Hemorrhage

What is the definition of hemorrhage?

a hematologic condition involving a loss of blood caused by a damaged blood vessel, occurring inside or outside the body

What is the approximate normal circulating blood volume in the human body?

4.5-5.5 liters

Up to what percentage of blood volume loss can most adults tolerate without manifestations?

approx 14%

In response to blood volume loss, the body initiates changes to promote adequate blood perfusion to which vital organs?

brain, heart, and lungs

A fracture of a _____ can cause a life-threatening hemorrhage because its center is highly vascular.

long bone (femur, fibula, radius, humerus, pelvis, vertebrae)

What physiological problem does the blood loss associated with hemorrhage cause regarding tissue oxygenation?

it causes a reduction in the amount of oxygenated Hgb available to meet tissue oxygen demand

What percentage of blood volume is lost in a Class I hemorrhage?

up to 15%

What is the range of blood volume loss for a Class II hemorrhage?

between 15-30%

At which class of hemorrhage do manifestations such as fatigue, nausea, and pallor begin to appear?

class II

What vital sign changes are associated with a Class II hemorrhage?

increase in respirations and tachycardia

What is the blood loss volume percentage for a Class III hemorrhage?

between 30-40%

A delayed capillary refill of greater than 2 seconds is a manifestation of which class of hemorrhage?

class III

What specific blood pressure and heart rate changes are characteristic of a Class III hemorrhage?

SBP < 90 and a HR over 120 bpm

What percentage of blood loss defines a Class IV hemorrhage?

> 40%

What happens to urine output and peripheral pulses in a Class IV hemorrhage?

urine output ceases or is decreased and peripheral pulses are absent

Severe hemorrhaging can eventually lead to _____, as the body is unable to meet the demands of oxygen to the tissues.

shock

What is the general term for a hemorrhage that occurs in the brain or skull?

intracranial hemorrhage

An epidural hemorrhage is when bleeding takes place in which specific location?

the dura mater

Where does an intracerebral hemorrhage occur?

in the lobes of the brain, the cerebellum, the pons, or anywhere inside the tissue of the brain itself

An intraventricular hemorrhage takes place in the ventricles of the brain, which are the areas where _____ is produced.

CSF

What is a hemothorax?

bleeding that develops between the visceral and parietal layers of the lung and the chest wall

What condition develops if hemorrhaging continues in the chest cavity, causing pressure to build?

tension hemothorax

What is an ischemic stroke?

a type of stroke caused by a blood clot blocking or narrowing a blood vessel in the brain 

What is a hemorrhagic stroke?

a type of stroke where a blood vessel ruptures, and blood leaks into an area of the brain

What are the four categories of hemorrhage based on its cause?

traumatic, obstetric, surgical, or medical

What is the most common cause of postpartum hemorrhage globally?

uterine atony

What is an aneurysm?

a weakened area in an arterial wall that may rupture

Name two classes of medications that can contribute to bleeding events and increase the risk of hemorrhage.

anticoagulant or antiplatelet meds

How can cancer increase a client's risk of hemorrhage?

d/t the increased vascularity of cancerous or metastatic tumors

Which blood-clotting disorder, caused by a gene mutation on chromosome X, is a comorbidity for hemorrhage?

hemophilia

What is the leading cause of death in Americans age 46 and younger?

hemorrhage secondary to traumatic injuries

According to the WHO, what percentage of traumatic injuries occur in low and middle-income nations?

90%

A client who experiences significant blood loss from a hemorrhage may develop what type of shock?

hypovolemic shock

Name three physiological changes that can result from hypovolemic shock.

decreased CO, circulatory insufficiency, and hypoxemia

What is orthostatic hypotension?

a drop in SBP > 20 mmHg upon standing

List three psychological conditions that clients recovering from hemorrhage are more likely to develop.

increased fatigue, depression, anxiety, and PTSD

What is a crucial early sign of shock that nurses must monitor for in a hemorrhaging client?

tachycardia, increased RR, hypotension, altered LOC

When a blood transfusion is indicated, what is a key nursing responsibility before administration?

verifying the compatibility of the blood product and ensuring all components are accurately matched 

Name two comorbidities common in older adults that increase their risk for hemorrhage.

