Medical Surgical Nursing

Topic: Fluids & Electrolytes

How important is water? Normal Water Balance

• Between 50% to 60% of the human body by
weight is water Intake Output
• Water provides a medium for transporting Liquid 1,200- Urine 1,200-
nutrients to cells and wastes from cells and 1500 ml 1,500 ml
for transporting substances such as Water in 700- Feces 100-250
hormones, enzymes, blood platelets, and red food 1,000 ml ml
and white blood cells Metabolism 200-400 Insensible
• Water facilitates cellular metabolism and ml Loses:
proper cellular chemical functioning Skin 350-400
• Water acts as a solvent for electrolytes and ml
non-electrolytes Lungs 350-400
• Helps maintain normal body temperature ml
• Facilitates digestion and promotes Total 2,100- Total 2,100-
elimination 2,900 ml 2,900 ml
• Acts as a tissue lubricant
Distribution of Body Fluids
Factors affecting the volume of body temperature
• Age
• Body weight
• Sex

Variations in Fluid Content

• Body Fat
- Fat cells contain little water and lean
tissue is rich in water, the more obese the
person, the smaller the percentage of
total body water compared with body
weight
• Intracellular Fluid
- This is also true between sexes because
- Located within the cells
females tend to have proportionally more
- Provides the cell with an internal aqueous
body fat than males
medium necessary-chemical function
- There is also an increase in fat cells in
- 2/3 – 3/4 compromising 70% TBW
older people
• Extracellular Fluid
• Age
- Body fluids outside the cells
- Infants – 77%
- Serves as body transportation system
- Adult Male – 60%
carrying H20, electrolytes, nutrients & 02
- Adult Female - 50%
– cell & removing waste product – cell
- Elderly - 45%
metabolism
- 30% - TBW
The function of body fluids
• Provide an aqueous medium for cellular
Compartment of Extracellular Fluid
metabolism
• Interstitial Compartment
• Maintains physical & chemistry constancy of
- 24-25% of TBW – ECF
intracellular or extracellular fluids
- Located in the space between the
• Transport material to & from the cell
• Aids in the regulation of body temperature vascular space & the cells that provide
cell with external aqueous medium
• Provides medium for excretion of waste from
necessary – cellular metabolism
the body
• Provide lubrication of muscle joints
Medical Surgical Nursing
Topic: Fluids & Electrolytes

• Intravascular Compartment • Osmosis

- 4-5% of TBW in ECF - Movement of fluids into an area which is
- Blood Plasma, colloids along with RBC – lower concentration to higher
maintain vascular volume concentration
• Small Fluid Compartment • Filtration
• Gastrointestinal Tract - Movements that separate fluids from
suspended particles
Continual movements of fluids and electrolytes
• Fluids move between components to Solutions develop after movement
maintain homeostasis • Hypertonic Solution
• Fluid movement from pressure changes body - Higher concentration of solutes in the
fluid shifts between the interstitial space in solution
the capillary as a result of differences in the • Hypotonic Solution
hydrostatic pressure and osmotic pressure. - Lesser concentration of solutes in the
• Hydrostatic Pressure is water being pushed solution
out by some force. If there is a lot of water in
the blood vessel, it will get pushed out, Composition of Body Fluids
causing edema in the tissues • Intracellular Fluid (ICF)
• Osmotic Pressure is water moving from its contains:
area of high concentration to its area of low H2O
concentration. If there are too many particles Electrolytes
in the plasma, water will be sucked into the Proteins
blood vessel, causing the blood pressure to Nucleic Acids
elevate Lipids
Polysaccharides
Movement of Body Fluids • Extracellular Fluid (ECF)
• First Phase contains:
- Blood plasma moves around the body Water
within the circulatory system & oxygen, Electrolytes
nutrients & fluids are picked up from the Proteins
lungs & the GIT RBC
• Second Phase WBC
- Interstitial fluid & its component move Platelets
between the blood capillaries & the cells
• Third Phase Electrolytes composition of body fluids contain
- Fluids & its components move back from • Sodium (135-145 mEq/L)
the cells to the interstitial space & then to • Potassium (3.5-5 mEq/L)
the intravascular compartment. The • Chloride (95-105 mEq/L)
intravascular fluid then flows to the • Calcium (8.5-10.5 mEq/L)
kidney’s where the metabolic by products • Magnesium (1.5-2.5 mEq/L)
of the cells are excreted in the form of • Phosphorus (2.5-4.5 mEq/L)
urine • Bicarbonate

