About how much fluid is lost through feces and sweat?
Feces:100-200 ml
Sweat: 300-500 ml
Lungs: 350-400 ml
Skin: 350-400 ml
What does isotonic mean?
Water and electrolytes are lost or gained in equal proportions.
What does osmolar mean?
Loss or gain of only water, resulting in serum osmolality alterations.
What are the causes of hypovolemia?
Abnormal loss from skin, GI tract, or kidneys.
Decreased fluid intake-Pt not drinking/or drinking too much alcohol
Bleeding
Examples of hypovolemia
Excessive diuretic or laxative use
Fever
Fistulas
Hemorrhage
NGT drainage
Vomiting/diarrhea
Abdominal surgery
Burns
T or F
A pt comes into the hospital with severe pitting edema. The care providers should recognize that the patient is not at risk for a fluid volume deficit.
False
Just because the pt. has edema doesnt mean that they are not at risk. The fluid has moved into a third space and is not in the vascular space.
Who is at risk for hypovolemia?
Children: higher body water-more dependent.
Elderly: 45% body water-Lower
What would you expect to find in a person with hypovolemia?
Increased respirations/HR
Subnormal temps
Orthostasis
Weight loss
Poor skin turgor
Decreased urine volume
Dark urine
Increased specific gravity
Increased hematocrit/hemoglobin-more concentrated
Altered LOC and confusion-decreased oxygen to the brain/decreased sodium
What would goals be for hypovolemia?
Restore fluid volume
Replace electrolytes as needed
Eliminate cause
Interventions for hypovolemia
Assess v/s, weight, turgor, neck and hand vein swelling, mucous membranes, bowel/breath sounds
Monitor I/O
Daily weights-Regular
Monitor labs-hct, hgb, electrolytes, BUN, specific gravity, albumin
Administer fluids PO and IV
Mouth care
Skin care
Fall risk
How do you treat hypovolemic shock?
Multiple fluid challenges given to restore circulating volume.
NS or LR given, plasma protein infusions (Albumin)
Blood transfusions
Drugs to support BP
O2 therapy
What is hypervolemia?
Body retains water and sodium in similar proportions and the serum Na concentration remains essentially normal.
Excessive intake of Na, Alka-seltzer, hypertonic enemas-makes body retain water
Excessive irrigation of body cavities or organs
Aggressive fluid replacements
What assessment findings would you expect to find in a pt. with hypervolemia?
Weight gain
Intake > output
Tachycardia
Full bounding pulses
Increased BP
JVD
Dyspnea
Mental confusion
Edema
What is edema?
Increased water and sodium content in interstitial and intravascular spaces. Caused by increased capillary hydrostatic pressures, decreaed oncotic pressures (decreased albumin, malnutrition), or increased capillary permeability (trauma)
A pt. comes into the ER with anasarca. What would you expect to find?
Severe edema all over the patient's body.
What are the goals for hypervolemia?
Maintain fluid balance
Prevent respiratory (pulmonary edema) and cardiovascular complications (CHF)
Eliminate cause of overload
What are interventions for hypervolemia?
Assess for s/sx of overload
Monitor daily weight, vs, I/O (hourly)
Assess and document edema
Assess breath sounds/pulse ox/heard sounds (S3)
Monitor labs
Chest x-ray
Fluid restrictions/Na restrictions
Diuretics as ordered
T or F
A client with hypervolemia needs to report to the doctor if they have a change in weight.
True
What is dehydration?
Water lost fromt he body without significant loss of electrolytes causing increased serum osmolality and increased serum Na levels. Water is drawn into the intravascular space from the cells=cellular dehydration.
What causes dehydration?
Decreased water intake
Decreasd thirst sensation
Prolonged fever
Acidosis
Enteral feedings w/o sufficient water intake
High risk:infants, confused/comatose, elderly, brain injury, inadequate production of ADH
What assessment findings would you expect to find in a pt. with dehydration?
Irritability
Confusion
Dizziness
Weakness
Extreme thirst
Fever
Dry skin/membranes
Sunken eyeballs
Poor turgor (Not reliable in elderly)
Decreased urine output
Increased HR with falling BP
What interventions would you perform on a pt. with dehydration?
Assess vs, weight, turgor, neck and hand vein filling, mucous membranes, bowel/breath sounds
Monitor I/O
Monitor daily weight
Monitor labs
Admin. fluids-isotonic NS or LR or hypotonic fluids----gradual
Monitor LOC, orientation and seizure precautions-for hypernatremia
Assist with mobility-positioning (orthostasis)
Safety and skin/mouth care
What is overhydration?
Water intoxication. Water is gained in excess of electrolytes causing low serum osmolality and low serum Na levels. Water is drawn in to cells causing them to swell. Can lead to cerebral edema, impaired neuro function and death!!!
What causes overhydration?
Fluids and electrolytes lost at equal balance but only water is replaced
Syndrome of inapporpriate ADH (SIADH)-body holds water
Milignant tumors, aids, head injury, drug admin (anesthetics, barbs-urinary retention)
Psychogenic polydipsia
What assessment findings would you expect to find in a pt with overhydration?
Tachycardia
Hypertension
Muscle twitching/weakness
Increased HR/BP
Low Na levels leading to changes in LOC, disorientation, seizures
Increased intracranial pressures-initially headaches-late signs are pupil changes, bradycardia, and wide pulse pressure
What interventions would you expect to perform on a pt. with overhydration?
Assess LOC, orientation and monitor for seizures (Neuro checks)
Limit water intake-fluid restriction 500cc/day
Allow sodium in diet, salt shaker at bedside
Safety
Irrigate with saline-no tap water irrigations, flushes, enemas
