Bulacan State University

COLLEGE OF NURSING
City of Malolos

JOSE B. LINGAD REGIONAL MEMORIAL HOSPITAL

(SURGERY WARD)

A CASE STUDY ABOUT

Hypovolemic Shock Probably 2O to Acute Blood Loss Probably 2O to Solid Organ Injury
2O to Penetrating Perforating Thoraabdominal Gun Shout Wound With G Lobe R: R
Flank / 6th Intercostals Space: L Deltoid / 2nd Intercostals Space: R Mandible R
Supraorbital.
  INTRODUCTION

This case presentation is about a client in surgery ward of Jose B. Lingad Regional Memorial Hospital who was diagnosed of having Hypovolemic Shock

probably secondary to Acute Blood Loss probably secondary to solid organ injury secondary to penetrating perforating Thoraabdominal gun shot wound with G

lobe R: R flank/6th ICS; L deltoid/2nd ICS; R: mandible; R: Supraorbital.

We chose this case to become familiar with the applicable nursing interventions that can be applied for a patient with hypovolemic shock. This disease if not

cured and controlled will lead to a more serious disease. Hypovolemic shock may be complicated by impaired function of any organ since all organs depend on an

adequate blood supply and oxygen delivery for their functions. Therefore, an individual with hypovolemic shock may sustain a stroke, heart attack, liver failure,

kidney failure, or gangrene of an extremity.

Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. Losing about

1/5 or more of the normal amount of blood in your body causes hypovolemic shock. Blood loss can be due to bleeding from cuts or other injury. The amount of

blood in your body may drop when you lose too many other body fluids, which can happen with diarrhea, vomiting, burns, and other conditions. The greater and

more rapid the blood loss, the more severe the shock symptoms.

The mortality rate in patients with hypovolemic shock is also high, with the cause of death generally being attributed to circulatory collapse due to severe

hemorrhage. Traumatic injury and blood loss induce irreversible circulatory shock and represent a major clinical problem, particularly in combat casualties.
Traumatic injury (often accompanied by severe blood loss) is the principal cause of death in patients aged 18-44 years. Traumatic injury accounts for millions

emergency room situations, millions of hospital admissions, and is estimated to cause 150,000 deaths each year. Although more effective prevention measures will

reduce the early deaths resulting from massive hemorrhage and central nervous system injury, the transition from reversible to irreversible hypovolemia, or

circulatory collapse, appears to play a major role in the majority of late deaths after trauma and blood loss.
 OBJECTIVES

General Objectives

Student centered:

• To be able to acquire knowledge on how to manage and care for a patient with hypovolemic shock.

Patient centered:

• To be able to educate the client in his condition and possible complication.

Specific Objectives

Student centered:

• To be informed about the definition of hypovolemic shock and its clinical manifestations.

• To become familiar with the applicable nursing interventions that can be applied for a patient with hypovolemic shock.

• To gain knowledge on what drugs are given to a patient with hypovolemic shock and its therapeutic actions.
 Patient centered:

• To implement health teaching for a patient with hypovolemic shock.

 NURSING ASSESSMENT

A. BIOGRAPHIC DATA

NAME : Mr. Jr
AGE : 30 Years of Age
GENDER : Male
CIVIL STATUS : Widower
POSITION IN THE FAMILY : Head of the Family
ADDRESS : Barangay Mining, Angeles City, Pampanga
DATE OF BIRTH : January 28, 1979
PLACE OF BIRTH : Angeles City, Pampanga
RELIGION : Roman Catholic
RACE : Asian
EDUCATIONAL ATTAINMENT : High School Graduate
HEALTH SOURCE : Prior hospitalization himself, presently his parents, some of his relatives and help coming from local
government.
 DATE OF ADMISSION : September 02, 2009 (Tuesday) at 02:25am
FINAL DIAGNOSIS : Hypovolemic Shock Probably 2O to Acute Blood Loss Probably 2O to Solid Organ Injury 2O to Penetrating
Perforating Thoraabdominal Gun Shout Wound With G Lobe R: R Flank / 6th Intercostals Space: L Deltoid / 2nd
Intercostals Space: R Mandible R Supraorbital.
B. CHIEFT COMPLAINT

According to him, he was brought to Jose B. Lingad Regional Memorial Hospital (JBLRMH) last September 02, 2009 at exactly 02: 25am by a policeman. At that

time he was totally unconscious and has 7 reported gunshot wounds all over his body.

