Exam 3 - ECF Volume DEFICIT (Hypovolemia)

1. ↑ sensible water loss or perspiration (high fever, heatstroke)
2. Diabetes insipidus
3. Osmotic diuresis
4. Hemorrhage
5. GI losses: vomiting, NG suction, diarrhea, fistula drainage
6. Overuse of diuretics
7. Inadequate fluid intake
8. Third-space fluid shifts: burns, pancreatitis

from the book

ECF volume deficit: causes / etiologies (8)

1. Restlessness, drowsiness, lethargy, confusion
2. Thirst, dry mucous membranes
3. Cold clammy skin
4. Decreased skin turgor, ↓ capillary refill
5. Postural hypotension, ↑ pulse, ↓ CVP
6. ↓ Urine output, concentrated urine
7. ↑ Respiratory rate
8. Weakness, dizziness
9. Weight loss
10. Seizures, coma

from the book

ECF volume deficit: manifestations (10)

**bolded ones are also noted in lecture

1. correct underlying cause
2. replace both water and any needed electrolytes (as simple as increased water intake)
3. IV solutions

from the book

ECF volume deficit: interprofessional care and treatments -- name 3

1. isotonic (0.9%) sodium chloride = for rapid volume replacement

2. lactated ringer's solution

3. blood products (packed RBCs) if volume loss is due to blood loss

name the 3 typical IV solutions given for ECF volume deficit

loss of pure water alone, WITHOUT loss of sodium

(1) ECV deficit and (2) hypernatremia

THINK --> low water, high sodium

dehydration is the loss of what?

characterized by what 2 things

decreased vascular volume --> sodium (salt) AND water is lost

hypovolemia is defined as what?

1. abnormal loss of normal body fluids (hemorrhaging, diarrhea, vomiting fistula drainage, diuretics)

2. inadequate intake (not drinking enough water)

3. plasma-to-interstitial fluid shift (edema, ascites is shift from ECV to third space)

name the 3 overarching etiologies of hypovolemia

1. ADH and aldosterone secreted - will increase water/fluid in blood
2. thirst mechanism is signaled
3. vasoconstriction - trying to conserve fluid
4. tachycardia - trying to circulate more blood

name the 4 pathophysiology components of hypovolemia

what 4 things happen in the body IN RESPONSE to decreased fluid volume

decreased BP and increased HR

nursing assessment / monitoring for hypovolemia

be alert for clinical manifestations

what happens to BP and HR?

hematocrit - high, above 55%

osmolality - high, above 295 mOsm/kg

sodium - high, greater than 145 mEq/L

urine specific gravity - high (concentrated urine > 1.025)

BUN - elevate, above 20 mG/dL

creatinine - elevated, above 1.3 mg/dL

labs with hypovolemia

hematocrit?
osmolality?
sodium?
urine specific gravity?
BUN / creatinine?

1. I&O
2. daily weights
3. vital signs
4. cardio and respiratory status
5. HTT assessment (skin, lungs, edema)
6. neurologic function
7. monitor labs
8. monitor IV sites / therapy
9. restrict fluids or IV therapy

name the 9 aspects of nursing management for fluid imbalances (BOTH excess and deficit)

daily weights -- weight patient at same time every day with same conditions

increase of 1 kg (2.2. lb) = 1000mL (1L) of fluid retention

nursing management from book (BOTH)

what is the most measure of volume status

increase of ___________ = __________ of fluid retention

intake

output

nursing management from book (BOTH)

___________ = oral and IV fluids, tube feedings, retained irrigation solutions

____________ = urine, excess perspiration, wound or tube drainage, vomitus, and diarrhea

increased BUN, sodium, and hematocrit levels

increased plasma and urine osmolality (concentrated urine)

nursing management from book

lab findings for fluid volume DEFICIT

1. increased HR results from peripheral vasoconstriction to keep BP within normal limits

2. pulse = weak and thready

3. orthostatic hypotension - moving from lying down to sitting/or standing may decrease BP or increase HR

nursing management from book

cardiovascular care - name 3 things to note for fluid volume DEFICIT

1. increased RR -- results from decreased tissue perfusion and progresses to hypoxia