DM, stroke, HTN

What is hemoptysis?

coughing up blood from the respiratory tract

What is hematemesis?

vomiting blood

List three signs of internal bleeding.

cool and clammy skin; chest or abdominal pain; abdominal rigidity; or confusion

What are three potential manifestations of an intracranial hemorrhage?

headaches; slurred speech; facial numbness; extremity weakness; or seizures 

A complete blood count (CBC) is ordered for a hemorrhaging client to evaluate which three components?

RBCs, Hgb, and Hct

Which two coagulation studies are used to assess for prolonged clotting times?

PT and PTT

For a suspected brain hemorrhage, what is typically the first diagnostic test ordered?

head CT scan

What procedure may be performed for a suspected gastrointestinal bleed to visualize the GI tract?

endoscopy

What is a significant risk factor for clients with a hemorrhage, which can become more severe and difficult to reverse if it occurs?

hypovolemic shock 

How can hypothermia affect a client with hemorrhage?

can impair coagulation, worsening the bleeding

What is the nurse's immediate action when external bleeding is visible?

apply gloves and direct pressure to the site

What size intravenous catheter is considered critical for rapid fluid and blood administration in a hemorrhaging client?

a large-bore catheter (18-g or larger)

What are two alternative methods for vascular access if peripheral IV access is not achievable?

central venous catheterization or IO access

What is the target mean arterial pressure (MAP) for a hypotensive client to maintain adequate perfusion?

greater than or equal to 65 mmHg

Calculate the MAP for a client with a blood pressure of 96/42 mm Hg.

60 mmHg indicating inadequate cardiac perfusion 

Chronic use of which substance can impair liver function and clotting mechanisms, increasing hemorrhage risk?

alcohol

What supportive measure may be needed to support tissue oxygenation in a hemorrhaging client?

supplemental oxygen

What should be used to maintain normothermia in a hemorrhaging client, particularly in trauma settings?

warming blankets

In the nursing process for hemorrhage, performing a complete history and physical is part of which step?

assessment

Determining if a client is hemodynamically stable by assessing vital signs and level of consciousness falls under which step of the nursing process?

analysis

What are the three main goals of treatment for a client who is hemorrhaging?

to control the bleeding, support cardiac perfusion, and promote adequate levels of oxygen

What two types of IV fluids are typically ordered for initial fluid resuscitation in a hemorrhaging client?

NS or LR

Besides packed red blood cells, what are two other blood products a client with hemorrhage might receive?

FFP or platelets

Bleeding in the _____ is vulnerable to pelvic and abdominal injury and contains vascular and visceral structures.

retroperitoneum

Which type of hemorrhage occurs during pregnancy or childbirth and is a leading cause of maternal morbidity?

obstetric hemorrhage

Lifestyle factors such as smoking and recreational drug use can elevate the risk of hemorrhage by negatively impacting _____ or liver function.

cardiovascular health

Clients recovering from hemorrhage may experience _____ impairments or alterations in mental status due to decreased circulatory volume.

cognitive

A provider should implement a _____ tool if an older adult requires a surgical procedure that may lead to hemorrhage.

bleeding risk assessment

The effects of SSC on the vasculature of the kidneys can lead to kidney damage due to a rapid rise in what?

blood pressure

DIC can occur as a reaction to several medical conditions or procedures and can lead to what life-threatening condition?

hemorrhage

In the 'Take Actions (Implementation)' phase of the nursing process for hemorrhage, what should the nurse continuously monitor?

VS, O2 sat, and LOC

A client who lost blood from a ruptured aneurysm is at high risk for _____, a condition of circulatory collapse from fluid loss.

hypovolemic shock

Calculate the MAP and interpret the result for a client with a blood pressure of 112/62 mm Hg.

79 mmHg, which indicates adequate cardiac perfusion