C. HISTORY OF PRESENT ILLNESS

When we try to ask and seek for further explanation and clarification about what really happen to him, he verbalized “Bandang 1am ata yun, biglang may

pumasok sa bahay namin at pinaputukan kami ng asawa ko, tapos di kona alam, ang bilis ng pangyayai pagkagising ko nasa ospital na ako at nalaman kong patay na

pala ang asawa ko”. Then after that life threatening incident, his life was totally changed and become miserable not only physically but also mentally. And he cannot

really move on, about what happened.

D. PAST HISTORY OF ILLNESS

According to him, he already has Rubeola, Mumps and Varicella when he was a child. He does not have any known food or drug allergies. There are no any major

injuries reported when he was a child in exception in some minor cases like falling in a bicycle and stairs. And there is no any serious hospital confinement which is

considered health threatening.

E. FAMILY HISTORY OF ILLNESS

 His father died with unknown cause, his mother is alive and according to him both of his parents have Osteoarthritis as well as his 3 siblings who are Mario,

Aurora and Eduardo. There is no any family history of DM, HPN, COPD,CVD, Malignant Neoplasm etc. in his family both mother and father side.

GENOGRAM

N N
/A /A
N
/A N
/A

N N
/A N
N
/A 63 /A
65
/A N
/A N
/A N
/A N
/A

45
47 39 36 32 30
42 40 37 34 31

LEGEND
- MALE - PATIENT
- FEMALE - HYPOVOLENIC SCHOCK
- ALIVE AND WELL - OSTEOARTHRITIS
 N
- DECEASE /A - NOT AVAILABLE
FUNCTIONAL PRIOR HOSPITALIZATION DURING HOSPITALIZATION
HEALTH
PATTERN

HEALTH He really believed in herbal medication like Lagundi Leaves extract in treating cough When I ask him if he can follow what doctors & nurse advices him he verbalized
PERCEPTION & and Guava Leaves extract as an effective anti-microbial; he also go to faith healers like “Minsan oo, minsan naman hindi, kasi mahirap ang pera ngayon tapos di naman ako
HEALTH Manghihilot and Manawas as they call it in Kapampangan dialect as a primary source ang gumagastos sa pag-kaka ospital ko”
MANAGEMENT of remedies if they experience unserious medical problems, he is a light smoker and
PATTERN
drinking alcoholic beverages occasionally.

NUTRITIONAL
METABOLIC 3 DAYS FOOD RECALL 3 DAYS FOOD RECALL
PATTERN

DATE FOOD FLUIDS DATE FOOD FLUIDS

BREAKFAST LUNCH DINNER BREAKFAST LUNCH DINNER BREAKFAST LUNCH DINNER BREAKFAST LUNCH DINNER

½
Aug. 30, Sept. - 2 slices - cup of - 1 cup DO fluid DO fluid DO fluid
N/A N/A N/A N/A N/A N/A of bread Rice as of Rice restriction restriction restriction
09 08, 09
estimate - 1 slice
d of fried - He - He - He
Aug. 31, - Bangus consumed consumed consumed
N/A N/A N/A N/A N/A N/A
09 Sinigang about 5 about 5 about 5
na Baboy cups of cups of cups of
Sept. - 3 cups - 3 to 4 - 3to 4 - 1 mug of -4 - 4 to 5 but only small small small
01, 09 of Rice cups of cups of Coffee(12 glasses of glasses of the soup mineral mineral mineral
- 2 fried Rice Rice 0 ml) water(1 water(1 is eaten water(1 water(1 water(1
Eggs - 1 serving -2 glass is glass is cup is cup is cup is
of Sinigang pieces around around equal to equal to equal to
na Bangus( of 110 ml as 110 ml as 3- 5ml) 3- 5ml) 3- 5ml)
consist of 2 Chicken estimated estimated every every every
slices of ) ) meal time meal time meal time
Bangus, Sept. - 1 cup - 1 cup of - 1 cup - Totally - Totally - Totally
the noodles Rice of Rice he he he
standard 09, 09
- 4 slice -1 consumed consumed consumed
Mangkok of Pork serving about one about one about one
cant of bottle of bottle of bottle of
handle at Tinolang C2 which C2 which C2 which
least 50- Manok is 1 Liter is 1 Liter is 1 Liter
1oo ml of ( consist
fluids & of 2
selected slices of
vegetables chicken)
) - 2 slices - 1 cup of N/A - 1 glass - 1 bottle N/A
Note: Some of these information are only estimated accordingly to what patient verbalized
Sept.10,
09 of Bread Rice of water(1 of C2 at
-1 (because glass is least 300 (because
serving our duty around ml) our duty
of is from 110 ml as is from
He is taking vitamin supplement, specifically Enervon C but not continuously, he eats Sinigang 7am- estimated 7am-3pm
F. GROWTH AND DEVELOPMENT

