Hypovolemia Overview and Management

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What condition is defined as the loss of extracellular fluid (ECF) volume exceeding fluid intake?

Dehydration

Hypovolemia (correct)

Edema

Hypervolemia

Which of the following is not a cause of hypovolemia?

Hyperglycemia

Vomiting

Diarrhea

Retention of sodium (correct)

What is a sign of hypovolemia identified by the acronym 'FEWCHART'?

Increased neck vein distention

Elevated blood pressure

Decreased heart rate

Dry tongue (correct)

Which type of therapy is appropriate for a patient experiencing severe hypovolemia with hypotension?

IV isotonic fluid therapy Signup and view all the answers

What should be monitored in patients with hypovolemia as indicated in nursing management?

I&O and daily weights Signup and view all the answers

What is the appropriate action for a nurse when administering IV fluids to a hypovolemic patient?

Adjust the IV rate according to the prescribed orders Signup and view all the answers

What major electrolyte is typically lost in proportion during hypovolemia?

Sodium Signup and view all the answers

Which medication may be administered to a patient experiencing hypovolemia associated with diarrhea?

Loperamide Signup and view all the answers

What is the first-line treatment for sodium correction in hypernatremia?

0.3% NaCl Signup and view all the answers

Which dietary adjustment should be made for patients with hyperkalemia?

Restrict potassium intake Signup and view all the answers

Which of the following is NOT a clinical manifestation of hyperkalemia?

Low blood pressure Signup and view all the answers

What relationship does potassium have with sodium?

Inverse relationship Signup and view all the answers

In the management of hypernatremia, which solution is used when water needs to be replaced without sodium?

5% dextrose in water (D5 W) Signup and view all the answers

What is a common cause of hypervolemia?

Heart failure Signup and view all the answers

Which clinical manifestation is NOT associated with hypervolemia?

Dry mucous membranes Signup and view all the answers

Which medication is typically used for severe hypervolemia?

Loop diuretics Signup and view all the answers

What should be monitored to prevent rapid weight gain in patients with fluid overload?

Daily weight Signup and view all the answers

What is the serum sodium level for hyponatremia?

Less than 135 mEq/L Signup and view all the answers

Which of the following is a recommended treatment for severe hyponatremia?

Hypertonic saline solution Signup and view all the answers

What dietary change is recommended for patients experiencing hypervolemia?

Low sodium diet Signup and view all the answers

Which of the following describes a clinical manifestation of hypernatremia?

Oliguria Signup and view all the answers

Which electrolyte is the most abundant in extracellular fluid (ECF)?

Sodium Signup and view all the answers

What is a safety precaution that should be implemented for patients with hyponatremia?

Keep side rails up Signup and view all the answers

What is the maximum normal value for ionized calcium?

5.1 mg/dL Signup and view all the answers

What is a potential clinical manifestation of hypocalcemia?

General muscle hypertonia Signup and view all the answers

Which condition is NOT a cause of hypocalcemia?

Excessive calcium supplementation Signup and view all the answers

Which sign is associated with overt tetany in hypocalcemia?

Trousseau’s sign Signup and view all the answers

Which of the following is a characteristic of latent tetany?

Numbness and tingling Signup and view all the answers

What dietary substance should be avoided by patients with hyperkalemia?

Potatoes Signup and view all the answers

Which of the following calcium types can be found complexed to anions?

Calcium complexed to anions Signup and view all the answers

What effect does hypocalcemia have on cell membrane permeability?

Increased permeability to sodium Signup and view all the answers

What is a potential side effect of Pamidronate disodium?

Fever Signup and view all the answers

Which statement about Magnesium is true?

Normal serum magnesium levels are between 1.3-2.3 mg/dL. Signup and view all the answers

Which of the following is a cause of hypomagnesemia?

Alcohol withdrawal Signup and view all the answers

What are clinical manifestations of hypomagnesemia?

Cramps and spasticity Signup and view all the answers

What is a likely nursing responsibility when administering magnesium sulfate IV?

Monitoring vital signs Signup and view all the answers

Which dietary sources can help manage mild hypomagnesemia?

Green leafy vegetables Signup and view all the answers

What characterizes hypermagnesemia?

Decreased neuromuscular irritability Signup and view all the answers

Which of the following conditions can lead to falsely elevated magnesium results?

Hemolyzed blood specimen Signup and view all the answers

What is a common clinical manifestation of hypermagnesemia?

Hypoactive reflexes Signup and view all the answers

Which intervention is crucial in nursing management for patients with severe hypermagnesemia?

