Welcome to Episode 90
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Tip of the Week–Hypovolemia/ Fluid Volume Deficit
Hypovolemia is defined as a state of decreased blood volume, more specifically plasma. It differs from dehydration, which is defined as excessive loss of body water. Hypovolemia or Fluid Volume Deficit (FVD) defines water deficiency only in terms of volume rather than specifically water.
Common causes of hypovolemia include bleeding, GI problems such as vomiting and diarrhea, burns, excessive urinary output or inadequate fluid intake, and medications like diuretics.
Symptoms that may be present in mild fluid depletion (less than 5% of ECF) include diminished skin turgor which is best assessed at the upper torso, dry mucous membranes, and oliguria.
Special considerations should be given in elderly patients since skin turgor may be low regardless of volume status. Mucous membrane assessment is also suspect because they may also be dry from mouth-breathing.
If 5-10% of ECF is depleted, orthostatic tachycardia, hypotension, or both are usually, but not always, present.
When fluid loss exceeds 10% of ECF volume, signs of shock can occur (eg, tachypnea, tachycardia, hypotension, confusion, poor capillary refill).
Other symptoms include concentrated urine, thirst, nausea, anorexia, and poor capillary refill.
Treatment modalities depend on the severity of fluid volume deficit. In minor hypovolemia, increase in oral intake of sodium and water can be done for conscious patients to replace depleted sodium ions. For more severe cases of hypovolemia, patient treatment includes IV 0.9% saline is given or fresh plasma replacement.
Nursing interventions aimed at improving fluid volume status include encouraging fluid intake and providing necessary patient teaching. Evaluation of outcomes include periodic assessment of skin turgor and mucous membranes, monitoring I&O, and obtaining daily weights.
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