NAME: MR. JR. AGE: 30 YEARS OLD HOSPITAL: JOSE B. LINGAD REGIONAL MEMORIAL HOSPITAL DATE: SEPT. 10, 2009

THEORY ERIK ERIKSON SIGMUND FREUD JEAN PIAGET LAWRENCE JAMES FOWLER
THEORY OF THEORY OF THEORY OF KOHLBERG THEORY THEORY OF FAITH
PSYCHOSOCIAL PSYCHOSEXUAL COGNITIVE OF MORAL DEVELOPMENT
DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT

STAGE INTIMACY VS GENITAL STAGE FORMAL POST UNIVERSALIZING

ISOLATION OPERATIONS CONVENTIONAL FAITH
 Once identity has been True maturity requires the The person at this stage An individual reaches this Unitive view of reality
established, person is able timing of aggressive and can think abstractive. stage acts out universal and enlightenment.
to form closed contacts sexual urges, allowing principles based upon the
and relationship with their to released their equality and worth of all
other and to share repress feeling in a more human beings.
themselves with others. A social and acceptable
DEFINITION person who has not manner.
established an identity
may developed a feeling
of isolation as a negative
feedback instead of
intimacy
Our pt. has feeling of He has a healthy and Our pt. accepts opinions The religion of our pt. is The pt. asks Gods help
intimacy because he active sex life and does of others and even of Roman Catholic. Since whenever he encounters
already has a stable not suffering from any other religions. He listens their religion is involved difficulties and problem in
relationship with his wife sexual problem prior that carefully on what the in charity works, he gives life. He believed that all
EXPLANATION and has an identity and incident. interviewers asking and financial support in some things are possible to God.
self acceptance. saying then responds small projects what their
correctly and appropriate church conducted without
to situation and questions. any hesitation.
The pt. has relevance of
thought.
  THE PATIENT AND HIS CARE
MEDICAL MANAGEMENT
Medical Management Date Ordered/Date General Description
Treatment Performed/Date Changed.
Jackson Pratt September 3, 2009 Once you are under anesthesia
your surgeon will make an
incision in your skin. The end
of the drain tubing will be
placed into the area where fluid
has collected. (If you are
having surgery, the drain tubing
will be placed at the end of
your surgical procedure.) The
other end of the tubing will be
connected to the squeeze bulb.
Indications/Purposes Client’s response to the
treatment
A Jackson Pratt drain allows None
excess fluid to be removed
from the body. Fluid that
collects inside the body after
surgery or injury can increase
the chance of infection or other
complications. The drains are
placed routinely after some
kinds of surgery if large
amounts of drainage are
expected.
 The surgeon will remove the
stopper from the bulb, squeeze
it to create suction inside the
drain system, and replace the
stopper. This suction will pull
the unwanted fluid out of your
body. The skin is closed over
the drain.

Dextrose 5% water September 4, 2009 1. Provides calories for some
metabolic needs. Each 100 mL
provides 5 gm of Dextrose.
Depending on the presence of
insulin, glucose enters cells and
is broken down to pyruvate.
With adequate oxygen, it enters
the Krebs’s cycle in the
mitochondria and is converted
into energy (A.T.P.), CO2 and
H2O. The brain and gonads do
not require insulin for glucose
metabolism.
2. Supplies body water for
hydration.
3. Spares body protein by
providing carbohydrate for
This medication is a solution None
given by vein (through an IV).
It is used to supply water and
calories to the body. It is also
used as a mixing solution
(diluents) for other IV
medications. Dextrose is a
natural sugar found in the body
and serves as a major energy
source. When used as an energy
source, dextrose allows the
body to preserve its muscle
mass.