Administering calcium gluconate IV Signup and view all the answers

Study Notes

Hypovolemia

Occurs when loss of extracellular fluid (ECF) volume exceeds intake
Water and electrolytes lost in equal proportions as normal body fluids
Dehydration refers to water loss only

Hypovolemia Causes

Abnormal fluid loss:
- Vomiting
- Diarrhea
- Gastrointestinal (GI) suctioning
- Profuse diaphoresis
Decreased fluid intake:
- Nausea
- Lack of access to fluids
Third spacing:
- Edema in burns
- Ascites in liver dysfunction

Other Hypovolemia Causes

Diabetes insipidus
Adrenal insufficiency
Hyperglycemia
Hemorrhage
Coma

Hypovolemia Clinical Manifestations "FEWCHART"

Flat neck veins
Eyes sunken
Weight loss
Concentrated urine (specific gravity > 1.025, oliguria)
Hypotension
Anxiety
Rapid, weak pulse; Respirations increased
Temperature elevated

Hypovolemia Medical Management

Fluid replacement therapy:
- Mild to moderate: Increase oral fluids, oral rehydration salts (e.g., Hydrite)
- Severe: Intravenous (IV) therapy
  - Hypotension: Isotonic fluids
  - Normotensive: Hypotonic fluids
Antidiarrheals (e.g., Loperamide (Diatabs)) if diarrhea present
Antiemetics (e.g., Metoclopramide (Plasil)) if nausea/vomiting present

Hypovolemia Nursing Management

Monitor intake and output (I&O) and daily weights
Monitor vital signs: Watch for hypotension and tachycardia
Monitor skin and tongue turgor

Hypervolemia

Isotonic expansion of ECF due to abnormal water and sodium retention
Often referred to as "fluid overload"

Hypervolemia Causes

Heart failure
Kidney injury
Liver cirrhosis
Excessive salt intake
Excessive sodium-containing fluid administration in patients with impaired regulatory mechanisms

Hypervolemia Clinical Manifestations

Edema
Distended neck veins
Puffy eyelids
Crackles (in lungs)
Weight gain
Hypertension
Bounding pulse
Tachypnea (rapid breathing), dyspnea (shortness of breath)
Increased urine output; dilute urine

Hypervolemia Medical Management

Low sodium diet
Diuretics:
- Thiazide diuretics: mild to moderate hypervolemia
- Loop diuretics: severe hypervolemia
Potassium supplementation to prevent hypokalemia while on diuretics
Dialysis for severe renal impairment

Hypervolemia Nursing Management

Monitor I&O
Weigh daily: Watch for rapid weight gain (1 kg = 1 L of fluid)
Monitor breath sounds, especially with IV therapy
Monitor for edema:
- Feet and ankles for ambulatory patients
- Sacral area for bedridden patients
Encourage bed rest
Regulate IV fluids as prescribed
Place patient in semi-Fowler's position if dyspnea present
Reposition patient regularly to prevent pressure ulcers
Emphasize need to read food labels
Instruct patient to avoid foods high in sodium
Encourage use of seasoning substitutes (e.g., lemon juice, onions, garlic)

Sodium

Most abundant electrolyte in ECF
Normal ECF concentration: 135-145 mEq/L

Sodium Functions

Controls body water distribution
Establishes electrochemical state necessary for:
- Muscle contraction -Nerve impulse transmission

Hyponatremia

Serum sodium level < 135 mEq/L

Hyponatremia Causes

Vomiting, diarrhea, gastric suctioning
Medications: Diuretics, lithium, cisplatin, heparin, NSAIDs
Decreased aldosterone (Addison's disease)
Water intoxication
Congestive heart failure (CHF)
Chronic renal failure

Hyponatremia Development

Excess water relative to sodium
Insufficient sodium relative to water

Hyponatremia Medical Management

Sodium replacement:
- Sodium-rich diet for those who can eat and drink
- NaCl tablets
- Plasma-Lyte R (PLR) or 0.9% Normal Saline Solution (NSS) IV infusion for those who cannot take sodium by mouth
Water restriction: Indicated for hyponatremic patients with normal or excess fluid volume
Hypertonic saline solution: Indicated for severe hyponatremia
AVP receptor antagonists (vaptans):
- Conivaptan HCl (Vaprisol) IV: Hospitalized patients with moderate to severe hyponatremia (Contraindicated in patients with seizure, delirium, coma)
- Tolvaptan (Samsca): Oral medication for clinically significant hypervolemic and euvolemic hyponatremia

Hyponatremia Nursing Management

Monitor I&O and daily weights
Monitor laboratory values
Monitor progression of manifestations
Encourage high sodium foods and fluids for those who can consume by mouth:
- Broth made with one beef cube (900 mg sodium)
- 8 oz of tomato juice (700 mg sodium)
Administer IV fluids as prescribed