Methods of Movement of Fluids & Electrolytes Organs involve in keeping the composition &
• Diffusion volume of body fluids within normal
- Movements of particles into an area • Kidney
which is high in concentration to a low • Heart
concentration • Blood Vessel
• Lungs
• Gastrointestinal Tract
Medical Surgical Nursing
Topic: Fluids & Electrolytes
• Hypothalamus
• Pituitary Gland
• Adrenal Gland’
• Parathyroid Gland
The Kidney
• Kidney is vital to the regulation of fluid &
electrolyte balance. It normally filters 170-
180L of plasma per day in the adult.
• Major functions of the kidney:
- Excretion of metabolic wastes & toxic
substances.
- Regulation of pH of ECF by retention of
hydrogen ions
- Regulation of ECF & osmolality by
selective retention & excretion of body
fluids.
- Regulations of electrolytes levels in the
extracellular fluid by retention of needed
substance & excretion of unneeded
substance.
The Heart
• Pumping action of the heart circulates blood
through the kidneys under sufficient pressure
for urine to form.
Blood Vessels
• Capillary pressure causing vasodilation &
vasoconstriction that influence balance of
fluids & electrolytes.
The Lungs
• Hypoventilation & hyperventilation influences
loss of carbon dioxide & H2O which effects
fluids & electrolytes.
Gastrointestinal Tracts
• Stomach & intestines help balance the body
fluids & electrolytes by absorbing those that
are needed & eliminating those that are
needed.
Hypothalamus
• Primary regulator of water intake.
• It manufactures hormones which is
responsible in the retention of H2O in the body
& excretion.
Pituitary Gland
• Stores ADH which is water conserving
hormones that causes retention of H2O in the
body
Adrenal Glands
• Adrenal Cortex secreted a hormone known
as Aldosterone, a mineralocorticoid which
has a profound effect on fluid balance
Parathyroid Glands
• Embedded in the corners of the thyroid gland,
regulate calcium & phosphate balance by
means of Parathyroid Hormones
Hormones that maintain fluids & electrolyte
balance
• Antidiuretic hormone (ADH)
- Also known as vasopressin, hormone
release from the posterior lobe of the
pituitary gland.
- Contains water re absorption by the
kidney & regulates body fluid osmolality
• Aldosterone
- A hormone secreted by zona glomerulosa
of the adrenal cortex.
- It increases renal reabsorption of sodium
& water, thus regulating ECF
- Factors stimulating release of
aldosterone:
✓ Decreasing circulating blood
volume
✓ Hyperkalemia
✓ High ACTH
✓ Stress
• Parathyroid hormone
- Hormone secreted by the parathyroid
glands that maintain serum calcium level.
- Functions:
✓ Increasing the release of calcium
from bones
✓ Stimulating vitamin D production
to increase calcium reabsorption
from the GIT
✓ Stimulating calcium reabsorption
from urine
Medical Surgical Nursing
Topic: Fluids & Electrolytes

• Thyroid hormone
- Thyrocalcitonin - help maintain calcium
balance.
- T3 & T4
T3 - Triiodothyronine
T4 - Thyroxine Maintain sufficient cardiac
output to adequately perfuse the kidney
nephron – promote glomerular filtration,
maintain urine output

Factors Stimulating ADH Secretion

• Emotional & Physiologic stress
• Presence of pain
• Reduced circulating blood volume Four Routes of Fluid Output
• Administration of morphine sulfate, • Kidney
barbiturate & anesthetic agent - Major avenue of fluid output in the form
• Hyperosmolality - decrease in water relative of urine
to solute concentration or increase in solute • Skin
relative to water - In the form of perspiration
- Stratum corneum - outer layer of the
epidermis that control fluid loss in the skin
• Lungs
- As water vapor in the expired air
• GIT
- Fluid loss through the intestine in the form
of Chyme that passes from the small
intestine into the large intestine contains
H2O & electrolytes

Factors affecting fluids & electrolytes loss

• Climate
• Diet
• Stress
• Illness
• Trauma
• Medical treatment
• Medication
• Surgical procedures

Abnormal sources of fluid intake

• Intravenous Solution
• Total Parenteral Nutrition
• Blood Volume Replacements
• Colloids
Medical Surgical Nursing
Topic: Fluids & Electrolytes

