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Fluid Volume Disturbances: Hypo Hyper Deficit Excess

Hypovolemia occurs when fluid loss exceeds intake, causing deficits in extracellular fluid. Common causes include vomiting, diarrhea, and third-spacing. Signs include weight loss, decreased skin turgor, and concentrated urine. Treatment focuses on oral or IV fluid replacement based on severity. Hypervolemia results from excess sodium and water retention, often due to heart, liver or kidney failure. Signs include edema, elevated jugular venous pressure, and shortness of breath. Treatment involves sodium restriction, diuretics, and dialysis to remove excess fluid. Edema forms when capillary pressure or interstitial oncotic pressure increases, commonly in dependent areas. Management focuses on diuretics

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Michael Baylon Dueñas
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44 views

Fluid Volume Disturbances: Hypo Hyper Deficit Excess

Hypovolemia occurs when fluid loss exceeds intake, causing deficits in extracellular fluid. Common causes include vomiting, diarrhea, and third-spacing. Signs include weight loss, decreased skin turgor, and concentrated urine. Treatment focuses on oral or IV fluid replacement based on severity. Hypervolemia results from excess sodium and water retention, often due to heart, liver or kidney failure. Signs include edema, elevated jugular venous pressure, and shortness of breath. Treatment involves sodium restriction, diuretics, and dialysis to remove excess fluid. Edema forms when capillary pressure or interstitial oncotic pressure increases, commonly in dependent areas. Management focuses on diuretics

Uploaded by

Michael Baylon Dueñas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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FLUID VOLUME

DISTURBANCES

hypo deficit
hyper excess
HYPOVOLEMIA/
FLUID VOLUME DEFICIT
‾ ECF loss > fluid intake
‾ Water and electrolytes are lost in the
SAME PROPORTION (fluid volume
decreases but water and electrolyte
ratio is STILL THE SAME)
‾ Different from DEHYDRATION (loss
of water alone, causing increased
serum sodium)
‾ Occurs rapidly when coupled with
fluid intake
Causes/Risk Factors
‾ LOSS of bodily fluids
• Vomiting, diarrhea, GI suctioning,
diaphoresis, hemorrhage
• Third-space fluid shifting (edema
formation in burns, ascites with liver
dysfunction)
‾ fluid intake (Comatose)
‾ Diabetes insipidus/ diuresis
‾ Adrenal insufficiency
S/sx:
• Acute weight loss
• Decreased skin turgor
• Oliguria/Concentrated urine
• Rapid but weak pulse
• Decreased CVP, BP
• Cool, clammy, and pale skin
• Thirst and anorexia
• Confusion and delirium
Assessment and Dx Findings:
• Hypokalemia occurs with GI and
• BUN renal losses
• Hyperkalemia occurs with adrenal
• Hct insufficiency
• Urine specific gravity • Hyponatremia occurs with ADH
release
• Hypernatremia results from
diabetes insipidus
Management:
• Oral fluid replacement for mild losses
• IV route is required for acute and severe cases
Fluid of choice for hypotensive patients: ISOTONIC
SOLUTION (PNSS/PLRS)
As soon as BP normalizes, HYPOTONIC SOLUTIONS follow
• Accurate assessment (I&O, wt, v/s, CVP, LOC and breath
sounds and skin color) to determine need to slow therapy to
prevent overload
 I&O is monitored q8h
 Daily weight (loss of .5kg = loss of .5L)
 Assess for orthostatic hypotension (decreased systolic
pressure by 15mmHg from lying to sitting position)
 Check for skin turgor (forehead, sternum and inner thigh)
 Assess the oral cavity and tongue (small and with multiple
longitudinal furrow)
 Assess LOC
Management:

• FLUID CHALLENGE TEST – for patients with U.O., to


determine presence of Acute Tubular Necrosis (ATN)
caused by prolonged FVD
 Amount of fluids are given at specific rates/intervals
while patients hemodynamic response is monitored
(V/S/, LOC, CVP, U.O., Breath sounds)
 For patients with ATN, still U.O., and for patients with
normal renal function, U.O.
• Shock – 25% loss of intravascular fluid
*Acute tubular necrosis (ATN) is a
medical condition involving the death
of tubular epithelial cells that form
the renal tubules of the kidneys. ATN
presents with acute kidney injury
(AKI) and is one of the most common
causes of AKI. Common causes of ATN
include low blood pressure and use of
nephrotoxic drugs.
HYPERVOLEMIA/FLUID VOLUME EXCESS

‾ Isotonic expansion of ECF caused by abnormal


retention of water and sodium in same
proportions
‾ Always caused by increased sodium in the
body
Causes:
‾ Fluid overload (excessive
intake/administration of Na-containing fluid)
‾ Heart, renal and liver failure
S/sx:
• Edema
• Distended neck vein
• Crackles, shortness of breath, and cough
• R.R.
• H.R.
• BP
• Pulse rate, bounding
• CVP
• Wt.
• U.O.
Assessment and Diagnostic Findings:
• BUN • X-ray reveals
• Hct pulmonary
• Serum Sodium/Osmolality congestion
Management:
• Nutritional Therapy
• Dietary restriction of sodium/Low sodium diet
of 250mg/day (normal average intake: 6-15 g
of salt)
• Advise the patient to read food and beverage
labels
• Provide patient the option of consuming salt
substitutes (usually contains potassium)
• Consume distilled water (local water supply
may contain high volumes of sodium)
Management:
• Administer DIURETICS as prescribed
- decreases reabsorption of sodium
- Thiazide diuretics – given for mild cases
- Ex: hydrochlorothiazide
- Loop – for severe cases (S/E: decreased
potassium and magnesium levels)
- Furosemide, bumetanide, torsemide
• Hemodialysis/Peritoneal Dialysis
- removal of water, sodium and nitrogenous
wastes
- to control potassium levels and acid-base
balance
Management:
• I&O monitoring q8h
• Daily weight
• Assess breath sounds and degree of edema (limb
circumference)
• Hypervolemia prevention measures: avoid OTCs
without medical advice
• Promote bed rest (favors diuresis)
• Monitor patient’s response to diuretics
• Semi-fowler’s position for patients with dyspnea
• Turn q2h (edematous skin is especially prone to
breakdown)
• Provide patient health teachings
EDEMA
‾ Caused by capillary fluid pressure,
interstitial oncotic pressure.
‾ Can be localized/generalized(anasarca)
‾ Usually affects dependent areas (Periorbital
region, Ankle, Sacrum and Scrotum)
‾ Pitting edema – pit forms after finger-press
‾ Pulmonary Edema – fluid in alveoli and
pulmonary interstitium
‾ Ascites – fluids that accumulate in the
peritoneal cavity caused by nephrotic
syndrome, cirrhosis and some malignant
tumors
‾ S/sx: shortness of breath/pressure
sensation, abdominal bloating
MANAGEMENT
‾ DIURETICS
‾ Extremity elevation
‾ Elastic compression stockings (anti-embolism
stockings)
‾ Paracentesis (for ascites)
‾ Dialysis

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