fluid and electrolyte balance Flashcards
older adult considerations: skin
- decrease elasticity and turgor
- unreliable indicator of fluid status
- catheter might not stay in
- tent over sternum or forehead
older adult considerations: renal
- decrease glomerular filtration
- retain fluid, waste product, medications
- unable to concentrate
- increased water loss
older adult considerations: muscular
- decrease muscle mass
- holds a lot of water
- increased risk for dehydration d/t decreased total body water content
older adult considerations: neurologic
- decreased thirst refelx
- decreased intake, increased risk for dehydration
older adult considerations: endocrine
- adrenal glands begin to atrophy
- poor regulation of na/k
intracellular
within cell
extracellular
plasma- blood
interstitial- space between
normal fluid intake
2300ml
fluid loss routes
urine, feces, emesis, drainage
insensible- perspiration, lungs
fluid loss output
obligatory: 400-600ml a day
prefer 30ml/hr—> 720ml/day
insensible: 500-1000ml/day
hypervolemia
results from too much fluid in body or dilution of electrolytes and rbcs
hypovolemia
not enough fluid in body, especially in the intravascular area
fluid deficit causes: inadequate fluid intake
- poor PO intake
- NPO- nothing by mouth
- dysphagia
- unconsciousness
- inadequate IVF replacement
fluid deficit causes: excessive fluid or sodium losses
- gastrointestinal losses
- excessive diaphoresis
- prolonged hyperventilation
- hemorrhage
- diabetes insipidus
- burns
- open wounds
- excessive use of diuretics
- fluid shifts: ascites, effusions
fluid deficit signs and symptoms
- thirst
- rapid weak pulse
- low bp
- dry skin and mucous membranes
- skin tenting
- increased temp
- decreased urine output: increase concentration/ specific gravity
- increase BUN
- increase HCT
fluid deficit interventions
MONITOR DAILY WEIGHT 1L=2.2LBS
- monitor intake and output
- treat underlying cause
- increase fluid intake: PO IV
- use caution with elderly pt
isotonic
what it does?
type of solutions
same concentration no fluid shift
- equal pressure inside and outside cell
- “stay where I put it”
- expands volume
- dilute meds
- fluid resuscitation
- .9 nacl
- lactated ringers
hypotonic
lower concentration- fluid shift out of vessel into cell
- less salt or more water than normal body fluids
- water leaves blood and into cells
- “goes out of vessel”
1/2 normal saline
D5W dextrose 5% water
could lead to vascular fluid depletion and cardiovascular collapse
hypertonic
- higher concentration- fluid shifts into vessel from cell s
- either more salt or less water than our own fluids
- water is removed pulled from cells and pulled into vascular
- can result in vascular overload and dehydration
- enters the vessel
used for na replacement
- volume replacement
D 1/2 NS
D5LR
fluid excess causes: excessive sodium or water intake
- high sodium diet
- psychogenic polydipsia
- hypertonic fluid admin
- free water
- enteral feedings
fluid excess causes: inadequate sodium or water elimination
inadequate sodium or water elimination
- organ failure:renal liver heart
- endocrine disorders: hyperaldosteronism, cushings syndrome, syndrome of inappropriate antidiuretic
fluid excess s/s
- bounding pulse
- elevated blood pressure
- respiratory changes
- weight gain
- edema
- increased urine output
- diluted/ decrease specific gravity
- decrease BUN decease NA
fluid excess interventions
- monitor dailey weight
- place in fowleys positon
- admin oxygen
- admin diuretics
- monitor I&O
- restrict fluid and sodium
sodium
135-145
potassium
3.5-5.0
calcium
9.0-10.5
magnesium
1.8-2.6`
interventions for hyponatremia
- daily weight
- monitor LOC
- I&O
- fluid restriction
- increase PO intake
medical:
- IVF- hypovolemic
- diuretics- hypervolemic
hypernatremia interventions
- monitor VS
- daily weights
- monitor LOC
- I&O
- encourage fluids
medical
- loop diuretics: lasix
- NA free IVFs: D5W
hypokalemia interventions
- cardiac monitor
- D/C loop osmotic diuretics
- frequent iv assessment
- monitor renal function
- decrease dietary intake
medical
- PO admin
- IV admin: always dilute, never IVP, monitor for phlebitis
hyperkalemia interventions
- cardiac monitor
- d/c k+
- increased fluid intake
- dietary restriction
medical:
- admin loop/ osmotic diuretics
- kayexalate
- dialysis
- insulin: moves k + out of blood into cells
- calcium gluconate: counteracts myocardial effect of increase k+ levels
hypocalcemia interventions
- encourage PO intake
- monitor for neuromuscular changes
- trousseaus sign
- chvostek sign
- fall prevention
medical
- oral Ca with it D
- calcium gluconate
hypercalcemia interventions
- cardiac monitor
- D/C thiazide diuretics
- D/C calcium supplements
- pathologcal fracture
medical
- loop diuretics
- IVF .9% NS
- calcitonin: decrease movement out of bones
- dialysis
hypomagnesemia interventions
- cardiac monitor
- monitor I&O
medical
- d/c diuretics
- IV mag sulfate
hypermagnesium
- increase fluid intake
- d/c mg supplements
medical
- diuretics
- calcium gluconate
dialisys