Colloids Laboratory test – Fluid Status

• Fluids that contains solutes of a higher • Osmolality
molecular weight. - Laboratory value defining solute
• Examples: concentration per liter of solvent.
Albumin - maintain colloid osmotic pressure - It measures the solute concentration per
inside the ECF & cell wall integrity kg in blood & urine
Plasmanate - plasmanate contain Albumin, - Milliosmoles per kg of H20 (mOsm/kg)
globulins, & fibrinogen - Serum Osmolality: 280-300 (mOsm/kg)
Dextran - highly concentrated glucose - Urine Osmolality: 50-1400 (mOsm/kg)
solution which may interfere with blood - Factors increase osmolality:
coagulation like Hetastarch. ✓ Urine
Hetastarch Fluid Volume Deficit
✓ Serum
Blood Volume Replacement Diabetes Insipidus
• Whole blood Hyperglycemia
• Plasma Sodium Overload
• Platelets Uremia
• PRBC • Osmolarity
- Measurement of the number of solute
Intravenous Solution particles per liter of solution.
• Fluids containing fluids & electrolytes which is - Most commonly used to express the
used to replace volume & correct osmotic pressure of body fluids
abnormalities. - Measures in milliosmoles per liter
• Types of IV solution: (mOsm/L)
Isotonic solution – has the same osmolar - 270 – 300 mOsm/L
concentration or tonicity as plasma. • Urine Specific Gravity
Hypotonic solution - contain lower osmolar - Measures the kidneys ability to excrete &
concentration than serum conserve H2O
Hypertonic solution - higher concentration of - Normal Range: 1.001- 1.040
particles in solution compared with the - Random: 1.010 – 1.020
plasma - Physiologic Range: 1.025 – 1.035
✓ Example: • BUN
Protein solution - Made up of UREA which is an end product
Hyperalimentation solution of 10%, of protein metabolism
50%, 70% Dextrose - Normal Range: 10-20 mg/dl (3.5 mmol/L)
- Factors that increase BUN:
✓ GI Bleeding
✓ Dehydration
✓ Increase protein intake
✓ Fever
✓ Sepsis
- Factors the decrease BUN:
✓ End Stage Liver Disease
✓ Low protein Diet
✓ Starvation
✓ Condition that result in expanded
fluid volume
Medical Surgical Nursing
Topic: Fluids & Electrolytes

• Creatinine Four categories of fluid imbalances

- End product of muscle metabolism. • Isotonic loss of water & electrolytes
- Normal Range: 0.6 – 1.5 mg/dl 53 – 133 • An osmolar loss of only water
mmol/L • An isotonic gain of water and electrolytes
• Hematocrit • Osmolar gain of only water
- Measures the volume percentage of RBC
in whole blood Disturbances in fluid & electrolytes balance
- Normal Range: Female: 35 – 47 % Male: 42 • Fluid Volume Deficit
– 52% • Dehydration (Hyperosmolar imbalance)
- Condition that increase hematocrit: • Fluid Volume Excess
✓ Dehydration • Overhydration (Hypo-osmolar imbalance)
✓ Polycythemia – abnormal increase in
the erythrocytes in the circulating Hypovolemia
blood. • Fluid Volume Deficit
- Condition that decrease hematocrit • Result when fluid loss exceeds fluid intake.
✓ Overhydration • Water and electrolytes are lost in the same
✓ Anemia proportions
• Urine Sodium Values
- Normal Range: 50-130 mEq/L 50-130
mmol/L

Clients at risk for fluid & electrolytes

• Clients dependent on others to meet their
food & fluid needs.
• Clients who have gained or lost more than 5
lbs. in a week
• Clients who are permitted nothing per Orem
• Clients with retention catheters & urinary
drainage system
• Clients with intravenous infusion Causes and Risk of Hypovolemia
• Clients with special drainages or suctions Causes:
• Clients receiving diuretics • Vomiting
• Clients experiencing excessive fluid losses & • Diarrhea
requiring increased intake • Gastrointestinal Suctioning
• Clients who retain fluids • Sweating
• Clients with fluid restrictions • Decrease Intake
• Post-operative clients • Presence of Nausea
• Clients with severe trauma or burns • Drainage of secretions from fistula
• Clients with chronic diseases • Inability to swallow
• Confused clients or those who/ with altered • Unavailability of fluids
level consciousness who may not be able to • Confusion
communicate needs or respond to thirst • Depression
Risk:
Types of Fluid Imbalance • Diabetes Insipidus
• Isotonic Imbalance - happen when water & • Adrenal Insufficiency
electrolytes are lost or gained in equal • Osmotic Diuresis
proportions. • Hemorrhage
• Osmolar Imbalance - involves the loss or gain • Coma
of only water. • Burn
• Ascites with liver dysfunction
Medical Surgical Nursing
Topic: Fluids & Electrolytes