2. give O2 as needed

nursing management from book

respiratory care - name 2 things to note for fluid volume DEFICIT

1. risk for falls due to orthostatic hypotension, muscle weakness, and changes inn LOC

2. assess LOC, gait, and muscle strength

3. implement fall precautions

4. change positions slowly

nursing management from book

patient safety for fluid volume DEFICIT - name 4 things

edematous

dehydrated, soap

nursing management from book -- good skin care is imperative (BOTH)

elevate __________ extremities -- promotes venous return and fluid reabsorption

____________ skin needs frequent care without use of ___________ -- apply moisturizes or creams which stimulates circulation and increase moisture retention

1. diminished skin turgor with tenting
2. lag in skin fold returning to original state
3. skin may be warm, dry, and wrinkled (mild cases)
4. skin may be cool, and moist (severe)
5. oral mucous membranes dry
6. tongue furrowed
7. person often thirsty

nursing management from book

skin care - name 7 things to note for fluid volume DEFICIT

low intake, normal output

normal intake, increased output

Mechanisms of Disrupted Fluid and Electrolyte Balance

ECV deficit = osmolality too high = plasma electrolyte deficits

2 ways this occurs?

increased

1. reduced thirst mechanism results in decreased fluid intake
2. lost elasticity of skin (causes tenting)
3. often frail and on many medications due to co-morbidities

Gerontologic Considerations

elderly have __________ susceptibility to fluid and electrolyte imbalances

name 3 reasons why

1. decreased GFR
2. loss of the ability to concentrate urine
3. decreased ability to conserve water

Gerontologic Considerations: elderly more susceptible to imbalances because of:

structural changes of kidneys and a decrease in renal blood flow

^^leads to what 3 things

1. decreased renin and aldosterone

2. increased ADH and ANP

Gerontologic Considerations: elderly more susceptible to imbalances because of:

hormonal changes

^^name 2

1. increased moisture lost through skin

2. inability to respond quickly to heat or cold

Gerontologic Considerations: elderly more susceptible to imbalances because of:

loss of subcutaneous tissue and thinning of dermis

^leads to what 2 things

1. greater need for water -- more vulnerable to alterations in fluid and electrolyte balance, occur more frequently and rapidly

2. relative greater BSA -- greater insensible fluid loss

3. kidneys are immature -- inability to concentrate and dilute urine efficiently

4. dehydration -- vomiting, diarrhea, not taking in enough fluid, diabetic ketoacidosis, burns

Pediatric Considerations: infants and children more susceptible to imbalances because of:

name 4 physical differences

1. sunken fontanels (infants)
2. crying - decreased tear production
3. different color or consistency of skin
4. dry mucous membranes

Pediatric Considerations:

name 4 CMs of dehydration in an infant or child

increased temp.

decreased BP

increased HR

Pediatric Considerations:

what happens to vitals (temp, BP, HR) with dehydration?

1g of wet diaper = 1 ml of urine

Pediatric Considerations:

I&Os are still very important

_________ wet diaper = ______ of urine

changes can be more subtle, but the s/s can be more drastic

Pediatric Considerations: physical assessment

similar to adults BUT . . .

1. pre-existing conditions
2. diabetic ketoacidosis (DKA)
3. HTN / pre-eclampsia / eclampsia
4. weight
5. hyperemesis gravidarum (extreme, persistent N/V)
6. viruses / flu

Pregnancy Considerations:

name 6 things that put them at higher risk of fluid imbalances

fast

acidic

Pregnancy Considerations:

diabetic ketoacidosis (DKA) occurs when the body starts breaking down fat at a rate that is much too __________

liver processes the fat into a fuel called ketones, which causes the blood to become ___________

1. abnormal loss of normal body fluids (diarrhea, fistula, drainage, hemorrhage), inadequate intake, or plasma-to-interstitial fluid shift

2. treatment: replace water and electrolytes with balanced IV solutions

3 isotonic (o.9% NaCl) for rapid volume replacement

4. blood for blood loss

4 summary points for hypovolemia

1. deficient fluid volume
2. deceased cardiac output
3. risk for deficient fluid volume
4. risk for injury

potential complication: hypovolemic shock, decreased BP

name 4 nursing diagnoses for hypovolemia

name the 2 potential complications