Hypovolemia & Hypervolemia: Causes, Signs, Lab Values, and Treatments

What is hypovolemia?

A condition characterized by a decrease in blood volume.

What are common causes of hypovolemia?

Hemorrhaging, diaphoresis, GI loss (vomiting/diarrhea), large burns, diuretics, and dehydration.

What are initial signs of hypovolemia?

Dry mucous membranes, poor skin turgor, decreased urine output, and thirst.

What compensatory mechanisms occur in hypovolemia?

Decreased blood pressure, increased heart rate, and poor perfusion.

What lab values indicate hypovolemia?

Increased BUN/Creatinine, increased Hgb & Hct, increased specific gravity, and decreased urine Na+.

What is the first-line treatment for dehydration?

Oral rehydration therapy if the patient is able.

What IV fluid is commonly used for dehydration?

D5W (5% dextrose in water).

What is hypervolemia?

A condition characterized by an excess of blood volume.

What are common causes of hypervolemia?

Kidney disease, excessive sodium intake, cirrhosis, and SIADH.

What are signs and symptoms of hypervolemia?

Tachycardia, bounding pulses, hypertension, JVD, and edema.

What lab values indicate hypervolemia?

Decreased Hgb & Hct, decreased osmolality, and decreased urine sodium.

What nursing care is essential for managing hypervolemia?

Fluid/sodium restrictions, monitoring I&Os, and daily weights.

What is the normal range for potassium (K+)?

3.5-5 mEq/L.

What causes hypokalemia?

Overuse of diuretics, GI losses, and prolonged NPO status.

What are mild symptoms of hypokalemia?

Decreased blood pressure, thready weak pulse, and altered mental status.

What nursing care is required for hypokalemia?

Administer potassium replacement and monitor cardiac rhythm.

What is the primary cause of hyperkalemia?

Overconsumption of high-potassium foods or excessive potassium replacement.

What are severe symptoms of hyperkalemia?

Weakness leading to paralysis, ventricular fibrillation, and peaked T waves.

What is the normal range for sodium (Na+)?

135-145 mEq/L.

What causes hyponatremia?

Excessive sweating, diuretics, and inadequate sodium intake.

What are mild symptoms of hyponatremia?

Tachycardia, headache, fatigue, and muscle weakness.

What nursing care is needed for hyponatremia?

Encourage sodium-rich foods and administer IV fluids like lactated Ringer's.

What is the significance of monitoring urine output?

It helps assess kidney function and fluid balance.

What is the role of diuretics in fluid management?

They help reduce excess fluid in conditions like hypervolemia.

What is the importance of daily weight measurement?

It helps monitor fluid status and detect changes in volume.

What is the effect of dehydration on blood pressure?

It typically causes decreased blood pressure.

What are the risks associated with rapid potassium replacement?

It can lead to cardiac complications and hyperkalemia.

What is the purpose of IV access in fluid management?

To provide rapid rehydration and medication administration.

What IV fluids are commonly administered for hypernatremia?

Lactated Ringer's or 0.9% isotonic saline.

What is the maximum rate of sodium replacement in hypernatremia?

12 mEq/L in a 24-hour period.

What are some causes of hypernatremia?

Kidney failure, Cushing's syndrome, aldosteronism, excessive oral sodium intake, and water deprivation.

What are mild symptoms of hypernatremia?

Thirst, hyperthermia, tachycardia, orthostatic hypotension, restlessness, irritability, muscle twitching, dry mucous membranes, nausea, vomiting, anorexia, and occasional diarrhea.

What are severe symptoms of hypernatremia?

Muscle twitching to weakness, decreased or absent DTRs, seizures, and coma.

What is the normal range for serum calcium (Ca++)?

8.5-10.5 mg/dL.

What are the functions of calcium in the body?

Keeps bones strong, aids in blood clotting, and maintains strong heartbeats.

What are some causes of hypocalcemia?

Inadequate intake, malabsorption, inadequate vitamin D, end-stage kidney disease, and conditions like alkalosis.

What are mild symptoms of hypocalcemia?

Paresthesia of fingers and lips, muscle twitches, hyperactive DTRs, and diarrhea.

What nursing care is required for hypocalcemia?

Administer calcium supplements, implement seizure precautions, and encourage high-calcium foods.

What are the symptoms of hypercalcemia?

Gastrointestinal discomfort, bone pain, renal calculi, fatigue, polyuria, and mental status changes.

What is the normal range for serum phosphorus (PO4)?

3-4.5 mg/dL.

What is the normal range for serum magnesium (Mg++)?

1.5-2 mEq/L.

What are the functions of magnesium in the body?

Vasodilation, heart contractility, neurotransmission, and muscle relaxation.

What are some causes of hypomagnesemia?

Celiac disease, malnutrition, ethanol ingestion, and certain medications.

What are severe symptoms of hypomagnesemia?

Widened QRS, severe dysrhythmias, seizures, and paralytic ileus.

What nursing care is required for hypermagnesemia?

Avoid Mg-containing laxatives, monitor for toxicity, and promote Mg excretion.

What is the normal range for serum chloride (Cl-)?

98-106 mEq/L.

What is the function of chloride in the body?

Maintains blood volume, blood pressure, and pH balance.

What are the nursing care considerations for hypochloremia?

Monitor electrolyte levels and provide appropriate fluid replacement.

What are the nursing care considerations for hyperchloremia?

Monitor vital signs and assess for signs of dehydration.

What are the potential complications of rapid sodium replacement?

Neurologic damage due to demyelination.

What should be monitored in patients with hypernatremia?

Level of consciousness, vital signs, heart rhythm, and I&O.

What dietary recommendations can help manage hypocalcemia?

Encourage foods high in calcium such as dairy products, canned salmon, and dark leafy greens.

What is the risk associated with administering calcium gluconate too quickly?

Cardiac arrest.

What is a common nursing intervention for patients with hypercalcemia?

Promote hydration and monitor ECG for changes.

What are the signs of severe hypocalcemia?

Tetany, seizures, decreased myocardial contractility, and hypotension.

What is the effect of magnesium on calcium absorption?

Magnesium is required for calcium absorption.