Clinical manifestations of hypovolemia Hypervolemia

• Acute weight loss • Fluid Volume Excess
• Decreased skin turgor • Increase blood volume or circulatory
• Oliguria overload
• Concentrated urine • Isotonic expansion of the ECF caused by
• Postural hypotension abnormal retention of water and sodium in
• Weak, rapid heart rate approximately the same proportions
• Flattened neck vein • Secondary to an increased in the total body
• Cool clammy skin sodium content.
• Thirst
• Anorexia Causes of hypervolemia
• Nausea • Excessive intake of NaCl
• Lassitude • Too rapid administration of Na containing
• Muscle cramps infusion particularly to patient with impaired
• Muscle weakness regulatory mechanism
• Steroid excess
Laboratory Test • Disease process that alter regulatory
• BUN mechanism
• Hematocrit
• CVP
• Urine Specific Gravity

Assessment Prior to Administration of Fluid

Management
• Intake & output
• Weight
• Vital Sign
• CVP
• Level of consciousness
• Breath sounds
• Skin color

Management • Since ECF becomes hypo osmolar, fluid

• Prevention moves into the cells to equalize the
• Oral fluids at frequent intervals concentration on both sides of the cell
• Medications to combat or minimize fluid loss membrane
• Enteral or Parenteral administration

Fluid Challenge Test

• Used to patient with severe FVD
• To determine whether the depressed renal
function is the result of reduced renal blood
flow 2’ to FVD or acute tubular necrosis due • Thus there, is an increase in intracellular fluid
to prolonged FVD • The brain cells are particularly sensitive to the
increase of intracellular water, the most
common signs of hypo osmolar
overhydration are changes in mental status.
Confusion, ataxia, and convulsions may also
occur.
Medical Surgical Nursing
Topic: Fluids & Electrolytes

• Other clinical manifestations include: Predisposing Factors

hyperventilation, sudden weight gain, warm, • Decreases water intake
moist skin, increased ICP: slow bounding • Increased water loss
pulse with an increase in systolic and • Excess solute intake
decrease in diastolic pressure and peripheral
edema, usually not marked Precipitating Factor – Decreases Water Intake
• Unavailability of fluids
Clinical manifestations of hypervolemia • Impaired thirst mechanism
• Edema • Impaired swallowing
• Distended neck vein • Inability to communicate needs
• Crackles • Debilitating disorders in which client cannot
• Tachycardia attend to thirst.
• Increase BP
• Increase CVP Precipitating factor - Increase Water Loss
• Increase weight • Diabetes Insipidus
• Increase urine output • Severe Burn
• Shortness of breath • Osmotic diuresis
• Wheezing • Increased respiratory rate

Diagnostic Test Predisposing Factor – Excess Solute Intake

• BUN • High protein diet or tube feeding without
• Decrease Hematocrit adequate fluid intake
• Low serum osmolality • Excessive IV infusion of hypertonic solution
• Decrease Na
• CXR Signs & Symptoms of Hypervolemia
• Thirst
Management • Weight loss
• Directed at the causative factor • Decrease urine output
• Elevated body temperature
Dehydration • Dry or cracked mucous membrane & tongue
• Occurs when water & electrolytes are lost in • Poor skin turgor
the same proportion. • Depressed fontanelle
• One of the most commonly body fluid • Sunken eyeball
disturbances in infancy/childhood • Decrease or absence of tears
• Etiology: • Alteration in CNS
Lack of oral intake • Manifestation of decreases circulating blood
Abnormal loss of fluids volume:
Postural hypotension
Rapid thready pulse
Decreased vein prominence
Increased vein refill time

