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What is the normal daily output of urine?
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
Examples of hypovolemia
- Excessive diuretic or laxative use
- NGT drainage
- Abdominal surgery
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.
- 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
- 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.
What are the causes of hypervolemia?
- Excessive intake of sodium chloride
- Rapid admin. of Na containing infusions
- CHF, Renal failure, liver cirrhosis, Cushings syndrome
- 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
- Full bounding pulses
- Increased BP
- Mental confusion
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.
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
- 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?
- Extreme thirst
- 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?
- 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
- Irrigate with saline-no tap water irrigations, flushes, enemas
- Vitals, I/O, labs (Na, (BUN, Creatnine--->Indicators of kidney function) Hematocrit), daily weight.