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Manifestations of Altered F&E balance Part 2 Cheat Sheet by

NURS601 Week 1 Concept 2: Fluid shift - Dehydration/Hypovolemic shock

What is Dehydr­ation?

The other end of the spectrum from oedema
Occurs when water loss exceeds water intake over a period of time and the body is in a negative balance
Caused by decrease of ECF volume - loss of Na+ containing fluid from the body
Causes include: vomiting, diarrhea, haemor­rhage, burns, profuse sweating, water depriv­ation, and diuretic abuse

Hemorr­hagic shock classi­fic­ation

 
Class I
Class II
Class III
Class IV
% Blood loss
Up to 15%
15-30%
30-40%
>40%
HR
Normal
Mild tachyc­ardia
Moderate tachyc­ardia
Severe tachyc­ardia
BP
Normal
Normal to decreased
Decreased
Decreased
RR
Normal
Mild tachypnea
Moderate tachypnea
Severe tachypnea
Urine output
Normal
0.5-1m­L/kg/h (min. goal)
0.25-0.4m­L/kg/h (markedly decreased
Negligible
Mental status
Slightly anxious
Mildly anxious
Anxiou­s/c­onfused
Confus­ed/­let­hargic
Fluid replac­ement
Crysta­lloid
Crysta­lloid
Crysta­lloid & blood
Crysta­lloid & blood

Fluid balance

Obligatory fluid loss
Urine (oblig­atory), Feces, Cutaneous transp­ira­tion, Sweat, Expired air
Totals to 1500mL
Required for normal function and health
Facili­tative fluid loss
Urine (facil­ita­tive)
Totals 1000mL
The ability to adapt to various situat­ion­s/c­ond­itions
A patient should be urinating every 6 hours
Absolute minimum urine output is 30cc/hour
Fluid intake
Performed water (food & drink)
Totals 2300mL

Pathop­hys­iol­ogical rationale for shock

Vital signs
Pathop­hys­iol­ogical rationale
Increased HR
SNS increases HR to maintain CO despite decrease in SV to support perfusion of O2 to major organs and tissues
Decreased BP
Decrease in circul­ating volume leads to decreased venous return to the heart, decreased preload, decreased SV and decreased CO and compen­sation for vasoco­nst­riction no longer effective
Skin is pale, cool and clammy
Body is attempting to maintain critical systems, so tissue perfusion to the skin is reduced
 

Hypovo­lemic shock

Occurs when there is inadequate intrav­ascular fluid volume which leads to inadequate tissue perfusion
Manife­sta­tions:
Decreased blood pressure
 
Increased heart rate, respir­atory rate
 
Pollor, cool, and clammy skin
 
Decreased urine output
 
Anxiety, confusion, Agitation
Average adult blood volume for a female is 4-5L of blood and 5-6L for a male
Approx­imately 8% of your body weight is blood
Average blood volume in a 70kg person is 5.5L, so mild loss = 825mL, Class II loss is 825mL-­1.65L, and class III is 1.65-2.2L

IV fluids

Crysta­lloids
Equal to body fluid
Keeps fluid in the intrav­ascular volume without causing a fluid shift from one compar­tment to the other
Usually used for replac­ement or mainte­nance fluids:
Plasma­-lyte
 
Normal saline
 
D5W
 
Lactated ringers
An isotonic solution, in a nutshell, is a balanced water-­solute concen­tration
When a solution is isotonic, it is at equili­brium
Plasma expanders (Collo­ids):
Albumin
 
Gelofusine
Colloids are gelatinous solutions that maintain a high osmotic pressure in blood
Particles in the colloids are too large to pass semi-p­erm­eable membranes such as capillary membranes, so colloids stay in the intrav­ascular spaces longer than crysta­lloids
 

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  • Published: 7th March, 2022
  • Last Updated: 16th March, 2022

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