Complications of Hypervolemia
• Fever
• Dilutional Hypernatremia
• Renal Failure
• Shock
• Coma
Medical Surgical Nursing
Topic: Fluids & Electrolytes
Implementation for Hypervolemia
• Assess for sign & symptoms of dehydration
• Monitor vital sign & I & O
• Check peripheral circulation
• Check specific urine gravity
• Administered IV therapy as ordered.
Monitor Sign of Water Intoxication
• Polyuria
• Decreases Na & Osmolarity
• CNS Alteration
Edema
• Excess in fluids in interstitial space, which
maybe localized or generalized.
• It forms in:
Peritoneal Cavity
Pleural Space
Pericardial Cavity
Subcutaneous
Predisposing factors
• Increased Capillary hydrostatic pressure
• Increased Capillary permeability
• Decreased Plasma Colloid Osmotic Pressure
• Lymphatic Obstruction
Precipitating Factors – Increased Capillary
Hydrostatic pressure:
• Condition causing venous obstruction
• Conditions causing arteriolar dilation
• Increases extracellular fluid volume
Renal Failure
Excessive fluid administration
Endocrine disorder or compensatory
mechanism:
Cushing’s disease, Liver disease, Renal
ischemia
Precipitating factors - Increased capillary
permeability
• Inflammation
• Allergic Reaction
• Burn
• Mechanical Injury
Precipitating factors – Decreased Plasma Colloid
Osmotic Pressure
• Conditions causing loss of albumin
• Condition causing decreased albumin
production
Precipitating factors – Lymphatic Obstruction
• Malignant invasion of lymph nodes
• Surgical removal of lymph nodes
• Infection & inflammation
Signs & Symptoms of Hypervolemia
• Weight gain
• Elevated BP
• Skin alteration
• Alterations in body contours:
✓ Pitting edema - indentation PIT that forms
over edematous area under pressure
from examiner’s fingers
✓ Dependent Edema - gravitational flow of
edema fluid to most dependent portion of
the body.
✓ Weeping Edema
- a very severe form of edema
- fluid leaks out of skin pores when
pressure exerted over area
✓ Brawny Edema - caused by trapping of
fluid by coagulated proteins in tissue
spaces; skin become thick & hardened
with an orange- peel appearance due to
severe stretching.
4 point scale
• 1+ - edema barely detectable with slight
pitting
• 2+ - deeper pit but fairly normal contours
• 3+ - deep pit & puffy appearance
• 4+ - excessive fluid accumulation with deep
pit & frankly swollen appearance
Medical Surgical Nursing
Topic: Fluids & Electrolytes

Edema Treatment ✓ Acute Pyelonephritis

• Specific depends on the cause of edema Due to:
• Pharmacology & nutrition Carbon Tetrachloride
Sulfomides
Edema Management Gentamycin
• Monitor I & O Poison Mushroom
• Administer prescribed drugs Mercury
• Restrict fluid & sodium intake Radiographic contrast agent
• Instruct client to read food labels for sodium Transfusion reaction
content Complication of Pregnancy
• Elevate body parts prone to edema avoid Hypercalcemic crisis
pressure / sharp bends Acute interstitial nephritis
• Use elastic support stocking & sleeves Severe crushing injuries
• Keep skin over edematous tissue clean & • Post-renal failure
lubricated - factors which cause obstruction of the
• Change client position frequently ureters or bladders outlets
• Monitor electrolytes for sign of hypokalemia - E.g. Tumor, Scar tissue, Calculi, Trauma
or hyponatremia & administer prescribed
electrolytes supplements if needed Clinical Manifestation
• Subjective symptoms
Renal Failure - Irritability & confused
• Acute Renal failure - Headache
- Abrupt reversible cessation of renal - Anorexia
function - Circumoral numbness
- Urine output 400ml/24 hours - Tingling of extremities
• Chronic Renal failure - Lethargy
- Irreversible slow or progressive failure of - Drowsiness – Stupor – Coma
the kidneys to function that result in death • Objective Symptoms:
unless treatment is instituted - Sudden dramatic drop in urinary output
- Restlessness, twitching, convulsion
Etiology - Nausea & vomiting
• Pre-renal failure - Skin pallor, anemia & increased bleeding
- refer to those factors which causes time
decreased blood flow to kidneys e.g. - Ammonia odor – breath & perspiration
decrease of cardiac output, hypotension, - Generalized edema, hypovolemia,
hypovolemia such as: • hypertension & increased venous
✓ Severe hemorrhage pressure
✓ Shock - Deep rapid respiration
✓ Severe burn - Elevated serum level BUN, Crea, K, Na,
✓ Severe loss of body fluids pH, CO2
✓ Severe dehydration - (+) Albumin in urine, decreased specific
✓ Circulatory collapse urine gravity
✓ Hemorrhage during maternal cycle -
✓ Hepatorenal syndrome Therapeutic Intervention
✓ Septic shock • Correct the underlying cause of renal failure •
• Intra-renal failure Complete bed rest
- refers to those factors which cause • Diet therapy - Restrict sodium, Protein intake
damage to the parenchyma of the • Monitor v/s, I & O
kidneys like: • Administer diuretics
✓ AGN • Monitor urine specific gravity
Medical Surgical Nursing
Topic: Fluids & Electrolytes

