what to do on a patient with hypovolemia

[kristine.guzman_rn]

I just want to know the opinion of my collegues about a patient i had encountered. I had patient with Hemoglobin count of 1.52g/dl, looks very pale, weak and emaciated. He is afebrile and with initial BP of 90/50. The resident ordered 500mL of Normal Saline, 1gm of Ampicillin and and oxygen. Blood is not available in blood bank and has to take it in another hospital. Transport of the blood will take 5 hours. On the 5 hour duration, the doctor did not order anything. I asked if IV fluid is needed but he replied the patient is on heart failure and only blood is needed for him to recover.

I just wanted to ask if in case like this, what should be the proper treatment for patient? thanks.

[loriangel14, RN]

What is the patient's history? What lead to him being in this condition? The doctor's orders sound reasonable.You don't want to load the patient up with fluids if they are going into heart failure. His kidney function probably compromised as well so his body wouldn't be able to cope with huge amounts of fluid.

Are you in disagreement with the doctors treatment? What exactly is he covering from? It would be easier to give advice if you gave us more background on the patient.

[kristine.guzman_rn]

after ECG, it appeared he is having MI already and renal function test result is high. I just thought he needs IV fluid coz there is a delay with the giving of blood.

[loriangel14, RN]

Is the patient drinking?

[Silverdragon102, BSN]

If in heart failure there is a risk of over loading with fluids causing more problems. Sometimes blood replacement does the job

[Labrynth]

Ask yourself what would happen if you gave him a bolus of 500 or 1000 ml of NS and then he received 2-4 units of blood. He is in heart failure right? Where will the fluid end up? In his lungs then it wont matter what his H&H is because he will have ineffective gas exchange and respiratory distress not to mention the increased load on the heart. Also in his assessment is he peeing? If you are getting 30 ml urine an hour his kidneys are perfusing well and he has time to wait for the blood.

[Jen87]

fluid overloading a patient in heart failure would defeat the purpose of pumping with fluids to increase volume in the vascular space. The reason for this is that the patients heart is not strong enough to handle pumping all that excess fluid to the rest of the body and the fluid would end up backing up into the lungs as Labrynth stated above. This would likely cause a flash pulmonary edema and would make the patients outcome worse. Also pumping with fluids could also dilute the hgb portion even further resulting in a low lab result. A blood transfusion at a slow rate would address the low hgb without putting the CHF patient at risk for fluid overload

[kristine.guzman_rn]

Thanks guys for the advise!!! =)