Conditions › Cardiovascular
Hypovolemic Shock Nursing Care Plan and Interventions
Hypovolemic shock nursing care starts by stopping the loss, then two large-bore IVs with fluids or blood as ordered; vasopressors come only after volume is replaced. A change in mental status is often the earliest cue, and urine output is the best gauge that resuscitation is working.
Hypovolemic shock nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Deficient fluid volume | BP, HR and mental status improve; urine output at least 30 mL per hour. | |
| Ineffective tissue perfusion | Lactate falling; skin warm. | |
| Risk for fluid overload during resuscitation | Lungs stay clear during boluses. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Hypovolemic shock: what it is
Too little volume in the vessels. Less blood returns to the heart, so stroke volume, cardiac output and BP fall and cells lack oxygen. 1,2
The pump is fine. The tank is low.
Causes: absolute vs relative loss
Absolute: bleeding, vomiting, diarrhea, big urine losses (DI, high glucose). Relative: fluid shifts out of vessels (burns, pancreatitis). 1,2
Bleeding can be hidden: long bone fracture, hemothorax, ruptured ectopic pregnancy.
Early: the body compensates
The sympathetic system speeds the heart and tightens vessels to shunt blood to the brain and heart. BP can stay normal at first. 1
A normal BP with a climbing heart rate is not reassuring. BP drops late.
Assessment: what you will see
Earliest cue: mental status
Anxiety, restlessness or confusion often comes first, because the brain senses low perfusion early. Thirst is another early clue. 1
A post-op client who is suddenly restless: check vitals and the dressing, don't just reorient.
Classic cues
Heart rate over 100, falling systolic BP, narrow pulse pressure, fast breathing, cool clammy pale skin, slow capillary refill. 1,3
Neck veins are flat because the tank is empty.
Labs in hypovolemic shock
Lactate over 2 mmol/L means cells are short on oxygen and using anaerobic metabolism. In bleeding, hemoglobin and hematocrit fall. 2,1
Hemoglobin also falls from dilution after large fluid volumes, so read it as a trend.
Priority: what the nurse does first
First priority: stop the loss
Direct pressure on visible bleeding, and prepare for surgery or a procedure. Fluids support the client but don't fix the leak. 1,2
Bleeding client: surgical control comes first. Volume goes in alongside it, not instead.
Access and volume
Two large-bore IVs (14 to 16 gauge). Rapid isotonic crystalloid (normal saline or lactated Ringer's). Blood products for bleeding. 2,1,4
Lost blood: replace with blood. Lost GI fluid or urine: replace with crystalloid.
Positioning and warmth
Flat with legs raised about 12 inches to boost venous return. Not Trendelenburg, which impairs breathing. Keep the client warm. 1
A cold client becomes acidotic faster. Use warm blankets and warmed blood for big transfusions.
Nursing interventions and treatment
Vasopressors: volume first
Norepinephrine squeezes the vessels. On an empty tank it can cause severe peripheral ischemia, so correct hypovolemia first. 4
Squeezing empty pipes doesn't move more blood. Fill first, then squeeze.
Massive transfusion risks
Hypothermia from cold blood, dilutional coagulopathy from too few clotting factors, and citrate toxicity causing low calcium. 1
Tetany or a new arrhythmia after many units of blood: think low calcium from citrate.
Evaluation: is care working?
Urine output: the kidney gauge
At least 30 mL per hour means the kidneys are perfused. A falling hourly trend is an early warning to report. 1
Output dropping hour after hour: call the provider before the BP falls.
Watch the lungs during boluses
Fast, high-volume fluid can cause pulmonary edema, especially with heart or kidney disease. Listen to lung sounds often. 1
New crackles or shortness of breath during a bolus: report to the provider right away.
Is resuscitation working?
Urine at least 30 mL per hour, HR 60 to 100, MAP 65 or higher, palpable pulses, normal level of consciousness, less anxiety. 1
Heart rate still climbing despite fluids: suspect the bleeding has not stopped.
NCLEX traps
Hypovolemic vs cardiogenic shock
Both: low BP, fast pulse, cool clammy skin, low urine. Hypovolemic: flat neck veins. Cardiogenic: JVD, crackles, S3. 3,5,6
Check the neck veins and listen to the lungs. That is what tells them apart.
Why fluids help one and hurt the other
Hypovolemic: the pump works but the tank is low, so volume restores output. Cardiogenic: the tank is full and the pump is weak. 5,2
Weak pump: fluid backs up into the lungs. Only small, careful boluses, and none with pulmonary edema.
Try a hypovolemic shock question
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Pharmacological and Parenteral Therapies
A nurse is preparing to administer IV fluids to a client in hypovolemic shock. Which fluid is the priority choice for volume replacement?
Show answer and rationale
Answer: C. 0.9% NS is isotonic and stays in the vascular space, making it appropriate for volume replacement in shock. 0.45% NS is hypotonic and shifts fluid into cells, which does not help restore intravascular volume quickly. 3% saline is hypertonic and reserved for severe hyponatremia, requiring slow administration and a central line, not rapid volume resuscitation. D10W acts like free water once the dextrose is metabolized and is not used for volume replacement in shock.
Checked against: OpenStax Clinical Nursing Skills, 13.3
Keep studying hypovolemic shock in NurseLingo Pro
Pro has 13 hypovolemic shock questions like these, with a rationale for every answer. Everything for hypovolemic shock in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free cardiac practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for hypovolemic shock?
Common nursing problems for hypovolemic shock include deficient fluid volume; ineffective tissue perfusion; risk for fluid overload during resuscitation. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for hypovolemic shock?
Direct pressure on visible bleeding, and prepare for surgery or a procedure. Fluids support the client but don't fix the leak. Two large-bore IVs (14 to 16 gauge). Rapid isotonic crystalloid (normal saline or lactated Ringer's). Blood products for bleeding. Flat with legs raised about 12 inches to boost venous return. Not Trendelenburg, which impairs breathing. Keep the client warm.
Which nursing diagnosis would be the priority for a patient with hypovolemic shock?
Deficient fluid volume is the priority, because the problem is too little blood in the vessels. Interventions follow from it: stop the loss, place two large-bore IVs, give fluids or blood as ordered and track blood pressure, heart rate, mental status and urine output.
How to manage a patient with hypovolemic shock?
Stop the source of loss, give isotonic fluids or blood through large-bore IVs as ordered and keep the client warm. Watch heart rate (a rising rate is often an early sign), mental status, blood pressure and urine output of at least 30 mL per hour. Vasopressors come only after volume is replaced.
More cardiovascular
Related cheat sheets
Sources
- OpenStax Medical-Surgical Nursing, 23.2
- merckmanuals.com
- OpenStax Medical-Surgical Nursing, 10.2
- OpenStax Pharmacology for Nurses, 22.3
- OpenStax Medical-Surgical Nursing, 35.2
- nhlbi.nih.gov
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.