• Report for sign of oliguria Management – Drainage Ceases:

• Report sign of Respiratory infection • Turn client from side to side
• Prepare client for dialysis - Hemodialysis, • Elevate head of bed
Peritoneal Dialysis • Check line for kink, clots or leaks
• Notify physician to reposition catheter if
Peritoneal Dialysis necessary
• Dialyzing solution is introduced via a catheter
inserted in the peritoneal cavity; the Hemodialysis
peritoneal membrane is used as a dialyzing • The client is attached to a machine that
membrane. pumps the blood along a semi-permeable,
dialyzing solution is on the other side of the
Types of Peritoneal Dialysis membrane & osmosis and/or diffusion of
• CIPD - Chronic Intermittent Peritoneal waste, toxins & fluids from the client occur.
Dialysis
• CAPD - Continuous Ambulatory Peritoneal Purpose
Dialysis • Remove the end product of protein
• CCPD - Continuous Cycler Assisted metabolism from blood
Peritoneal Dialysis • Maintain safe level of electrolytes
• Remove excess fluid from the blood
Nursing Care • Correct acidosis & replenish blood
• Explain procedure, equipment, & care bicarbonate system
• Obtained consent
• Weigh Access line:
• Measure abdominal girth • Subclavian catheter
• Monitor serum electrolytes, BUN, CREA • Anteriovenous shunt
• Make the patient void • Bovine graft
• Warm dialysate to body temperature • Gortex graft
• Shave abdomen • Arteriovenous fistula
• Administer sedatives as prescribed • Saphenous vein graft
• Assist physician with insertion of peritoneal • External shunt – Exanguination
catheter
Nursing Care
During nursing care • Secure consent
• Make sure outflow line is clamped • Have client void
• Open inflow line & allow dialysate to flow into • Assess v/s before & every 30 mins. During
peritoneum procedure
• Clamp inflow line after dialysate has flowed • Withhold anti HPN, sedatives, & vasodilators,
into the peritoneum diuretics
• Allow dialysate solution to remain in • Ensure bed rest
peritoneal cavity for specified time • Change position frequently
• Unclamped outflow line after “dwell time” is • Assess insertion site
completed • Maintain patency of femoral or subclavian
• Allow solution to drain by gravity catheter
• Record type of dialysate used • Assess for patency of shunt, fistula or graft by
• Measure amount of fluid that flowed in & listening to bruit & feeling thrills or
amount that flowed out
• Report any deficit or excess
• Record color of outflow drainage
Medical Surgical Nursing
Topic: Fluids & Electrolytes

Post Dialysis Complication II - Dehydration due to

• Dialysis Disequilibrium syndrome: • Prolonged vomiting
Nausea & vomiting • Excessive diarrhea
Hypertension • Excessive GIT drainage
confusion • Overuse of diuretics
Seizures • Endocrine disorder
• Hypovolemia (Hypovolemic shock)
III - Third Space fluid
Shock • Burn
• Failure of circulatory system to provide tissue • Peritonitis
perfusion necessary for normal cellular • Bowel obstruction
function & failure to remove waste products • Liver disease
of metabolism that accumulate due to
inadequate venous return Clinical Manifestations
• Changes in vital sign
Types of Shock • Changes in the level of consciousness
• Hypovolemic shock • Changes in the skin & mucous membrane
• Vasogenic shock • Changes in urine output
• Cardiogenic shock Diagnostic Measures
• CXR
Hypovolemic shock • CBC
• Result from decreased intravascular volume • Electrolytes BUN/CREA
of at least 15- 25 % causing decreased venous
return Management
• Maintain adequate fluid volume
Predisposing factor • Insert foley catheter
• Hemorrhage • Monitor I & O
• Dehydration • Fluid therapy
• Third space of fluid
Fluid Replacement Therapy
I – Hemorrhage due to • Whole blood or blood products
• Injury/ trauma • Plasma expander
• Surgery • Crystalloid Solution
• GIT bleeding
• Delivery of baby Monitor – Sign – Fluid overload
• Bleeding disorder • Rales
• Defect in coagulation • Peripheral edema
• Liver disease • Jugular venous distention
• Hemophilia
• DIC

Signs & Symptoms - DIC

• Tissue Hypoxia
• Infarction

Common Cause - DIC

• Abruptio Placenta
• Retained Dead Tissue
• Amniotic fluid Embolism
• Ca – pancreas, lungs, stomach, prostate