Hypovolemia Fluid Volume Deficit | Dehydration Nursing NCLEX Treatment, Pathophysiology

hey everyone it's nurse Sarah with registered nurse rn.com and in this video I'm going to be going over fluid volume deficit so let's get started fluid volume deficit occurs in the body because there's not enough fluid in it to support its needs and functions now you may also hear fluid volume deficit referred to as hypovolemia or dehydration and dehydration can occur for many different reasons with one reason being that there's a loss of water or electrolytes in the body and we're specifically talking about the electrolyte sodium another reason it can happen is because the patient just isn't consuming enough water or electrolytes or the patient has had something happen in their body where water has shifted around within those fluid compartments for instance water has moved from the intravascular compartment to the interstitial compartment which is referred to as third spacing so fluid volume deficit results in a deficit of fluid within our fluid compartments and some fluid compartments can be more affected than others and this really depends on the type of dehydration that we're talking about so let's quickly review those fluid compartments so we have two fluid compartments we have intracellular and extracellular intracellular is the inside of the cell extracellular is the outside of the cell and it can be subdivided into three other compartments we have the interstitial compartment which is the fluid that surrounds the cell found in between the cell then we have the intravascular compartment and this is the fluid inside of our vessels we also refer to this as the plasma and then we have the trans cellular compartment and this is the smallest compartment of them all and this is the fluid that is found within certain organs and Joints like your heart and your lungs Etc and fluid Within These compartments can actually be shifted around through a process known as osmosis and this process is highly affected by the osmolarity of specifically that extracellular fluid so let's quickly review the different types of movements we can have based on osmolarity so if we have a hypertonic environment in that extracellular fluid so we have a high amount of solute concentration what that's going to do is it's going to pull fluid from the inside of that cell to the outside of the cell where the cell is going to shrink and become really dehydrated then we can have a hypo hypotonic environment where that extracellular fluid is really diluted so it has a low osmolarity a low amount of solutes in it and what's going to happen is that water is going to move from that extracellular compartment to the intracellular compartment inside that cell and cause that cell to get really big and swell and eventually it could rupture then we can have an isotonic environment and this is where there's an equal amount of solutes on the inside of the cell on the outside of the cell so we have equal osmolarity so there's no drastic shifting of water from intracellular to extracellular or extracellular to intracellular it really just stays the same so with all those Concepts in your mind let's now take a closer look at the causes of fluid volume deficit and the different types of dehydration so the first type of dehydration is known as hypertonic and this is where there's mainly a loss of water rather than electrolytes hence our solutes which we're mainly talking about sodium this is also sometimes referred to as hypernatremia which means we have a high amount of sodium in the blood so when we're talking about hypertonic dehydration we're talking about things causing the extracellular compartment hence really our intravascular system to become extremely concentrated with solutes specifically sodium and we're going to have less fluid in there and that's what really hypertonic means it means that our extracellular fluid has a high osmolarity and again is really highly concentrated of these solutes so the result of this in these conditions is that water is going to move from the intracellular compartment to the extracellular compartment and our cell is going to shrink and become dehydrated so when we're thinking of causes of this type of dehydration let's think of causes that makes our blood more concentrated which would be like losing a lot of water and this is happening in cases of severe diarrhea or vomiting or with diabetes insipidus and this is where the patient is passing a high volume of urine due to a low ADH level which is anti-diuretic hormone and when the patient has this it's literally just ready their body of all of this fluid through the urine so we're not going to have a lot left in our blood hence we'll have a lot more solute or sodium and then another causes of the patient is just not taking in enough water and this can happen for many reasons maybe they don't have access to water or they're experiencing impaired thirst where they're not able to really recognize that they need to take in water so they easily become dehydrated and treatment for this type of dehydration is usually to rehydrate that cell and we can do that by administering hypotonic fluids because hypotonic fluids change the tonicity or the osmolarity of our extracellular fluid by adding more free water to it which is hence going to in a sense water down that high solute concentration and it's going to allow osmosis to pull water into that dehydrated cell and rehydrate it then we have hypotonic dehydration and this occurs when there's mainly a loss of electrolytes hence our sodium rather than water so it's the opposite of hyper tonic dehydration and this is sometimes referred to as hyponatremia so a low sodium level in the blood and hypotonic means that that extracellular