Week 5 - Hypovolemia and Hypervolemia

Question 1

What is hypovolemia? Hypervolemia?

Answer 1

low circulating volume, high circulating volume

Question 2

Why does hypovolemia occur? (3)

Answer 2

• can occur with loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), decreased intake, or plasma-to-interstitial fluid shift (3rd spacing)
• aka dehydration, fluid-volume deficit

Question 3

What is the goal to treating hypovolemia? (4)

Answer 3

• treat cause
• replace water and electrolytes
• give blood if due to hemorrhage
• IV fluids to replace quickly

Question 4

What is the cause of hypervolemia? (2)

Answer 4

• may result from excessive intake of fluids, abnormal retention of fluids (CHF), or interstitial-to-plasma fluid shift
• aka overhydration, fluid volume overload (would have high BP)

Question 5

What are the goals in treating hypervolemia? (2)

Answer 5

• remove Na+ and water without causing other electrolyte imbalances
• treat with diuretics and fluid restriction
  In lecture: so removing salt means less H2O holding on

Question 6

Hypovolemia and Hypervolemia are typically associated with _____ _______.

Answer 6

electrolyte imbalance

Question 7

Why might one experience hypovolemia? (7)

Answer 7

• vomiting
• diarrhea
• suctioning gastric or intestinal fluid
• wound drainage
• overuse of some diuretics
• hemorrhage
• massive diaphoresis

Question 8

What are some clinical manifestations of hypovolemia? (7)

Answer 8

• decreased weight
• decreased BP
• weak, thready pulse (+1)
• increased HR (from SNS response-baroreceptors) trying to maintain CO
• flat neck veins
• prolonged capillary refill
• pre-syncope, dizziness or syncope (faint)

Question 9

What are clinical manifestations of hypovolemia on the kidney and urine output? (2)

Answer 9

1. decreased blood flow to kidney
   - RAAS and aldosterone
2. low urine output
   - oliguria, increased urine specific gravity

Question 10

What are the clinical manifestations of hypovolemia on tissue turgor?

Answer 10

• slow fluid loss = decreased tissue turgor (tenting)

Question 11

What are the clinical manifestations of hypovolemia on the mucosa? (2)

Answer 11

• mucosa dry
• tongue furrowed, cracked

Question 12

What are the clinical manifestations of hypovolemia on the GI system? (2)

Answer 12

• constipation
• hard stools

Question 13

What are the clinical manifestations of hypovolemia on physical appearance? (2)

Answer 13

• eyes sunken if extreme loss of tears and sweating
• infants may have sunken fontanelle

Question 14

Why might one experience hypervolemia? (3)

Answer 14

• from IV fluid overload (NS/R/L)
• many pathos that increase aldosterone or cause the kidney to fail
• some drugs like corticosteroids

Question 15

What are the clinical manifestations of hypervolemia (5)

Answer 15

1. increased weight
2. edema (lower legs, sacrum, around eyes)
3. circulatory overload*
4. increased hydrostatic pressure in capillaries will cause “fluid leak” interstitial space and body cavity space
   - frothy pink sputum from pulmonary edema…can lead to resp. failure and death

Question 16

What occurs in circulatory overload? (3)

Answer 16

• bound pulse +4
• Distended neck veins
• Increased BP

Question 17

What is the connection between fluid and weight? (3)

Answer 17

• fluid has weight
• 1 mL of water weighs 1 gram
• rapid weight loss or gain reflects fluid loss or gain