Dextrose 5% Lactated Ringer’s
Solution
metabolism.
4. Osmolarity of D5W is 252
mOsm/L. The fluid is isotonic
when in the container. After
administration, the dextrose is
quickly metabolized in the
body, leaving only water – a
hypotonic fluid.
5. The pH range is 3.5 – 6.5.
6. Capable of producing
diuresis depending on clinical
state of the patient.
September 7, 2009 Dextrose 5% Lactated Ringer's, It is indicated as a source of None
USP administered water, electrolytes and calories
intravenously has value as a or as an alkalinizing agent.
source of water, electrolytes,
and calories. One liter has an
ionic concentration of 130 mEq
sodium, 4 mEq potassium, 2.7
mEq calcium, 109 mEq
chlorides and 28 mEq lactate.
The osmolarity is 525
mOsmol/L (calc). Normal
physiologic range is
approximately 280 to 310
mOsmol/L. Administration of
substantially hypertonic
 solutions may cause vein
damage. The caloric content is
180 kcal/L.

Peritoneal Lavage September 3, 2009 It is performed when intra-
abdominal bleeding
(hemoperitoneum) usually
secondary to trauma is
suspected performed to identify
abdominal injury.
a) Abdominal trauma and None
shock
b) Multiple trauma with head
injury and decreased level of
consciousness
c) Multiple trauma with
spinal cord injury

d) Acute pelvic fracture and

hypovolemia.

Thoracic Lavage September 3, 2009 Can be performed using an Provides satisfactory heat None
open or closed thoracostomy. transfer.
Thoracostomy and open
thoracic irrigation allow
“bathing” of the mediastinal
structure.

Peri-Hepatic Packing September 2, 2009 Peri-hepatic packing procedure, The purpose of this study was None
which is the basic damage to evaluate the efficacy of the
control technique for the perihepatic packing procedure

Plain Normal Saline Solution
treatment of hepatic
hemorrhage, is one of the
cornerstones of the surgical
strategy for abdominal trauma.
Normal Saline Solution is a
solution common salt in
September 4, 2009 distilled water, of strength 0.9
percent. It is called Normal
Saline Solution because the
percentage of salt resembles
that of the crystalloids of
plasma.
by comparing the outcomes of
appropriately and
inappropriately performed
interventions.
It is used to give intravenous None
fluids to the patients suffering
from salt and water deprivation.
It can be used to wash the
wounds.
 DRUG STUDY

Generic Date Route of General Action, Indications/Purpose Client Response

Name/Brand Ordered, administratio Classification, Mechanism to medication,
Name take/give n, dosage, of Action Actual Side
n. frequency Effects.
Date
changed.
Nalbuphine September 5 mg IV every 6 Opioid Analgesics. Moderate to sever pain, also provides • Dizziness
7, 2009 hours. sedation before surgery, supplement to • Headache
Nubain Opioid Agonists. balanced anesthesia. • Sedation
September PRN • Sweating
8, 2009 Binds to opiate receptors in the CNS
• Clammy
the perception of and response
skin
September stimuli while producing generalized
9, 2009 CNS depression, it also decreases
pain.
Ceftriaxone September 1 gm IV every 8 Cephalosporin, 3rd Before instituting treatment with • Nausea
9, 2009 hours. Generation.Ceftriaxone is a Ceftriaxone for Injection, appropriate • Pain at the
cephalosporin antibiotic. It works by specimens should be obtained for isolation incision site.
interfering with the formation of the of the causative organism and for
bacteria's cell wall so that the wall determination of its susceptibility to the
ruptures, resulting in the death of drug. Therapy may be instituted prior to
the bacteria. obtaining results of susceptibility testing.

Famotidine September 20 mg x 2 doses Histamine 2 Blockers. Famotidine is used to treat and prevent • Bleeding
7, 2009 IV every 12 ulcers in the stomach and intestines. It also • Confusion
hours. Famotidine is in a group of drugs treats conditions in which the stomach • Jaundice
September called histamine-2 blockers. It produces too much acid, such as Zollinger- • Weakness
8, 2009 works by decreasing the amount of Ellison syndrome. Famotidine also treats • Mood Changes
acid the stomach produces. gastroesophageal reflux disease (GERD) • Muscle Pain
September
and other conditions in which acid backs up • Headache
9, 2009
from the stomach into the esophagus,
causing heartburn.

