension
- Avoid
hypothermia
- Effective
collaboration
Hemodynamic
Monitoring
- Conventional
- Advanced
End Point of
Resuscitation
- Monitor organ
perfusion
The SVO Algorithm: Putting It All Together
You can Resize without
losing quality
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PPT
TEMPLATES
Nursing care delivery
ABCD Approach
Clinical
assessment
Early hemorrhage
control
Keep warm nursing
Hemodynamic
monitoring
Balance
resuscitation
Effective
Collaboration
End organ perfusion
Thank you for your attention
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