Hyponatremia Nursing Management, Watch For

Signs of circulatory overload: Cough, dyspnea, puffy eyelids, dependent edema, excessive weight gain in 24 hours, crackles
Institute safety precautions: Keep side rails up, supervised ambulation

Hypernatremia

Serum sodium level > 145 mEq/L

Hypernatremia Causes "MODEL"

Medications (Medications), meals
Osmotic diuretics
Diabetes insipidus
Excessive water loss
Low water intake

Hypernatremia Clinical Manifestations

Extreme thirst (first sign)
Dry, sticky mucous membranes
Oliguria (decreased urine output)
Firm, rubbery skin turgor
Red, dry, swollen tongue
Restlessness, tachycardia, fatigue
Disorientation, hallucinations

Hypernatremia Medical Management

Safety alert! Gradual serum sodium correction
- Too rapid correction makes plasma temporarily hypo-osmotic to brain tissue
Treat underlying cause
Sodium correction:
- Hypotonic electrolyte solution (first line): IV of choice is 0.3% NaCl
- Isotonic non-saline solution (second line): D5W (indicated when water needs to be replaced without sodium)

Hypernatremia Nursing Management

Provide oral fluids at regular intervals
Restrict sodium in diet as prescribed
Monitor behavioral changes
Promote safety
Monitor I&O

Potassium

Most abundant electrolyte in the ICF
Normal serum concentration: 3.5 to 5 mEq/L
Inverse relationship with sodium; direct relationship with magnesium

Potassium Functions

Maintains ICF volume
Neuromuscular excitability
Regulates contraction and rhythm of heart

Hypokalemia

Serum potassium level < 3.5 mEq/L
Less common than hyperkalemia but more life-threatening because of increased risk of cardiac arrest

Hyperkalemia

Serum potassium level > 5 mEq/L

Hyperkalemia Causes "CARED"

Cellular movement of K+ from ICF to ECF
Addison's disease (hypoaldosteronism)
Renal failure
Excessive K+ intake
Drugs (Spironolactone, ACE inhibitors, NSAIDs)

Hyperkalemia Clinical Manifestations "MURDER"

Muscle weakness (late sign)
Unable to calm down (irritability, anxiety)
Respiratory failure (secondary to muscle weakness)
Decreased bowel sounds
ECG changes (Tall, peaked T waves, widened QRS complex, prolonged PR interval)
Elevated serum potassium levels
Arrhythmias (ventricular tachycardia, ventricular fibrillation)
Cardiac arrest

Hyperkalemia Nursing Management

Avoid: Fruits, vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, cocoa
Caution patients to use salt substitutes sparingly if taking other supplementary forms of potassium or potassium-sparing diuretics

Calcium

Primarily located in bones and teeth, the rest circulates in serum

Calcium Functions

Bone mineralization
Stabilizes resting membrane potential of neurons preventing spontaneous activation
Regulation of muscle contraction (actin and myosin filaments to slide)
Cardiac contractility and conduction

Calcium Types

Ionized calcium
Protein-bound calcium
Calcium complexed to anions

Calcium Normal Values

Ionized calcium: 4.5 to 5.1 mg/dL
Total calcium: 8.5 to 10.5 mg/dL

Hypocalcemia

Serum calcium level < 8.5 mg/dL

Hypocalcemia Causes

Primary hypoparathyroidism
Surgical hypoparathyroidism
Radical neck dissection
Massive administration of citrated blood
Pancreatitis
Kidney injury
Prolonged bed rest/bedridden patients

Hypocalcemia Extracellular Calcium

Increased cell membrane permeability to sodium
Increased neuromuscular irritability (everything is high and fast)

Hypocalcemia Clinical Manifestations

Tetany (general muscle hypertonia, tremor, spasmodic/uncoordinated contractions)

Latent Tetany

Numbness, tingling, cramps in extremities
Stiffness of hands and feet

Overt Tetany

Bronchospasm
Laryngospasm
(+) Trousseau's sign: Carpopedal spasm from arm blood flow occlusion for 3 minutes
(+) Chvostek's sign: Sharp tapping over facial nerve causes spasm/twitching of mouth, nose, eye
Seizures
Dysrhythmias (torsades de pointes)
Photophobia

Hypocalcemia Medical Management

Calcium replacement:
- Oral calcium supplements
- Calcium gluconate IV
- Calcium chloride IV
Vitamin D therapy:
- Cholecalciferol (vitamin D3)
- Ergocalciferol (vitamin D2)
Parathyroid hormone (PTH) replacement therapy:
- Indicated for chronic hypoparathyroidism

Hypocalcemia Nursing Management

Encourage early and frequent ambulation
Encourage oral fluids up to 3-4 L/day
Encourage high-fiber diet
Implement safety precautions
Assess for signs of digitalis toxicity (calcium enhances effects of digoxin)
Monitor heart rate and rhythms