Metronidazole September 500 g IV every 8 Antibiotic

7, 2009 hours.
Flagyl
September
8, 2009 Metronidazole is used to treat It fights bacteria in your body. It is thought • Body aches
bacterial infections of the vagina, to work by entering the bacterial cell, acting • Numbness
September stomach, skin, joints, and on some components of the cell and • Nausea
9, 2009 respiratory tract. This medication destroying the bacteria. • Headcahe
will not treat a vaginal yeast
infection.
Omeprazole September 7, 40 mg IV Omeprazole may also be given Omeprazole decreases the amount of acid • Stomach Pain
2009 together with antibiotics to treat produced in the stomach. • Nausea
Prilosec OD gastric ulcer caused by infection • Vomiting
September 8, with helicobacter pylori (H. pylori).
2009

September 9,
2009

Erythromycin September 7, OD Macrolide Antibiotics Macrolide antibiotics slow the growth of, or • Nausea
2009 sometimes kill, sensitive bacteria by • Stomach Pain
( eye ointment ) Erythromycin is used to treat many reducing the production of important • Loss of
September 8, different types of infections caused proteins needed by the bacteria to survive. Appetite
Ery- Pad 2009 by bacteria. It is also used to prevent • Chest Pain
bacterial endocarditis and attacks of
September 9, rheumatic fever.
2009

Cefazolin September 3, 1 gm IV every 8 Cephalosporin Antibiotic Cefazolin injection is used to treat many • Pain
2009 hours kinds of bacterial infections, including • Muscle
Anzef Cefazolin is in a group of drugs severe or life-threatening forms. Weakness
September 4, called cephalosporin antibiotics. It • Headache
2009 works by fighting bacteria in your
body.

Ketorolac September 3, 30 mg Non-Steroidal Anti- Inflammatory It used to treat moderate to severe pain. • Weakness
2009 Drugs. • Sensitive to
Toradol IV light.
September 4, Ketorolac is in a group of drugs • Headache
2009 called nonsteroidal anti- • Loss of
inflammatory drugs (NSAIDs). Appetite
 Ketorolac works by reducing
hormones that cause inflammation
and pain in the body.

Tramadol September 3, Narcotic Drug. Tramadol is used to treat moderate to severe • Drowsiness
2009 pain. Tramadol extended-release is used to • Dizziness
Ultram Tramadol is a narcotic-like pain treat moderate to severe chronic pain when • Blurred Vision
September 4, reliever. treatment is needed around the clock. • Sleep Problems
2009

Calcium September 3, 1 ampule Mineral To relieve muscle cramping. • Chalky taste in

Gluconate 2009 mouth.
Tamponade Absorption • GI irritation.
September 4,
Oral absorption occurs primarily
2009
from the small intestine by active
transport and passive diffusion and
is enhanced by calcitriol, a vitamin
D metabolite.

Elimination
Excess calcium is primarily excreted
renally while unabsorbed calcium is
excreted in the feces along with that
secreted in the bile and pancreatic
juice.

Diclofenac September 3, 75 mg x 2 doses Non-Steroidal Anti-Inflammatory Diclofenac is used to treat pain. • Weakness
Sodium 2009 IM every 12 Drugs. • Headache
hours. • Nausea
Voltaren September 4, It works by reducing hormones that
2009 cause inflammation and pain in the
body.

Gatifloxacin September Antibiotic- Fluoroquinolones It fights bacteria. • Light

10, 2009 headedness
Tequin Gatifloxacin is used to treat bacterial • Nausea
infections of the lungs, sinuses, skin, • Stomach pain
and urinary tract. It is also used to
treat certain sexually transmitted
diseases.

Celecoxib September Non-Steroidal Anti- Inflammatory Celebrex is prescribed for acute pain. • Abdominal
10, 2009 Drugs. Pain
Celebrex • Headache
It is a member of a new class of • Nausea
nonsteroidal anti-inflammatory
drugs (NSAIDs) called COX-2
inhibitors.
 ACTIVITY
EXERCISE DATE GEN. DESCRIPTION
DEEP BREATHING September 2(prior to surgery) An exercise enhancing the
EXERCISE cardiac muscle and organs to
function, preparing the patient
for surgery and preventing
respiratory arrest
RANGE OF MOTION September 4 onwards (after ACTIVE ROM- this is done
EXERCISES surgery) by the pt, it increases and
maintains muscle tone and
INDICATION
An exercise advised to be
performed by patients
expected and scheduled for
surgery
An exercise indicated for
patients with musculoskeletal
impairment
CLIENT'S RESPONSE
The pt. was cooperative and
willing to perform the exercise
as he is aware of its
importance
The pt is actively participative
and says that he exercises
everyday.
 joint mobility

PASSIVE ROM- the nurse

assists the pt in performing the
exercise to enhance joint and
muscle function

RESISTIVE ROM- it is the

contraction of the muscle
against an opposing force or
weight, it increases the muscle
power

