Hypervolemia vs Hypovolemia

In this video, we're going to dive into hypovolemia and hypervolemia, breaking them both down so you fully understand what is happening with them and you can pass your nursing school exams. Let's dive in. Both hypovolemia and hypervolemia are disorders that you will hear about often in nursing school. They can happen due to many different disease processes and recognizing that they are happening with early intervention is really key to managing them well. So let's break them both down so that you can fully understand what they are and can critically think about them for your exams. Let's start with hypovolemia. Now, hypovolemia happens when there is not enough circulating blood volume in the body. And this is really important because you need enough blood volume, right, to keep the organs perfused with nutrients and oxygen rich blood. Hypovolemia can be caused by many things, but some of the most common causes of hypovolemia are shocked, severe dehydration, trauma with a large amount of blood loss or burns, and medications that can cause fluid to shift like diuretics. So if there's less circulating blood volume, let's walk through the signs and symptoms of hypovolemia that you might see. Now, this is key. We don't want to just memorize a list of signs and symptoms. Now, that won't help you pass your exam, my friend. Instead, we always want to think back to the pathophysiology of what is happening in the body and connect it back to that. This is the exact process that we teach inside the nursing SOS membership community. Because you shouldn't have to struggle to just memorize things in nursing school. That's not how we do it here. Your exams are going to test you a lot on how well you connect the dots between concepts and critically think. Which is why we walk you through the critical thinking behind everything inside the nursing SOS membership community. So if you're ready to start feeling more confident in nursing school and want to learn things faster and easier for your exams, definitely check out the community. I'm going to put a link down below in the description with all the details. So let's go through the signs and symptoms of hypovolemia and critically think about them and why they happen. To start, everything will have to do with less fluid volume. Overall, the patient may have dizziness or feel weak or tired or fatigued because there's not enough blood flow going to the organs. Dry mucous membranes and excessive thirst can happen because of the decrease in water in the body, then postural hypotension and a thready pulse are possible symptoms due to that lack of circulating blood volume, as well as dark urine and a low urine output. Because there's less water circulating in the body and there's not enough to dilute the urine as much. As hypovolemia gets more severe, the body will try to compensate and the blood vessels will vasoconstrict. They'll tighten to try to create more pressure in the vascular space to hopefully oxygenate the body more efficiently. So think of your blood vessels like a hose. During hypovolemia, there's not as much fluid going through that hose, so the pressure is low. So in order to get more fluid to where it needs to go, we need to increase that pressure. And to do this, the blood vessels will constrict to try to move more fluid through and get the blood to the organs. The heart rate will also increase in an effort to try to increase the cardiac output and the blood flow to the organs. Because if there's less blood volume to circulate, the heart will try to pump faster and faster to compensate and get the little blood volume that there is to those organs. And something that nursing school exams and the NCLEX love to test you on is what happens to the hematocrit level. With hypovolemia, you may find an elevated hematocrit level because the blood is more concentrated, because there is less excess fluid. Hematocrit measures the percentage of red blood cells in relation to the rest of the blood. So if there's less blood volume and fluid, that would increase the percentage of red blood cells overall, not because there's more red blood cells, but because the amount of fluid has now decreased. So now, how do you fix hypovolemia and what fluids do you give for hypovolemia? Since we know there is not enough blood volume circulating in the vascular vascular space, so our nursing interventions are going to be based around getting more volume in that vascular space. This can be done a few different ways, depending on the situation and the severity. If the hypovolemia is not too severe, oral rehydration or increasing fluid intake may do the trick. This would help to increase the overall volume circulating blood. For more severe cases, though, IV fluids with isotonic solution may be needed to increase the fluid volume. Remember, our goal here is to increase these circulating blood volumes so that more blood can get to the organs to help oxygenate them. If hypovolemia is quite severe and becomes hypovolemic shock, then emergency treatment and medications will be needed. Hypovolemic shock happens when the organs aren't getting enough blood flow and impairs their function. The vital signs for hypovolemic shock may look like tachycardia, tachypnea, and a decrease in pulse pressure or blood pressure. With hypovolemic shock, emergency treatment is important and should happen fast. Emergency treatment of hypovolemic shock would include IV fluids like normal saline to help replace the fluid in the body, medications to help constrict the blood vessels, like epinephrine, norepinephrine, and ionotropic medications like dobutamine, which help the heart to contract and pump more blood. So now that we understand what hypovolemia is, what it may look like in terms of symptoms, and how you would treat it. Now let's move on over to hypervolemia. Hypervolemia happens when there is too much fluid circulating and the body cannot compensate to regulate it. So in contrast to hypovolemia, which is too little blood volume, hypervolemia is when there is too much blood volume and it's overloading the organs. This is also referred to as fluid volume overload. Hypervolemia is typically caused by organ issues, issues like with the kidneys, heart and liver, and when they aren't functioning to eliminate or balance or circulate fluid in the body like they normally should be. These could be disorders like kidney failure or cirrhosis, where in some cases it can also be caused by too much IV fluids or IV fluids given at too fast of a rate. This makes sense because if the organs aren't doing their job to eliminate and balance and circulate fluid in the body, it will build up and keep increasing, leading to hypervolemia. Now, the thing goes, with IV fluids, if there's too much fluid going into the body, it can really overload the body quickly, leading to fluid volume overload. So with too much fluid circulating in the body, what are some typical signs and symptoms for hypervolemia that you might see? Some mild symptoms you might notice would be edema of the ankles or the hands, weight gain since there's more fluid now staying in the body and veins that look and feel very full. As hypervolemia worsens, you might hear crackles in the lungs or pulmonary edema from the fluid not having anywhere else to go because the heart is working hard to pump more fluid. If it can't keep up with it, all that extra fluid will end up back flowing into the lungs, leading to pulmonary edema. So when there's fluid volume overload, it will sound like crackles in the lungs. Now, just as we talked about hematocrit levels, with hypovolemia, the hematocrit level will change. With hypervolemia as well, there will be a decreased hematocrit level because the blood is now more dilute. Remember, the hematocrit level measures the percentage of red blood cells in relation to the rest of the blood. So if there's now more blood volume and fluid, that would decrease the percentage of the red blood cells. This isn't because there's now less red blood cells, but because the amount of fluid has increased in relation to the rest of the blood. So the hematocrit level will decrease. Now, with hypervolemia, we know there is too much fluid circulating in the body. The body is overloaded and it doesn't know what to do with all that extra fluid. So we need to get rid of that extra fluid to get the body back in balance. So in order to do this, we would need to give a medication that helps to Hint, hint diuresis, the body diuretics. We will give diuretics to help pull out that extra fluid so the kidneys can get rid of it. The first line treatment, if medications are necessary, is loop diuretics, namely furosemide or Lasix. Furosemide will help kick the kidneys into high gear and help them get rid of more fluid through the urine. Now, if you want an easy breakdown of furosemide and how it acts in the body, click on this video here. And you know that nursing school exams and the NCLEX are going to test you a ton on IV fluids. So click on this video here for a quick breakdown of those so that you can pass your exams. And I'd love to know what topic you want to see next on our channel, so leave your suggestions in the comments. And as always, my friend, go become the nurse that God created only you to be. And I will see you over there in that next video.