A patient with peptic ulcer presents with hypovolemic shock (BP 84/60 mmHg). What is the fluid of choice for… - NORCET 10 Mains

NORCET 10 Mains

Medical & Surgical Nursing

Easy

Appeared in: NORCET 10 Mains

Explanation

The primary goal in hypovolemic shock is to rapidly restore circulating blood volume to improve tissue perfusion.
Isotonic crystalloid solutions, such as Normal Saline (NS) and Ringer's Lactate (RL), are the first-line treatment because their solute concentration is similar to that of blood plasma.
These fluids expand the intravascular volume without causing significant shifts of fluid into or out of cells.
Both NS and RL are appropriate for initial resuscitation efforts in a hypotensive patient.

Option B: This is a hypotonic solution once the dextrose is metabolized. It would cause fluid to shift from the intravascular space into the cells, worsening the shock state.
Option C: Dextrose 10% is a hypertonic solution used to treat hypoglycemia. It is not a volume expander and would cause an osmotic diuresis, further depleting the patient's volume.
Option D: D5NS is a hypertonic solution. The added dextrose is unnecessary for volume resuscitation, can cause hyperglycemia, and is not the preferred fluid for large-volume replacement in shock.

Visual 1: Diagram: A diagram illustrating the movement of water between the intravascular, interstitial, and intracellular compartments when isotonic, hypotonic, and hypertonic solutions are administered.
Visual 2: Infographic: An infographic classifying common IV fluids (e.g., 0.9% NS, RL, D5W, 0.45% NS) by their tonicity and listing their primary clinical uses.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Fluid resuscitation in hypovolemic shock in acute care settings.
A nurse's primary role in hypovolemic shock is rapid assessment, securing large-bore IV access, administering fluids as ordered, and continuously monitoring the patient's response.
Failure to promptly restore volume can lead to irreversible organ damage and death. Recognizing the correct fluid type is a critical patient safety competency.
What if the patient also had a severe head injury? In that case, Normal Saline would be preferred over Ringer's Lactate. RL is slightly hypotonic and could potentially increase intracranial pressure, whereas NS is isotonic and has a lower risk of this complication.

How to Approach the Question

First, identify the patient's problem from the clinical cues: The patient has a low BP (84/60 mmHg), indicating shock, likely hypovolemic due to a peptic ulcer (potential bleed).
Next, recall the primary goal for treating hypovolemic shock: rapid expansion of the intravascular volume.
Then, evaluate the provided fluid options based on their tonicity and suitability for volume expansion.
Recognize that isotonic solutions (NS, RL) are the standard of care for initial resuscitation.
Eliminate hypotonic solutions (D5W + 0.45% NS) as they would shift fluid out of the vessels.
Eliminate hypertonic dextrose solutions (D10W, D5NS) as they are not designed for primary volume replacement and can cause complications like hyperglycemia.

Concept Tested & Keywords

Concept Tested: Fluid resuscitation in hypovolemic shock
Stem keywords: peptic ulcer, hypovolemic shock, BP 84/60 mmHg, initial management
Lead-in keywords: fluid of choice
Clinical cues: BP 84/60 mmHg indicates hypotension, a cardinal sign of shock.
Clinical cues: Peptic ulcer suggests a potential gastrointestinal bleed as the cause of volume loss.

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