ATI - Fluid Imbalances - 57 Flashcards
Fluid volume _____ includes the both isotonic FVD and dehydration.
deficit (FVD)
______ is the loss of water and electrolytes from the ECF.
isotonic FVD
Isotonic FVD is often referred to as ______ because intravascular fluid is also lost.
hypovolemia
______ is the loss of water from the body without the loss of electrolytes.
dehydration
This hemoconcentration results in increases in Hct, serum electrolytes, and _____.
urine specific gravity
Compensatory mechanisms of _______ include sympathetic nervous system responses of increased thirst, ADH release, and aldosterone release.
fluid volume deficit (FVD)
FVD can lead to ______ shock.
hypovolemic
Older adults have an increased risk for ______ due to multiple physiological factors including a decrease in total body mass, which includes total body water content and a decrease in ability to detect thirst.
dehydration
Risk Factors (causes of isotonic FVD) Hypovolemia
Excessive GI loss: vomiting, nasogastric suctioning, diarrhea
Excessive skin loss: diaporesis
Excessive renal system losses: diurectic therapy, diabetes insipidus, kidney disease, adrenal insufficiency, osmotic diuresis
Third spacing: peritonitis, intestinal obstruction, ascities, burns
Excessive loss of fluids from a wound
Hemorrhage
Altered intake: anorexia, nausea, impaired swallowing, confusion, nothing by mouth (NPO)
Risk Factors (causes of dehydration) Hypovolemia
hyperventilation prolonged fever diabetic ketoacidosis (DKA) enteral feeding without sufficient water intake
Fluid Volume Deficit (FVD) vital signs
hypothermia tachycardia thready pulse hypotension orthostatic hypotension decreased central venous pressure tachypnea (increased respirations) hypoxia
Fluid Volume Deficit (FVD) neuromusculoskeletal
dizziness syncope confusion weakness fatigue
Fluid Volume Deficit (FVD) GI
thirst dry mucous membranes dry furrowed tongue nausea vomiting anorexia acute weight loss
Fluid Volume Deficit (FVD) renal
oliguria (decreased production of urine)
Fluid Volume Deficit (FVD) other findings
Diminished capillary refill Cool clammy skin Diaphoresis Sunken eyeballs Flattened neck veins Absence of tears Decreased skin turgor
Assessment of skin turgor in the ________ might not provide reliable findings due to a natural loss of skin elasticity.
older adult
Laboratory Tests (4) for FVD
Hct
Serum osmolarity
Urine specific gravity
Serum sodium
Hct is _____ in both hypovolemia and dehydration unless the fluid volume deficit is due to hemorrhage.
increased
With dehydration how is serum osmolarity effected?
Hemoconcentration osmolarity (greater than 295 mOsm/kg); increased protein, BUN, electrolytes, glucose.
With dehydration _____ is increased above 1.030.
urine specific gravity
With dehydration, serum sodium lab tests reveal an increased ________ (greater than 145 mEq/L).
hemoconcentration
Review pg 344 patient centered care list
-
_____ includes fluid volume excess (FVE) and overhydration.
fluid volume excesses (FVE)
______ is the isotonic retention of water and sodium in high proportions.
fluid volume excess (FVE)
FVE is often referred to as _______ because of the resulting increased blood volume.
hypervolemia
Overhydration, or _________, is the retention of more water than electrolytes.
hypoosmolar fluid imbalance
With overhydration, hemodilution results in _____ in Hct, serum electrolytes, and protein.
decreases
Severe FVE can lead to ______ and heart failure.
pulmonary edema
With fluid volume excesses (FVE), compensatory mechanisms include an increased release of natriuretic peptides, resulting in increased excretion of sodium and water by the kidneys, and __________.
a decreased release of aldosterone
Risk Factors of Hypervolemia (FVD)
Chronic stimulus to the kidney to conserve sodium and water (heart failure, cirrhosis, increased glucocorticosteroids)
Altered kiney function with reduced excretion of sodium and water (kidney failure)
Interstitial to plasma fluid shifts (hypertonic fluids, burns)
Age-related changes in cardiovascular and kidney function
Excessive sodium intake from IV fluids, diet or medications (sodium bicarbonate antacids, hypertonic enema solutions)
Risk Factors of Overhydration (FVD)
Water replacement without electrolyte replacement (strenuous exercise with profuse diaphoresis)
Syndrome of inappropriate antidiuretic hormone (SIADH), which is the excess secretion of ADH
Head injuries
Barbiturates
Anesthetics
Expected findings for Fluid Volume Excesses (FVE) vital signs
Tachycardia bounding pulse hypertension tachypnea increased central venous pressure
Expected findings for Fluid Volume Excesses (FVE) - neuromusculoskeletal
confusion
muscle weakness
Expected findings for Fluid Volume Excesses (FVE) - GI
weight gain
ascities
Expected findings for Fluid Volume Excesses (FVE) - respiratory
dyspnea
orthopnea
crackles
Expected findings for Fluid Volume Excesses (FVE) - other findings
edema
distended neck veins
For FVE: Hypervolemia Hct will ______.
decrease
For FVE: Overhydration Hct will ______ = hemodiution.
decrease
With overhydration osmolarity will be less than _____ mOsm/kg
280
With hypervolemia sodium will be _____.
within expected ranges
Overhydration/hypervolemia results in decreased electrolytes, _____, and _____.
BUN
creatinine
______ can indicate pulmonary congestion involved with FVE.
Chest x-rays
With FVE PaCO2 ______(less than 35 mm Hg).
decreased
With FVE there urine specific gravity will be ______ (if not due to SIADH)
less than 1.010
The blood pH will be _____with FVE.
increased (greater than 7.45)
respiratory alkalosis?
p344 nursing care
?
