Foundations: Hyper and Hypovolemia and dehydration

What is dehydration?

Loss of water without a concomitant loss of sodium leading to hypernatremia and increased serum osmolality

What happens in dehydration pathophysiology?

Body water shifts from intracellular to extracellular space causing cellular shrinkage

How is dehydration different from hypovolemia?

Dehydration is water loss only while hypovolemia is loss of fluid and electrolytes

What are common causes of dehydration?

Diarrhea, vomiting, fever, excessive sweating, DKA, insufficient water intake, impaired thirst response

Who is most at risk for dehydration?

Infants and older adults

What are the signs and symptoms of dehydration?

Thirst, lethargy, altered cognition, dry mucous membranes, oliguria, increased serum osmolality, elevated urine specific gravity, tachycardia, hypotension, lactic acidosis, risk for shock, coma if severe

What is an early sign of dehydration?

Thirst

What should the nurse do for dehydration?

Oral rehydration first if alert, IV D5W if needed, administer D5W slowly, identify and treat cause, monitor urine specific gravity, strict I&O

What IV fluid is the fluid of choice for dehydration?

D5W

What should the nurse monitor in dehydration?

Sodium, osmolality, urine specific gravity, vital signs, LOC, mucous membranes, skin turgor, strict I&O, daily weight

What should NEVER be done in dehydration?

Do not give hypertonic fluids as sole replacement, do not give IV D5W too rapidly, do not restrict fluids

What should the nurse teach a dehydrated client?

Drink adequate water daily, increase fluids with fever vomiting or diarrhea, monitor urine color, drink on a schedule especially older adults, report dizziness confusion dry mouth or decreased urination

What is hypovolemia?

Loss of both fluid and electrolytes causing decreased circulating blood volume and tissue perfusion

What is another name for hypovolemia?

Fluid volume deficit

How is hypovolemia different from dehydration?

Hypovolemia involves fluid and electrolyte loss while dehydration is water loss only

What are common causes of hypovolemia?

Blood loss, GI losses, severe burns, third spacing, sweating, fever, diuretics, trauma

What are the signs and symptoms of hypovolemia?

Thirst, dry mucous membranes, decreased skin turgor, decreased urine output, lethargy, muscle weakness, orthostatic hypotension, tachycardia, vasoconstriction, confusion, tachypnea, chest pain, oliguria, weak pulse, decreased BP, shock

What is an early sign of hypovolemia?

Tachycardia

What is a key blood pressure sign in hypovolemia?

Orthostatic hypotension

What should the nurse do for hypovolemia?

Treat underlying cause, oral rehydration with electrolytes if mild, IV 0.9% normal saline or lactated ringers if moderate to severe, blood products if hemorrhage, monitor urine output, repeat CBC and BMP

What IV fluids are first line for hypovolemia?

0.9% normal saline or lactated ringers

What blood products may be given in hypovolemia?

PRBCs, platelets, fresh frozen plasma

What should the nurse monitor in hypovolemia?

Vital signs, orthostatic BP, BMP/CMP, CBC, BUN creatinine, urine output, skin turgor, LOC, signs of shock

What urine output indicates adequate perfusion in hypovolemia?

Greater than 0.5 mL/kg/hr

What should NEVER be done in hypovolemia?

Do not delay fluid replacement, do not give hypotonic fluids, do not confuse with dehydration treatment, do not rely only on skin turgor in older adults

What should the nurse teach a client with hypovolemia?

Recognize thirst dizziness decreased urination, replace fluids with electrolyte solutions during illness, seek care if unable to keep fluids down, report dizziness fast heart rate dark urine

What is hypervolemia?

Excess water and sodium in the extracellular space causing fluid overload

What are common causes of hypervolemia?

Heart failure, kidney failure, nephrotic syndrome, cirrhosis, pregnancy, antihypertensive medications

What happens in hypervolemia pathophysiology?

Fluid backs up into interstitial spaces and lungs causing edema and pulmonary edema

What are the signs and symptoms of hypervolemia?

JVD, hypertension, bounding pulse, dyspnea, crackles, edema, rapid weight gain, tachycardia, decreased oxygen saturation, increased CVP

What lung sounds are commonly heard in hypervolemia?

Crackles

What is the most reliable sign of hypervolemia?

Rapid daily weight gain

What should the nurse do for hypervolemia?

Treat underlying cause, give diuretics, fluid restriction, sodium restriction, daily weights, dialysis if renal failure, elevate HOB, monitor respiratory status

What medications are commonly used for hypervolemia?

Loop diuretics, thiazide diuretics, potassium-sparing diuretics

What should the nurse monitor in hypervolemia?

Daily weight, lung sounds, O2 saturation, edema, JVD, strict I&O, BMP/CMP, BUN creatinine, sodium level

What is the priority thing to monitor in hypervolemia?

Lung sounds and oxygen saturation because pulmonary edema is an emergency

What should NEVER be done in hypervolemia?

Do not increase fluid intake, do not give high-sodium IV fluids, do not ignore crackles or low oxygen saturation, do not skip daily weights

What should the nurse teach a client with hypervolemia?

Weigh daily at same time, report rapid weight gain, follow fluid restriction, follow low sodium diet, take diuretics as prescribed, report swelling shortness of breath or rapid weight gain