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A client with shock brought on by hemorrhage has a temperature of 97.6° F (36.4° C), a heart rate of 140 beats/minute, a respiratory rate of 28 breaths/minute, and a blood pressure of 60/30 mm Hg. For this client, the nurse should question which physician order?

a) "Administer oxygen by nasal cannula at 3 L/minute."
b) "Infuse I.V. fluids at 83 ml/hour."
c) "Monitor urine output every hour."
d) "Draw samples for hemoglobin and hematocrit every 6 hours."

1 Answer

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Final answer:

The nurse should question the physician order to draw samples for hemoglobin and hematocrit every 6 hours in a hemorrhagic shock patient, as further blood loss could worsen the patient's critical condition.

Step-by-step explanation:

In a patient with circulatory shock due to hemorrhage, classic signs of hypovolemic shock, such as tachycardia, hypothermia, and a significant drop in blood pressure, are indicative of a critical condition requiring immediate attention. While hemoglobin and hematocrit levels are valuable indicators of blood volume and oxygen-carrying capacity, the frequency of drawing these tests should be carefully considered.

In the context of a patient experiencing acute hemorrhage and circulatory shock, the primary focus should be on rapid and effective intervention to restore blood volume and pressure. Drawing blood every 6 hours for hemoglobin and hematocrit tests may be questioned due to concerns about contributing to further blood loss in an already critically compromised patient.

Frequent blood draws have the potential to exacerbate the patient's condition by contributing to additional blood loss, which is particularly crucial in cases of acute hemorrhage where every drop of blood is essential for maintaining tissue oxygenation. Instead, the healthcare team should prioritize immediate measures to stop the bleeding, initiate fluid resuscitation, and administer blood products if necessary.

While hemoglobin and hematocrit levels are important for diagnosing and monitoring the severity of hemorrhage, a judicious approach to blood testing frequency is warranted. Balancing the need for diagnostic information with the potential risk of exacerbating blood loss is crucial in managing patients with acute circulatory shock due to hemorrhage. Frequent reassessment and adjustment of the monitoring strategy based on the patient's response to interventions are essential components of providing optimal care in this critical situation.

User Flavio Wuensche
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