Hypovolemia/Hypervolemia - Patel

Clinical symptoms may not be present until ______ of total whole blood volume is lost

10-20%

What is the blood volume loss in stage 1 shock?

15%

What is the blood volume loss in stage 2 shock?

15-30%

What is the blood volume loss in stage 3 hypovolemic?

30-40%

What is the normal CVP measurement?

8-12

What is the CVP measurement in hypovolemia?

<8

Which of the following stages has signs of: BP maintained, normal respiratory rate, normal cap refill, pallor, compensation by constriction of vascular bed a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4

A

What happens to JVD in hypovolemia?

Absence

When writing orders for fluid, what should you remember?

Always write a time ending or fluid amount

Which of the following stages has signs of: BP cannot be maintained by arterial constriction, tachycardia, SBP maintained, increased DBP, narrow pulse pressure, mildly anxious a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4

B

Which of the following stages has signs of: BP falls to 100mmHg or less, tachycardia >120 bpm, marked tachypnea >30, mental status changes, sweating with cool, pale skin a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4

C

Which of the following would you not see in hypervolemia? a) Low BUN b) Low serum osmolarity c) High urine sodium excretion d) Decreased oxygen level e) Signs of pulmonary congestation on chest radiographs

C Low urine sodium excretion of less than 10meq per day

What are some causes of hypervolemia?

CHF Liver cirrhosis Low protein Nephrotic syndrome Glomerulonephritis Excess intake of sodium and fluids Fluid shift into the intravascular space

Which of the following stages has signs of: Extreme tachycardia >140, significant tachycardia, SBP of 70 or less, skin is sweaty and cool, absent cap refill, negligible urine output a) Stage 1 b) Stage 2 c) Stage 3 d) Stage 4

D

What is hypovolemia specifically?

Decrease in volume of blood

What happens to the JV from elevated blood volume and preload?

Distention

What happens to mucosa in hypovolemia?

Dry oral mucosa

What is the blood volume loss in stage 4 hypovolemic?

Greater than 40%

What is the treatment of hypovolemia?

Oxygen should be immediately employed Use of IV fluids Allow permissive hypotension in patients suffering from hypovolemic shock, both to ensure clotting factors are not overly diluted but also to stop BP being artificially raised to a point where it 'blows off' clots that have formed

How do you treat hypervolemia?

Restriction Monitor input and electrolytes Diuretics

What happens in cardio from hypervolemia?

S3 gallop

Hypervolemia symptoms and signs

SOB Increased pulses with bounding character (2/2 elevation) Labored breathing and difficulty breathing Moist skin as compensation for increase fluid excretion HTN

How is hypervolemia primarily diagnosed?

Signs and symptoms

What happens to HR and BP in hypovolemia?

Tachycardia, diminished BP

What are the skin findings for hypovolemia?

Tenting Orange peel skin

What's the most important treatment for hypervolemia?

Treat underlying cause

Whats the difference between dialysis and ultrafiltration?

Ultrafiltration - removes water Dialysis - removes water and toxin

What is the best sign of ECF volume excess?

Weight gain

What are the lungs like in hypovolemia?

lack of crackles