Fluid and Electrolyte part 2

Question 1

What are some geron. considerations for fluid volume risks?

Answer 1

• structural changes in kidneys decreased ability to conserve water
• hormonal changes (decrease in renin and aldosterone) (increase in ADH and ANP)
• loss of subq tissue leads to increased moisture lost
• reduced thirst mechanism

Question 2

What are the S and S of dehydration in elderly?

Answer 2

confusion
increased HR
subnormal temperature
“pinched” facial expression

Question 3

What is the cation and anion in ICF?

Answer 3

cation = K+ 
anion = PO-

Question 4

What is the cation and anion in ECF?

Answer 4

cation = Na+ 
anion = Cl-

Question 5

What is hypovolemia?

Answer 5

extracellular fluid volume deficit

• abnormal loss of body fluids (diarrhea, vomiting, hemorrhage, polyuria)
• inadequate fluid intake
• plasma to interstitial fluid shift (still extracellular)

Question 6

Why is dehydration different than a fluid volume deficit?

Answer 6

-dehydration is loss of pure water alone without corresponding loss of sodium.

Question 7

What puts pt’s at risk for hypovolemia?

Answer 7

-diarrhea, vomiting, fistula drainage, hemorrhage, inadequate intake (NPO), plasma to interstitial fluid shift (burns, ascites), diaphoresis, diuretics, diabetes insidious, kidney disease, adrenal insufficiency, impaired swallowing, confusion

Question 8

What are the clinical manifestations of hypovolemia?

Answer 8

postural hypotension 
tachycardia 
tachypnea 
weakness
dizziness 
decreased: skin turgor, capillary refill, urine output

Question 9

Will the lab values serum plasma osmolality, serum sodium, and urine specific gravity be increased or decreased for someone with hypovolemia?

Answer 9

increased because there is not as much fluid and water to dilute

Question 10

What does urine specific gravity tell us?

Answer 10

• Elevated: concentrated urine, dehydration, reduced renal blood flow, increased ADH secretion
• Low: dilute urine, over hydration, early renal disease, inadequate ADH secretion

Question 11

• Excess intake of fluids
• abnormal retention of fluids
• interstitial to plasma fluid shift

Answer 11

Hypervolemia: extracellular fluid volume excess

Question 12

What pt’s will likely have hypervolemia?

Answer 12

heart and kidney failure pt’s

Question 13

What pt would have a low specific gravity?

Answer 13

hypervolemic (dilute urine) like kidney and heart failure pt’s

Question 14

What pt would have a high specific gravity?

Answer 14

hypovolemic (concentrated urine)

Question 15

What is the most consistent manifestation of fluid volume excess?

Answer 15

weight gain

Question 16

What are the clinical manifestations of hypervolemia

Answer 16

headache
confusion
JVD
bounding pulse 
hypertension 
dyspnea
crackles
pulmonary edema 
peripheral edema

Question 17

What does elevated for Hgb, Hct, and urine specific gravity have in common?

Answer 17

-elevated = concentrated = hypovolemia and dehydration

if electrolytes are normal it is only dehydration

Question 18

How do you fix hypervolemia?

Answer 18

• remove fluids without messing up electrolyte composition.
• diuretics
• fluid restriction
• restriction of sodium intake to treat ascites or pleural effusion