fluid has a low osmolarity so there's this low concentration of solutes particularly again sodium in that fluid and because of these conditions in this fluid it's going to result in water moving from that extracellular compartment to the intracellular compartment and the cell is going to swell and possibly rupture and the problem with this type of dehydration is that it can quickly deplete the intravascular compartment our plasma which can result in a low cardiac output and when you're trying to think of the causes of this type of dehydration think of causes that lead the body to lose electrolytes or conditions that dilute solutes and some things that can do this is administering too much of certain diuretics specifically like thiazides because thiazides waste too much sodium or too much free water replacement because this lowers the amount of solutes like you know with hypotonic Solutions so we have a loss of solute concentration and starvation or malnourishment can do this because the person is not consuming enough electrolytes and treatment for this type of dehydration could include administering hypertonic Solutions because these Solutions will go in there and help remove the fluid from those swollen cells because what it will do is it'll change the osmolarity of the extracellular fluid which is going to through osmosis draw water out of that swollen cell and put it back into the extracellular compartment and then lastly we have isotonic dehydration and this is where we've had an equal loss of water and electrolytes and remember ISO means equal and with this there's no drastic shifting of water between those fluid compartments and this is actually the most common type of dehydration we see and the big problems that arise from this type of dehydration is that intravascular loss can happen and we're going to lose the ability to pump fluid throughout the body and this could quickly lead to hypovolemic shock causes for this type of dehydration include overusage of diuretics third spacing of fluids where water shifts from the intravascular space to the interstitial space the patient has experienced some type of trauma like they're bleeding out losing all that fresh nice blood in the body or they're experiencing vomiting diarrhea or excessive sweating now let's talk about the signs and symptoms you're going to see in a patient who has fluid volume deficit so we know the patient is going to be dehydrated so D is for dry mucous membranes when you look at their mucous membranes they're going to be sticky and very dry and uncomfortable to the patient if they can communicate that to you e is for early sign with this an early sign of dehydration is that they have an increased heart rate and when you go to fill that pulse it can feel very weak H is for hypotension so a low blood pressure and the reason they're having this is because they don't have a lot of fluid blood volume to pump throughout that system so when we go to measure that blood pressure it's going to be low and this can present as orthostatic hypotension and this is a form of hypotension that occurs when the patient goes from a supine or sitting position to a standing position and this can happen up to three to five minutes after that person changes the position so to have this the patient's systolic blood pressure that top number is going to decrease at least 20 millimeters of mercury or their diastolic blood pressure number that bottom number is going to decrease at least 10 millimeters of mercury and these decreases are from their Baseline blood pressure so as a nurse you want to make sure that you get a Baseline and you measure these blood pressures at these different positions Y is for young babies whenever they're dehydrated how you can tell especially in severe cases is that they're going to have sunken font nails and these are like those soft spots on the young infant's head that they had because it helps facilitate vaginal birth delivery because those skull plates haven't fully fused together so normally they should not be sunken in and if they are sunken in this is an extremely bad sign then D is for decreased skin turgor and what skin tiger is is it's talking about skin elasticity so whenever we go to check their skin tiger instead of just bouncing back real quickly it can tint it can be very sluggish it'll be decreased that's how we would refer to it now there's a certain patient population you can't really use this as a great indicator of dehydration and that's the older adults of geriatric population because as we get older so does our skin elasticity it's naturally going to decrease in itself so we want to check other signs and symptoms in those patients and then we have R for refill to the capillaries is going to be sluggish fish so in severe cases of dehydration when we go to check that capillary refill it's going to be sluggish it can be greater than three seconds also attitude changes can occur where the patient becomes extremely Restless lethargic confused and it could progress to seizures so if you start to see mental status changes in a patient with dehydration this indicates you're dealing with a very severe case of dehydration because now it's affecting our neurostatus which we really don't want it to get to that point and then another sign is thirst so the patient could just be extremely thirsty that's trying to replace those fluids that they have lost or those electrolytes now not all patients are going to have this for example geriatric patients as we get older so does our thirst response so we're not as responsive to that sensation of thirst also young patients may not even be able to communicate thirst to you so you definitely don't want to use that as a specific sign for that those patients experience weight