Hemorrhage

What is the pathophysiology of a hemorrhage?

A condition that involves a loss of blood caused by damaged blood vessels, which can occur inside or outside the body. An adult can lose up to 14% of their blood volume before experiencing any symptoms.

What are the differences between the classes of hemorrhage?

• Class I: Blood loss up to 15% of total volume

• Class II: Blood loss between 15% and 30% of total volume

• Class III: Blood loss 30% to 40% of total volume

• Class IV: Blood loss greater than 40% of total volume

What are the different types of hemorrhages?

• Intracranial hemorrhage (subdural, subarachnoid, and epidural)

• Intracerebral (in the lobes, cerebellum, and brainstem)

• Intraventricular (in the ventricles of the brain)

• Hemothorax (bleeding between the visceral and parietal layers of lungs and chest wall)

• Hemorrhage stroke (blood vessel rupture cause blood leakage in the brain)

What are the causes of hemorrhage?

• Trauma: injuries from cuts, penetrating wounds, or blunt force trauma

• Obstetric: occurs during pregnancy or childbirth

• Surgical: occurs during a complication during or after a procedure

• Medical: causes of hemorrhage by conditions, such as GI bleeding due to medications like warfarin

What are the most common causes of hemorrhage?

Cancer, a clotting disorder, alcohol use disorder, complications of childbirth, violence, or traumatic brain injury.

What are the risk factors for developing hemorrhage?

Underlying vascular conditions (aneurysms), clotting disorders, chronical medical conditions (HTN, DM, liver and kidney disease), the use of antiplatelet or anticoagulant medications, smoking, alcohol use, recreational drug use, living in lower to middle socioeconomic communities, and childbirth?

What is the most common cause of postpartum hemorrhage?

Uterine atony, which is the loss of uterine tone due to ineffective contractions.

What are the comorbidities of hemorrhage?

Cancer and blood clotting disorders (hemophilia)

What are the physiological changes a patient may experience with hemorrhage?

Orthostatic hypotension, dizziness, fatigue, palpitation, weakness, and SOB.

What may a client experience when recovering from hemorrhage?

Cognitive impairments or alterations in mental status due to decreased circulatory blood volume and a decrease in oxygenated hemoglobin.

What is hypovolemic shock?

It is a condition where there is an inadequate amount of blood flow into organs and tissues as a result from severe blood or fluid loss. It causes a decrease in cardiac output, circulatory insufficiency, and hypoxemia.

What are the psychosocial impacts of hemorrhage?

There is an increased in possibility in developing fatigue, depression, anxiety, and PTSD. These clients are more likely to avoid normal exercise routines or social interactions/activities that increase the risk for recurrent bleeding.

What are the early signs of shock?

Tachycardia, increased respiratory rate, hypotension, and altered level of consciousness.

What are the safety considerations for hemorrhage?

Orthostatic hypotension can result in falls due to causing dizziness or lightheadedness. When giving blood, ensure the proper safety precautions have been performed.

What are the safety considerations for blood transfusions?

Confirm that blood has been drawn for type and crossmatch, verifying the compatibility of the blood product, and ensure that all components are accurately matched before administration. Make sure to monitor the client's reaction to the transfusion.

What are the considerations regarding older adults with hemorrhage?

Older adults are increased risk for bleeding due to age and comorbidities like DM, stroke, and HTN. They are also likely to be on medications that cause increased risk of bleeding like anticoagulants or NSAIDs.

What are the manifestations of hemorrhage?

Nausea, dizziness, skin feeling cool to the touch, shortness of breath, and weakness.

What are addition manifestations that occur with untreated hemorrhage?

They can experience chest pain, confusion, tachycardia, tachypnea, seizure, and progression into hypovolemic shock/coma.

What are the manifestations of internal bleeding?

Hemoptysis, hematemesis, cool and clammy skin, nausea, feeling lightheaded or faint, chest or abdominal pain/rigidity, and confusion.

What are the manifestations of intracranial hemorrhage?

Headaches, slurred speech or difficulty speaking, facial numbness, upper or lower extremity weakness or numbness, decreased LOC, seizures, or difficulty with ambulating.

What are the manifestations of hemorrhage related to traumatic injuries?

Diaphoresis, hypotension, cool and clammy skin, tachycardia, tachypnea, and decreased oxygen saturation.

What are the labs/diagnostics performed during hemorrhage?

CBC, coagulation studies (PT/PTT), CT scan, chest X-ray, ultrasounds, and endoscopy. Most are depended on the type of injury.

What are the environmental conditions that can affect a client physiology response to hemorrhage?

High altitude, extreme heat or cold, excessive exertion, or dehydration.

What are the immediate roles of a nurse when there is suspected hemorrhage?

Apply gloves and direct pressure onto the site immediately. Establish IV access with a large-bore catheter (18g or larger) as it is critical to administer rapid fluid and blood. If the client is hypotensive, fluids and blood is necessary, in order to raise MAP.

How do you calculate mean arterial pressure (MAP)?

(DBP x 2 + SBP) / 3

What should a nurse monitor when treating a patient with hemorrhage?

Signs of hypovolemia, hypotension, and hypothermia as these indicate worsening hemorrhage.

What is the necessary client education for hemorrhage?

Ensure the client and their caregivers are prepared to set realistic goals for the rehabilitation period following hemorrhage. Recommend collaboration with physical/occupational therapist to help create these goals. Instruct patient on slowly increasing their levels of activity in order to avoid fatigue. If fatigue occurs, take time to rest.

What is the treatment/therapy for hemorrhage?

Control the bleeding, support cardiac perfusion, promote adequate levels of oxygen, and emotional support. Fluid administration of either NS or LR is used as well as blood products like packed RBCs, fresh frozen plasma, or platelets.