Hypovolemia

Question 1

Why does this happen?

Answer 1

1. Loss of fluids from anywhere!!
   (thorcentesis, paracentesis, vomiting, diarrhea, hemorrhage)
2. Third spacing
3. Diseases with polyuria

Question 2

What is third spacing?

Answer 2

When fluid is in a place that does you no good–like interstitial space

• burns (fluids go to tissue)
• ascites (fluid in abdomen)

Question 3

Why do diseases with polyuria cause loss of fluid?

Answer 3

Polyuria (loose fluid and can cause shock)

Oliguria (trying to save as much fluid as possible)

Anuria (no urine!!–can lead to kidney problems)

Question 4

S/S?

Answer 4

• Weight decreases
• Decreased skin turgor
• Dry MM
• Decreased UO
• BP decreases
• HR and RR increases
• CVP decreases
• Tiny veins (hard to start IVs)
• Cool extremities
• Urine specific gravity increase

Question 5

Why is there decreased UO?

Answer 5

Kidneys aren’t being perfused or they are trying to hold on to the fluid to compensate

Question 6

Why is there decreased BP?

Answer 6

Less volume, less pressure

Question 7

What is pulse like?

Answer 7

Increased–heart is trying to pump what little fluid is left

Question 8

Hypovolemia or hypervolemia

Increased HR

Answer 8

Both

Question 9

Hypovolemia or hypervolemia

HR weak and thready

Answer 9

Hypo

Question 10

HR full and bounding

Answer 10

Hyper

Question 11

Why is RR increasing?

Answer 11

Body thinks decrease BV is from hypoxia so trying to get more O2 in

Question 12

Urine specific gravity increased (concentrated)…If UO is happening at all, how will it be?

Answer 12

Very concentrated

Question 13

Treatment?

Answer 13

• Prevent further losses
• Replace volume
• Safety

Question 14

How to replace if mild deficit?

Answer 14

Po fluid

Question 15

How to replace if severe deficit?

Answer 15

IV fluids

Question 16

Why is there a higher risk for falls?

Answer 16

Decreased BP—risk for orthostatic hypotension

Question 17

Why would there be high risk for overload with tx for deficit?

Answer 17

Giving too much fluid too quick

Question 18

How to take VS for someone with orthostatic hypotension and 3 checks?

Answer 18

• Lie down 3 min
• Take VS while lying
• Take VS with sitting
• Take VS while standing
• Record

Question 19

What do isotonic fluids do?

Answer 19

Go into vascular space and STAYS

Question 20

Examples of isotonic fluids?

Answer 20

NS (0.9)
LR
D5W
D51/4NS

Question 21

Who would get isotonic fluids?

Answer 21

Those who lots fluids from burns, NV, sweating, and trauma

Question 22

What is the basic solution when administering blood?

Answer 22

Normal saline

Question 23

Who does NOT get normal saline?

Answer 23

HTN
Cardiac disease
Renal disease

Question 24

Isotonic fluids can cause what 3 things?

Answer 24

FV excess
HTN
Hypernatremia (for those that contain sodium)

Question 25

What do hypotonic solutions do?

Answer 25

Go into vascular space, then shifts to cells to replace cell fluid

Question 26

Do hypotonic solutions rehydrate?

Answer 26

Yes

Question 27

Do hypotonic solutions cause HTN?

Answer 27

NO

Question 28

Examples of hypotonic fluids?

Answer 28

D2.5W 0. 45 NS 0. 33 NS

Question 29

Who gets hypotonic fluids?

Answer 29

Those with HTN, renal or cardiac disease Those who need fluids because of NV, burns, hemorrhage *also used for client with hypernatremia and for cell dehydration

Question 30

What is the alert with hypotonic fluids?

Answer 30

Watch for cell edema bc this fluid is moving to cells which can lead to FV deficit and decreased BP

Question 31

What are hypertonic solutions?

Answer 31

Volume expanders that will draw fluid into vascular space from cells

Question 32

Examples of hypertonic solutions?

Answer 32

``` D10W 3%NS 5% NS D5LR D51/2NS DF NS TPN ALbumin ```

Question 33

Who gets hypertonic solutions?

Answer 33

Pt. with HYPOnatremia Client who has shifted large amounts of vasc. volume to 3rd space Burns, edema, ascites

Question 34

What solution returns fluid volume to vascular space?

Answer 34

HYPERtonic

Question 35

What is alert for hypertonic fluids?

Answer 35

Fluid volume excess and pulm. edema *do frequent monitoring of BP, HR, and CVP!!

Question 36

What solution: Stay where I put it

Answer 36

Isotonic

Question 37

What solution: Enter vessel

Answer 37

Hypertonic

Question 38

What solution: Go out of vessel

Answer 38

Hypotonic