Hypercalcemia

Serum calcium level > 10.5 mg/dL

Hypercalcemia Causes

Hyperparathyroidism
Malignancy
Immobilization
Thiazide diuretics
Vitamin D toxicity
Milk-alkali syndrome

Hypercalcemia Clinical Manifestations "MY BACKS"

Muscle weakness
Yawn (frequent)
Bone pain
Anorexia
Constipation
Kidney stones
Stones (gallstones)

Hypercalcemia Medical Management

Treat underlying cause
Hydration: Oral fluids, saline IV fluids
Bisphosphonates (e.g., Pamidronate disodium (Aredia), Zoledronic acid (Reclast))
Calcitonin: Inhibits bone resorption
Loop diuretics (e.g., Furosemide (Lasix))
Hemodialysis
Corticosteroids (e.g., Prednisone)
Gallium nitrate (Ganite)

Hypercalcemia Nursing Managemet

Encourage early and frequent ambulation
Encourage oral fluids up to 3-4 L/day
Encourage high-fiber diet
Implement safety precautions, as necessary
Assess for signs of digitalis toxicity, especially in patients taking digoxin
Monitor heart rate and rhythms

Magnesium

Intracellular cation
Direct relationship with potassium and calcium
Normal serum Mg++: 1.3-2.3 mg/dL

Magnesium Functions

Activator of intracellular enzyme systems
Plays a role in carbohydrate and protein metabolism
Affects neuromuscular irritability and contractility
Has a sedative effect (inhibits release of acetylcholine)
Vasodilator and decreases peripheral resistance

Hypomagnesemia

Serum Mg++ level < 1.3 mg/dL
Frequently associated with hypokalemia and hypocalcemia
Hypoalbuminemia can lead to hypomagnesemia

Hypomagnesemia Causes "FAT GUM"

Fistulas
Alcohol withdrawal
Tube feedings/Total parenteral nutrition (TPN) (magnesium deficiency)
Gastric suctioning (prolonged)
Uncontrolled bowel movements (diarrhea)
Malabsorption disorders (small intestine)

Hypomagnesemia Clinical Manifestations

Cramps, spasticity
(+) Trousseau's and Chvostek's sign
Insomnia
Mood changes
Anorexia, vomiting
Increased tendon reflexes
Hypertension
Similar to hypocalcemia

Hypomagnesemia ECG Changes

Depressed ST segment
Prolonged QRS complex
Dysrhythmias:
- Premature ventricular contractions (PVCs)
- Supraventricular tachycardia (SVT)
- Torsades de pointes
- Ventricular fibrillation

Hypomagnesemia Medical Management

High-magnesium diet for mild deficiencies:
- Green leafy vegetables
- Nuts
- Seeds
- Legumes
- Whole grains
- Seafoods
- Peanut butter
- Cocoa
Magnesium supplements
Magnesium sulfate IV: For patients with overt manifestations of hypomagnesemia, administered using an infusion pump at a controlled rate

Hypomagnesemia Nursing Responsibilities (Magnesium sulfate IV)

Monitor vital signs
Monitor urine output (report if < 30 mL/hour)

Hypermagnesemia

Serum Mg++ level > 2.3 mg/dL
Rare electrolyte abnormality

Hypermagnesemia Causes

Kidney injury
Excessive intake of magnesium-containing antacids
Diabetic ketoacidosis (DKA)

Hypermagnesemia Falsely Elevated Serum Mg++ May Result From:

Hemolyzed blood specimen
Blood drawn from an extremity with a tourniquet applied too tightly

Serum Magnesium (Hypermagnesemia)

Decreased acetylcholine release
Decreased neuromuscular irritability (everything is low and slow)

Hypermagnesemia Clinical Manifestations

Flushing
Hypotension
Muscle weakness
Drowsiness
Hypoactive reflexes
Respiratory depression
Cardiac arrest (in severe cases)
Coma
Diaphoresis

Hypermagnesemia Medical Management

Avoid giving magnesium to patients with kidney injury
Discontinue all sources of magnesium if severe hypermagnesemia present
Calcium gluconate IV (calcium antagonizes magnesium)
Ventilatory support if respiratory depression present
Hemodialysis: if adequate renal function
- Furosemide (Lasix)
- PLR or NSS

Hypermagnesemia Nursing Management

Monitor vital signs, noting hypotension and shallow respirations
Assess deep tendon reflexes
Assess level of consciousness
Caution on use of over-the-counter (OTC) medications

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the causes, clinical manifestations, and medical management of hypovolemia. Understanding hypovolemia is crucial for recognizing fluid loss and implementing appropriate treatments. Prepare to test your knowledge on this critical health issue.