Hypovolemia, BPH (Elimination / Metabolism)

What is hypovolemia?

decrease in the volume of blood plasma in the body, leading to decreased blood flow and oxygen delivery to tissues.

causes of hypovolemia

dehydration, bleeding, and fluid loss due to vomiting or diarrhea

fluid moving to interstitial spaces (edema or ascites)

excessive diuresis

bowel obstruction —> fluid accumulation in intestines—> hypovolemia

hypovolemic shock

a life-threatening condition resulting from severe hypovolemia, leading to inadequate blood flow and oxygen delivery to organs

approx 750-1500 mL lost

What does sodium do in the body?

fluid balance, transmitting nerve impulses, and muscle function.

helps regulate blood pressure and blood volume.

What does potassium do in the body?

maintaining normal cell function, regulating heart rhythm, and facilitating muscle contractions.

nerve impulse transmission and fluid balance.

What is a BMP?

A blood test that measures various substances in the blood, including electrolytes, glucose, and kidney function indicators.

What is a CBC with differential?

A blood test that provides information about the different types of cells in the blood, including red blood cells, white blood cells, and platelets, as well as their relative proportions.

BMP results for hypovolemia

may show elevated BUN and creatinine levels, indicating impaired kidney function due to decreased blood flow.

electrolyte imbalances; elevated sodium due to dehydration and hyperkalemia due to decreased kidney perfusion or hypokalemia due to fluid loss (vomiting/diarrhea)

metabolic acidosis (increased lactate due to decreased perfusion)

magnesium expected range

1.3 to 2.1

calcium expected range

8.5 to 10.5 mg/dL

phosphorus expected range

3.0 to 4.5

hyponatremia expected findings

may include headache, confusion, seizures, and muscle cramps

hypotension,tachycardia

hyponatremia nursing care

• Administer IV fluids (lactated Ringer’s, 0.9% isotonic saline).Monitor sodium levels and assess neurological status.

• Replacement of sodium with 3% Saline slowly until sodium levels are within range

• Monitor I&O and daily weights

• Fall Precautions

hypernatremia expected findings

thirst, dry mucous membranes, restlessness, seizures, and confusion.

nursing care for hypernatremia

Administer hypotonic fluids (such as 0.45% and 0.3%saline, D5W), monitor sodium levels, and assess neurological status. Encourage oral fluid intake and monitor I&O.

Diuretics for sodium excretion

expecting findings hypokalemia

muscle weakness, cramps, fatigue, cardiac arrhythmias, and constipation.

hyperkalemia expected findings

muscle weakness, fatigue, palpitations, numbness, diarrhea

hypomagnesemia expected findings

muscle weakness, tremors, seizures, cardiac arrhythmias, and increased reflexes.

magnesium role in the body

energy production, protein synthesis, muscle and nerve function, and maintaining bone health.

calcium role in the body

bone health, muscle contraction, blood clotting, and nerve transmission.

CBC results for hypovolemia

increased hemoglobin and hematocrit due to decreased blood volume/dehydration (blood more concentrated—>falsely shows increased RBCs)

RBCs decreased if due to hemorrhage

nursing care for hypovolemia

monitoring vital signs/electrolytes/I&Os/LOC, administering IV fluids(fluid resucitation), assessing for signs of dehydration, give oxygen, calm anxiety, monitor weight and gait

colloids

substances that contain large molecules which stay in the bloodstream longer than crystalloids

can help expand blood volume by drawing fluid into the vascular space, often used in fluid resuscitation

whole blood, PRBC, albumin

crystalloids

solutions that contain small molecules which can easily pass through cell membranes

They are used for fluid replacement and electrolyte imbalance and include isotonic, hypotonic, and hypertonic solutions

LR, NS

indications for a crystalloid

• initial fluid resuscitation - sepsis, hypovolemia and shock

• electrolyte imbalance

• dehydration

• maintain hydration in people who are NPO

indications for a colloid

hypovolemic shock due to hemorrhage

How much fluids should be administered during fluid resuscitation?

3 liters for every liter lost

how often should vital signs be monitored in a hypovolemic patient?

Vital signs should be monitored every 15 minutes during the initial phase of resuscitation, then every 30 minutes as stability improves.

causes of dehydration

hyperventilation/excessive perspiration, prolonged fever, DKA, insufficient water intake, diuresis, excessive intake of salt or hypertonic IV fluids

hypertonic IV fluids

water shifts out of cells and into blood stream—>cell shrinkage and dehydration—> high vascular volume triggers kidneys to excrete excess fluid—> increased urine output

expected vital signs in hypovolemia

Tachycardia, hypotension, tachypnea, hypoxia, hypothermia, thready pulse

expected findings in hypovolemia

dry mucous membranes, decreased skin turgor, oliguria, dizziness, altered mental status, sunken eyeballs, weakness, fatigue

oliguria

a condition characterized by reduced urine output, typically defined as less than 400 mL per day.

seen in hypovolemia

Benign Prostatic Hyperplasia (BPH)

a common condition in older men where the prostate gland enlarges primarily due to estrogen buildup, leading to urinary difficulties

What does estrogen buildup lead to?

less responsiveness to DHT

low hanging scrotum

less pubic hair due to less testosterone

decreased libido

enlarged prostate gland

risk factors for BPH

lack of exercise and obesity (excess fat and estrogen)

smoking (vasoconstriction)

alcohol consumption

HTN

diabetes (more weight /estrogen)

western diet (high in fat and animal protein, low in fiber)

What diet should patients eat to prevent BPH?

mediterranean diet rich in fruits, vegetables, whole grains, and fiber.

low fat

clinical manifestations of BPH

UTI- urinary frequency, urgency, dribbling, urinary retention, painful urinartion

nocturia, sensation of incomplete bladder emptying, can lead to kidney failure

BPH diagnostics

include digital rectal exam (DRE), prostate-specific antigen (PSA) testing, and urinary flow studies to assess prostate size and urinary function.

TRUS(transrectal ultrasound) to visualize the prostate

urinalysis and culture results - BPH

high WBCs, hematuria, bacteria

treatments for BPH

finasteride, tamsulosin, transurethral needle ablation, transurethral microwave therapy, prostatic stent, surgical resection, TURP

finasteride

is a medication that inhibits the conversion of testosterone to dihydrotestosterone (DHT)to reduce prostate size and improve urinary symptoms.

tamsulosin

relaxes the muscles in the prostate and bladder neck to improve urine flow

transurethral needle ablation

needle injected into prostate —> coagulation

transurethral microwave therapy

heat applied to prostate —> coagulation of tissue

prostatic stent

A device placed in the urethra to keep it open and facilitate urine flow in patients with urinary obstruction due to prostate enlargement.

TURP (transurethral resection of the prostate)

removes excess prostate tissue to improve urine flow

nursing actions for BPH

monitoring urinary patterns, educating patients about medication adherence, and promoting lifestyle modifications to manage symptoms.

nursing care for continuous bladder irrigation (CBI)

monitor for bladder distention

assess urine color and clots—> normal: pale pink; abnormal: bright red and clots, increase irrigation if seen

no output: stop CBI and assess for blockage; notify provider

check for signs of infection (fever; cloudy, foul smelling urine)

purpose for CBI

to maintain patency of the bladder and prevent clot formation after surgery and ensure proper urine drainage.