Fluid and Electrolytes Hypovolemia Flashcards
What are the most common reasons for excessive fluid loss?
GI issues:
- vomiting
- diarrhea
- GI suctioning
- Intestinal fistulas
- Intestinal drainage
What are other reasons for fluid loss besides GI issues?
- diuretic therapy, renal disorders, and endocrine disorders
- have sweating
- hemorrhage
- Chronic abuse of laxatives or enemas
- inadequate intake
- burns
- Diabetic Ketoacidosis
What are the risk factors for hypovolemia?
- factors preventing normal intake
- factors leading to increased fluid loss
- Daily life issues
What are some factors preventing normal intake?
- NPO status
- Dysphagia
- Lack of portable water
- inaccurate fluid replacement compared to a loss
- Fluid shifts due to burns, albuminuria, or diabetes insipidus
What factors from daily life can cause Hypovolemia?
- sweating, especially in hot, humid weather or under heavy clothing in cold weather
- Artificially heated indoor air
- Altitudes >8200 feet
- Very cold, dry environments for an extended time
What are the manifestations of hypovolemia?
- initially: thirst
- Late symptoms: lethargy, weakness, dry mucous membranes, reduced urine output, coma, or death
- diminished skin turgor
- postural or orthostatic hypotension
- Compensatory mechanisms: tachycardia, pale and cool skin, decreased urine output
What diagnostic tests may be used with hypovolemia?
- serum electrolyte level (elevated BUN, low serum bicarb)
2. Urine specific gravity (may not be useful in younger children)
What are some clinical therapies for hypovolemia?
- oral rehydration
2. IV fluids
What is the purpose of oral rehydration with hypovolemia?
- safest and most effective treatment for hypovolemia if the patient is alert and can drink
- for mild fluid deficit: water alone
- For more severe fluid deficit: sports drinks, ginger ale, Pedialyte, rehydralite
- Replace fluid gradually, especially in older adults
What is the purpose of IV fluids with hypovolemia?
- for severe deficit or when patient cannot ingest fluids
- Normal saline can be used by may lead to acid-base imbalance
- LR solution preferred
- 5% dextrose in water or half NS mix to treat body water deficiency
- Fluid challenge to evaluate volume when urine output is low, cardiac or renal function is questionable
What can cause children and adolescents to have fluid loss?
- low birth weight
- higher BSA, increased RR= more insensible fluid loss through skin and lungs
- Fevers
- Vomiting and diarrhea
- more likely to experience imbalance from exercise
- adrenal insufficiency
- overuse of diuretics or laxatives (especially in adolescents with bulimia)
What is a sign of dehydration in infants?
irritability
What is a sign of dehydration in children?
thirst
What are the most common symptoms of dehydration in children and adolescents?
- lethargy and sleepiness
- restlessness and irritability
- Decreased skin turgor
- Dry mucous membranes
- Increased pulse, normal or low BP
- Seizure activity
- Decreased or absent urinary output
What are the treatments for children and adolescents who have hypovolemia?
- oral rehydration (frequent small amounts)
Hospitalized children and severe dehydration: - IV fluids following careful assessment of type of imbalance
- Administer Fluid challenge with caution in young children
When are pregnant women more at risk for hypovolemia?
- during the first trimester
- vomiting from morning sickness
- blood loss in spontaneous abortion
What are the interventions for Hypovolemia?
- record I&O’s accurately
- Daily weights
- VS, CVP, Peripheral pulse volume at least every 4 hours
- Administer and monitor intake of fluids as prescribed
- Administer IV fluid using electronic infusion pump
- Monitor lab values
- Monitor for changes in LOC and mental status
- Reposition pt every 2 hours
- Institute safety precautions to avoid falls
- Teach pt and family (how to reduce orthostatic hypotension, importance of maintaining adequate fluid intake, and how to prevent fluid deficit)
- teach parents not to give diet beverages for oral rehydration
- encourage parents to keep on hand an oral rehydration solution to use when child has diarrhea