loss is another sign and symptom and actually measuring a patient's weight is a good way to tell us about their fluid status so we definitely want to make sure we're weighing our patients so you want to remember that one kilogram about 2.2 pounds is equal to about one liter of fluid give or take so as you're weighing your patient look at the trending of those weights if they're experiencing dehydration are they losing weight have they lost one kilogram that could mean that they've lost one liter of fluid and then we have lastly D for Diagnostics so let's go over the diagnostic results that you would be seeing in a patient with dehydration and the lab results you're going to see really depend on the type of dehydration that the patient has so you want to keep that in mind whenever we're going over these lab results but in a nutshell with fluid volume deficit what's happening is that we have a low amount of fluid so when we remove that fluid out of the body what we have left are those solutes so the the concentration of them are going to be really high in our blood and in our urine so it's going to be increase all around which is the opposite of what we've seen in fluid volume overload everything was diluted so everything was decreased because we had so much water watering down those solutes therefore you're going to see an increased serum osmolality which is measuring osmolality in the blood you're going to see an increase hemoglobin hematocrit increased bun increase sodium level and again if we're dealing with hypotonic dehydration that wouldn't be the case because remember we're actually going to be lowering our sodium level in that type so just keep that in mind and an increase specific urine gravity and osmolality but again this is not going to be the case with let's say patients who have diabetes insipidus because that urine is going to be extremely diluted because they are passing High volumes of it from that low level of ADH now let's talk about nursing interventions for fluid volume deficit so the goal is that we want to replace that water and electrolytes that have been lost and treatment is going to revolve around finding the cause and treating the cause so let's say the patient is bleeding out somewhere well we want to find why they're bleeding stop that bleeding and transfuse them some blood or let's say the patient has just been taking too many diuretics they have urinated all their fluid out what we want to do is stop those diuretics and Infuse some more fluid with electrolytes added to it to help correct that imbalance so as a nurse what we can do to help with this whole treatment of correcting fluid volume deficit is that we can provide daily weights so we want to weigh the patient at the same time every day with the same scale and we're looking at those weights are they trending up are they trending down now a fluid volume deficit we want to make sure that our patient isn't losing weight because that's one of those signs and symptoms so we're going to be looking at that weight making sure it's going up we also want to make sure that we are strictly measuring their intake an output so everything that they're taking in this includes IV fluids IV flushes anything that they take in orally or their tube feedings irrigations and so forth and we want to make sure we know exactly what they are putting out of course this is urine but it also includes vomit any types of watery diarrhea or suction we want all that in our calculation and we particularly want to pay attention to that urinary output because this tells us how well our kidneys are working and if we are improving their hydration status so we want to calculate that out over that 24 hour period so you want to make sure that your patient's putting out at least 30 MLS per hour or 0.5 ml per kilogram per hour which is based on their weight in addition we want to make sure that we are encouraging treatments that help hydrate the body so for instance oral hydration that's one of the easiest ways to help rehydrate your patient now not all patients can do this and in some cases they're so severe really dehydrated that they're going to need that extra help with those IV fluids but we want to make sure that our patient has access to these fluids and that they're consuming healthy fluids promote healthy hydration avoiding like teas and coffees and we're going to play a role with administering IV fluids per the doctor's orders so typically isotonic fluids are used but in different types of dehydration for example hypotonic dehydration we may want to administer hypertonic fluids and then in a hypertonic dehydration hypotonic fluids may be used so it really depends on the type of dehydration your patient has on what fluids we're going to use and then also we want to make sure that we're looking at those electrolyte reports and checking the sodium the potassiums and all those levels to make sure that they're within normal range okay so that wraps up this review over fluid volume deficit now I also have a review on fluid volume overload if you want to check that out as well you can access that in the YouTube description below and thank you so much for watching

Channel: RegisteredNurseRN

Views: 57,620

Keywords: hypovolemia, fluid volume deficit, hypovolemia nursing, hypovolemia pathophysiology, hypovolemia symptoms, hypovolemia causes, hypovolemia treatment, dehydration symptoms, dehydration causes, dehydration treatment, dehydration nursing, hypovolemia nclex, nclex review, next generation nclex, hypovolemia ngn, fluid and electrolytes, fluid solutions, iv fluids, hypovolemia vs hypervolemia, fluid volume deficit nursing interventions, fluid volume deficit treatment

Id: -15e2Br8W4Y

Length: 16min 10sec (970 seconds)

Published: Mon May 22 2023