 SURGICAL MANAGEMENT
• OPERATING ROOM SPONGES, NEEDLES INSTRUMENT COUNT

• DATE OPERATION: September 3, 2009

• SURGEON: Dr. Santos / Dr. Mayday

• ANESTHESIOLOGIST: Dr . Lucas / ANESTHETIC-6A

• OPERATION PERFORMED: RE- EXPLORATION RENUEWAL OF PERI-HEPATIC PACKING

INSTRUMENT COUNT BEFORE COUNT AFTER

Blade handle #4 1 1
Blades # 20 1 1
Tissue forcep 2 2
Thumb forcep 1 1
Towel clips 4 4
Alus 4 4
Kelly clamps 10 10
Bobcook 2 2
Needle holder 2 2
Sponge forcep 1 1
Army navy 2 2
Richard bon big 1 1
Scissors Metz 1 1
Mayo 1 1
Needle 1 1
Suture 9 9
Abdominal pack 2 2
Surgical gauze 15 15
 WOUND SITE
  DISCHARGE PLANNING
Medications
• Teach the patient and if necessary a family member as to the necessary medication: the purpose, dosage, actions, administration scheduled and
adverse effects of all discharge medications as prescribed by the physician.
• Advise patient to take full course of drug on prescribed days.
• Emphasize the need to avoid over-the-counter medications unless specifically approved by the physician.

Environment / Exercise
• Before discharge, assess the patient on the following:
 ability to tolerate activity within the expected parameters
 ability to ambulate
 ability to perform activities of daily living

• Teach the patient how to perform ROM exercises.

• Explain the need to follow ordered exercise program.
• Provide rest periods during exercise.

Treatment

• Before discharge, check if the following patient shows evidence of

 stable vital signs
 blood volume within acceptable parameters
Health Teachings

• Advise the patient of increasing activity, avoiding prolonged bed rest and minimizing stress.
• Advise the family member to check patient regularly for evidence of complications such as skin breakdown or infections.
• Advise significant others to provide physiological support and understand expected emotional changes and coping stress.

Out-patient
• After a week of discharge, instruct the patient and family the need for follow up check up and adhere fully to the date, time and location of follow up
appointment.

Diet
• Encourage sodium-restricted diet. Mention some dietary source of sodium such as processed meats and fish, some dairy products, processed grains,
most canned goods, snack foods and some condiments and food additives.
• Encourage increase fluid intake.
• Encourage eating potassium rich foods for wound healing.

Spiritual
• Encourage strengthening faith to God, it can help to become emotionally and psychologically stable.
 HEALTH TEACHINGS

LEARNING LEARNING CONTENT METHOD/ TARGET DATE/TIME/ RESOURCES EVALUATION

OBJECTIVES STRATEGY POPULATION VENUE
After 4 hours of Importance of… -Discussion Client and his Relatives Date: A. Materials: After 4 hours of
rendering nursing rendering nursing
intervention the client Promoting proper wound care 09/10/09 1. Nanda book intervention the client
will: was able to:
Wounds are categorized as bruises, -Identify the risk 2. M.S. book
abrasions, lacerations, puncture, and factors of saving
contusions. Bruises are only infection Time: 3. Drug hand book
Explain the concept of discolorations of the skin that may be A. Explain the
7:00-3:00am 4. A.P. book
wound care. cured by means of applying a cold concept of
compress. Abrasions puncture wound care.
Identify measures for -The exert of the B. Identify
wounds and contusions are the more
proper wound care. wound measures for
serious types since they already Venue: B. Money
proper wound
involve skin, nerve and tissue care.
Explain the relevance of JBLRMH
damage. These kinds of wounds C. Explain the
wound care.
require the use of medical wound care -Assess the wound of relevance of
C. Man power
supply as a form of protection from the patient. wound care.
bacteria and other harmful elements. -student nurses
In applying any of this medical
wound care supply to a specific -Be available for
wound, it is very important to observe questions
cleanliness in order to avoid further
damage to the wound. These medical
wound care supply items must also be
kept sterile at all times.
 CONCLUSION
Hypovolemic shock is always a medical emergency. However, symptoms and outcomes can vary depending on the amount of blood volume lost, rate

of blood loss, and illness or injury causing the loss. In general, patients with milder degrees of shock tend to do better than those with more severe shock.

Hypovolemia can be recognized by elevated pulse, diminished blood pressure, and the absence of perfusion as assessed by skin signs (skin turning pale)

and/or capillary refill on forehead, lips and nail beds. Blood transfusions coupled with surgical repair are the definitive treatment for hypovolemia caused by

trauma.