Nursing management of postoperative hemorrhagic shock: A case study in intensive care

Postoperative hemorrhagic shock is a time-critical complication associated with high morbidity and mortality, particularly in older surgical patients, requiring rapid, coordinated management in the intensive care unit (ICU). This case report describes specialized nursing management guided by the International Classification for Nursing Practice (ICNP®/CIPE®) and Benner's Clinical Wisdom Theory.

An 89-year-old woman underwent emergency gastrojejunostomy for intestinal obstruction and subsequently developed hemorrhagic shock with profound anemia (hemoglobin nadir 5.8 g/dL), severe hyperlactatemia (12 mmol/L), hypothermia (33.6 °C), peripheral hypoperfusion, and hypotension (mean arterial pressure <65 mmHg). She required orotracheal intubation, invasive mechanical ventilation, and deep sedation. Diagnostic reassessment included serial hemoglobin and arterial blood gas analyses, lactate trending, invasive hemodynamic monitoring, and surgical re-exploration with intraoperative upper endoscopy, which suggested an upper gastrointestinal source (suspected Mallory-Weiss type lesion) treated endoscopically. Nursing priorities, structured using ICNP®, focused on perfusion restoration and correction of the lethal triad (hypothermia, acidosis, coagulopathy), multimodal analgesia, continuous monitoring, prevention bundles (infection and pressure injury prevention), and structured family communication.

The patient progressively stabilized, with hemoglobin increasing to 9.6 g/dL, lactate decreasing to <1 mmol/L, normothermia recovery, discontinuation of vasopressors, and no documented ICU-acquired complications during the ICU stay. This case highlights how standardized nursing language (ICNP®/CIPE®), combined with advanced clinical reasoning and evidence-based ICU bundles, can improve the structure, traceability, and continuity of nursing care in postoperative hemorrhagic shock.