F+E Flashcards
fluid overview
fluid processes -> diffusion and osmosis
colloidal osmotic P (oncotic P) -> albumin = pulling power (fluid in IV, 3rd space if not)
hydrostatic P -> pushing -> HF (IV -> interstitum)
FVE: cm
HA, confusion, lethargy, peripheral edema, JVD (IVF), S3, bounding pulse (IVF), htn, centravenous P - F in RA (ICU), polyuria (w normal function), dyspnea, pulm edema, muscle spasms, weight gain (water), seizures and coma (hypoNa)
pulm edema, peripheral edema, 3rd spacing
FVE: causes
excess isotonic or hypotonic -> older (HF)
HF, RF (not peeing), primary polydipsia (drink lots of water), endocrine (SIADH, cushing S, long term corticosteroids - also fluid retention)
FVD: causes
high insensible water loss or perspiration (high fever, heatstroke) -> insensible means cannot be measured in cylinder - breathing/fever/sweat)
SM insipidous -> endocrine
osmotic diuresis -> mannitol
hemorrhage
low intake -> no thirst, obtunded, older (most common issue)
GI loss: v, ng, d, fistula drainage
overuse of diuretics
3rd spacing: burns bc increase in cap perm, pancreatitis
FVD: cm
restless, drowsy, lethargy, confusion
thirst dry mucus (elderly!)
cold clammy
decreased turgor, decreased cap refill
postural hypoT, increased pulse (tachy bc CO = Hr x SV, so it is to maintain CO), decreased CVP
urine output, [] urine
increased RR
weak, dizzy, weight loss (water), seizure, coma
fluid status nc
daily weight (same scale, clothes, time)
I+O but unreliable
labs: BUN, Na, hct but can all be false high/low; urine and serum osmolality -> particles/solution -> [] specifically
FVD: nc
mild: oral rehyd
severe: replaces with blood (esp if d/t blood loss) or balances IV solutions (NS, LR)
FVE: nc
HF, CKD, liver
restrict
fluid status nc: CV
monitor VS
FVE = bounding
FVD = tachy to keep BP wnl, weak/thready, orthostatic hypoT
fluid status nc: resp
FVE = risk for pulm edema
fluid status nc: pt safety
Na
change in LOC, orthostatic
fluid status nc: skin care
dry v pitting edema
fluid status nc: fluid therapy
rate, hc, needed?
delegate
RN interprets assessment findings
daily weights and VS
other freq oral care
I+O, skin care and position change, encourage oral fluids as appropriate, elevate edematous extremities (FVE)
Na
major ecf cation, sucks and governs osmolality (most particles in body are Na), activate muscle/nerve cells (AP)
135 - 145
hyperNa: causes
> 145
excessive intake: hypertonic IVF, tube feed without h2o supplements - free water usually added
inadequate h2o intake: elderly, anorexia, v/d, depressed
excessive loss of h2o (Na retained): insensible water loss, d, diuretics
diseases: diabetes insipidous and cushings S are endocrine, uncontrolled DM like ketoacidosis
hypoNa: causes
< 135
excess loss: GI, renal, diuretics, skin (burns, wounds)
inadequate intake
excessive h2o gain (low Na dilution): hypotonic IVF
diseases: SIADH (counterpart to DI), HF and KF = fluid retention, cirrhosis
hyperNa: cm
cellular shrink: mental change -> HA, irritable, difficulty [], confusion, seizure, coma
if also ECF v deficit: postural hypoT, tachy, weak
hyperNa: nc
depends on cause
water loss = add h2o
Na excess = remove
monitor serum Na/osmolality
gradually over 48hr for cerebral edema
hypoNa: cm
cellular shrinking: mental change -> drowsy, restless, confused, lethargy, seizures, coma
if also ecf V excess: weight gain and htn