Signs of hypovolemic shock (rapid weak pulse, falling BP, cool clammy skin, altered mental status) - escalate immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is admitted with severe dehydration. Which IV fluid does the nurse anticipate initially?
Answer: A. Initial resuscitation for hypovolemia/dehydration uses an isotonic crystalloid (0.9% normal saline or Lactated Ringer's) to expand intravascular volume. Hypotonic fluids alone don't rapidly restore volume.
Question 2 of 5
A client has fluid volume deficit (dehydration). Which assessment finding is expected?
Answer: B. Dehydration → tachycardia, hypotension, poor skin turgor, dry mucous membranes, concentrated (dark) urine, and weight loss. Bounding pulses and crackles suggest overload instead.
Question 3 of 5
A nurse is caring for a client with severe dehydration (fluid volume deficit). Which finding indicates the condition is worsening and requires immediate intervention?
Answer: A. Worsening hypovolemia leads to decreased circulating volume and shock. A blood pressure of 84/50 with a thready pulse of 124 indicates compensatory tachycardia and hypotension from inadequate perfusion, requiring immediate fluid resuscitation. Moist mucous membranes and a normal output would indicate improvement.
Question 4 of 5
A client with severe Crohn disease has developed a fistula between the bowel and the skin. Which is the priority nursing assessment related to this complication?
Answer: A. Enterocutaneous fistulas drain intestinal contents externally, leading to significant losses of fluid and electrolytes plus risk of malnutrition and skin breakdown; monitoring fluid and electrolyte balance is the priority because large losses can cause dehydration and dangerous imbalances. Skin protection and nutrition are also important, but the immediate priority is detecting fluid and electrolyte deficits. This complication commonly requires bowel rest and parenteral nutrition.
Question 5 of 5
A client with HHS has a serum glucose of 820 mg/dL and a serum osmolality of 340 mOsm/kg. Which clinical manifestation does the nurse most expect?
Answer: B. The hallmark of HHS is severe hyperosmolarity and dehydration, which impair cerebral function and produce altered mental status ranging from confusion to seizures and coma. Because ketosis is minimal, fruity breath and Kussmaul breathing are not expected. The osmotic diuresis causes profound fluid volume deficit rather than overload.
Keep the streak going with more questions like these, each with a full rationale.
What is fluid volume deficit (dehydration)?
Common causes include vomiting, diarrhea, hemorrhage, excessive diuresis, fever/diaphoresis, and inadequate intake (common in older adults). It matters because falling volume reduces perfusion to organs and can progress to hypovolemic shock. Key signs reflect concentration and poor perfusion: rising heart rate, falling blood pressure, and concentrated urine.
Key points to remember
- Vital sign changes include tachycardia, weak thready pulse, hypotension, and orthostatic (postural) hypotension.
- Urine output decreases (under 30 mL/hr) and urine becomes dark and concentrated with high specific gravity.
- Skin and mucous membranes are dry, skin turgor is poor (tenting), and the tongue may be furrowed.
- Acute weight loss is a sensitive indicator; 1 liter of fluid equals about 1 kg (2.2 lb).
- Other findings include thirst, dizziness, flat neck veins, sunken eyes, and decreased capillary refill.
- Hemoconcentration raises hematocrit, BUN, and serum osmolality.
Signs & symptoms
- ↑ HR, ↓ BP, orthostatic
- Dry mucosa, poor skin turgor
- ↓ urine, ↑ urine concentration
- Weight loss, flat neck veins
Nursing priorities
- Monitor vital signs, intake and output, daily weights, and level of consciousness for early shock.
- Replace fluids with oral rehydration if tolerated, and isotonic IV fluids (0.9% NaCl or lactated Ringer's) for moderate-severe deficit.
- Implement fall and safety precautions because of orthostatic hypotension and dizziness.
- Treat the underlying cause (control vomiting/diarrhea, stop bleeding, hold diuretics as ordered).
- Reassess perfusion: urine output of at least 30 mL/hr, improving blood pressure, and capillary refill.
Labs & values
Patient teaching
- Increase fluid intake during illness, heat, exercise, and fever.
- Older adults should drink on a schedule even without feeling thirsty.
- Use oral rehydration solutions for vomiting or diarrhea and seek care for dizziness, dark urine, or low urine output.
Red flags: report now
- Signs of hypovolemic shock (rapid weak pulse, falling BP, cool clammy skin, altered mental status) - escalate immediately.
- Urine output less than 30 mL/hr despite fluids suggests inadequate perfusion or kidney injury - notify provider.
- Sudden large drop in blood pressure or unresponsiveness - emergency.
References
Clinical references for this topic
