Hypovolemia Flashcards
Why does this happen?
- Loss of fluids from anywhere!!
(thorcentesis, paracentesis, vomiting, diarrhea, hemorrhage) - Third spacing
- Diseases with polyuria
What is third spacing?
When fluid is in a place that does you no good–like interstitial space
- burns (fluids go to tissue)
- ascites (fluid in abdomen)
Why do diseases with polyuria cause loss of fluid?
Polyuria (loose fluid and can cause shock)
Oliguria (trying to save as much fluid as possible)
Anuria (no urine!!–can lead to kidney problems)
S/S?
- 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
Why is there decreased UO?
Kidneys aren’t being perfused or they are trying to hold on to the fluid to compensate
Why is there decreased BP?
Less volume, less pressure
What is pulse like?
Increased–heart is trying to pump what little fluid is left
Hypovolemia or hypervolemia
Increased HR
Both
Hypovolemia or hypervolemia
HR weak and thready
Hypo
HR full and bounding
Hyper
Why is RR increasing?
Body thinks decrease BV is from hypoxia so trying to get more O2 in
Urine specific gravity increased (concentrated)…If UO is happening at all, how will it be?
Very concentrated
Treatment?
- Prevent further losses
- Replace volume
- Safety
How to replace if mild deficit?
Po fluid
How to replace if severe deficit?
IV fluids
Why is there a higher risk for falls?
Decreased BP—risk for orthostatic hypotension
Why would there be high risk for overload with tx for deficit?
Giving too much fluid too quick
How to take VS for someone with orthostatic hypotension and 3 checks?
- Lie down 3 min
- Take VS while lying
- Take VS with sitting
- Take VS while standing
- Record
What do isotonic fluids do?
Go into vascular space and STAYS
Examples of isotonic fluids?
NS (0.9)
LR
D5W
D51/4NS
Who would get isotonic fluids?
Those who lots fluids from burns, NV, sweating, and trauma
What is the basic solution when administering blood?
Normal saline
Who does NOT get normal saline?
HTN
Cardiac disease
Renal disease
Isotonic fluids can cause what 3 things?
FV excess
HTN
Hypernatremia (for those that contain sodium)
What do hypotonic solutions do?
Go into vascular space, then shifts to cells to replace cell fluid
Do hypotonic solutions rehydrate?
Yes
Do hypotonic solutions cause HTN?
NO
Examples of hypotonic fluids?
D2.5W
- 45 NS
- 33 NS
Who gets hypotonic fluids?
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
What is the alert with hypotonic fluids?
Watch for cell edema bc this fluid is moving to cells which can lead to FV deficit and decreased BP
What are hypertonic solutions?
Volume expanders that will draw fluid into vascular space from cells
Examples of hypertonic solutions?
D10W 3%NS 5% NS D5LR D51/2NS DF NS TPN ALbumin
Who gets hypertonic solutions?
Pt. with HYPOnatremia
Client who has shifted large amounts of vasc. volume to 3rd space
Burns, edema, ascites
What solution returns fluid volume to vascular space?
HYPERtonic
What is alert for hypertonic fluids?
Fluid volume excess and pulm. edema
*do frequent monitoring of BP, HR, and CVP!!
What solution:
Stay where I put it
Isotonic
What solution:
Enter vessel
Hypertonic
What solution:
Go out of vessel
Hypotonic
