Fluid and Electrolytes

Question 1

Fluid Implications

Answer 1

1. Dehydration: Fluid intake/retention does not meet the body’s fluid needs; results in fluid volume deficit (especially plasma volume)
2. Fluid Volume Overload (Hypervolemia): Expansion of the ECF caused by abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the extracellular fluid
3. Fluid Volume Deficit (Hypovolemia):
   o May occur alone or in combination with other imbalances
   o Loss of extracellular fluid exceeds intake ratio of water
    Electrolytes lost in the same proportion as they exist in normal body fluids
   o Dehydration
    Loss of water alone, with increased serum sodium levels

Question 2

What are examples of Isotonic Fluids?

Answer 2

1. 0.9% saline
2. 5% dextrose in water (D5W)
3. 5% dextrose in 0.225% saline
4. Lactate Ringer (LR)
5. Normosol

Question 3

What are examples of HYPOtonic Fluids?

Answer 3

1. 0.45% saline

Question 4

What are examples of HYPERtonic Fluids?

Answer 4

1. 10% dextrose in water (D10W)
2. 5% dextrose in 0.9% saline
3. 5% dextrose in 0.45% saline
4. 5% dextrose in Ringer’s Lactate
5. 3% Normal Saline

Question 5

What are Colloids?

Answer 5

IV fluids that contain larger non-water-soluble molecules that increase the osmotic pressure in the plasma volume

Question 6

History Assessment for Dehydration

Answer 6

1. Ask about food and liquid intake
2. Weigh patient-weight loss is an indication of dehydration
3. Medication History- older patient use diuretic or laxatives that can lead to dehydration
    Ask about the prescribed drugs and over-the-counter medication, check the dosage, the length of time required and the patient’s adherence to the drug
4. History of kidney or endocrine diseases
5. Assess LOC and Mental Status

Question 7

Physical Assessment for Dehydration

Answer 7

1. Cardiovascular Changes:
    Increased heart rate
    Pulse is weak and difficult to find
    Decreased Blood Pressure
    Neck veins are flat
2. Respiratory Changes:
    Increased respiratory rate
3. Skin Changes:
    Dry mucus membranes (thick, sticky coating)
    Tenting
    Dry and Scaly
4. Neurologic Changes:
    Low-grade fever
    Altered Mental Status
5. Kidney Changes:
    Monitor intake and output
    DAILY WEIGHTS
    Dark amber color urine with strong odor

Question 8

Laboratory Assessment for Dehydration

Answer 8

Elevated levels of Hemoglobin, Hematocrit, Serum Osmolarity, Glucose, Protein, BUN

Question 9

Imaging Assessments for Dehydration

Answer 9

Ultrasonography and basic echocardiography

Question 10

Intervention for Dehydration (Fluid Replacement)

Answer 10

1. Provide fluids that meet the patient’s dietary restrictions
2. Collaborate with other members of the interprofessional team
3. Ensure fluids are offered and ingested on an even schedule at least every 2 hours
4. Do not withhold fluids to prevent incontinence
5. Infused prescribed IV fluids at a rate consistent with hydration
6. Monitor the patient’s response to fluid therapy q2 hour for indicators of adequate rehydration or the need for continuing therapy especially:
   
   • Pulse quality and pulse pressure
   • Urine output
   • Weight (every 8 hours)
7. Monitor for and report indicators of fluid overload
   
   • Bound pulse
   • Difficulty breathing
   • Neck vein distention in the upright position
   • Presences of dependent edema
8. Assess IV infusion site hourly for indication of filtration or phlebitis
9. Give drugs prescribed to correct the underlying cause of dehydration

Question 11

Interventions for Dehydration (Drug Therapy)

Answer 11

1. Antidiarrheal drug- prescribed when diarrhea causes dehydration
2. Antimicrobial therapy- prescribed when patients with bacterial diarrhea
3. Antiemetics- used when vomiting causes diarrhea
4. Antipyretics: to reduce fever

Question 12

Interventions for Dehydration (Preventing Injury)

Answer 12

1. Patient safety issues and strategies are PRIORITIES of care before and during other therapies for dehydration
2. Monitor vital signs (heart rate quality and blood pressure)
3. Patient is at risk for falls because of orthostatic hypotension, dysthymias, muscle weakness and possible confusion
4. Assess muscle strength, gait, stability and level of alertness
5. Instruct patient to get up slowly from a lying or sitting position and to immediately sit down if they feel light-headed
6. Stress the importance of asking for help when ambulating

Question 13

Physical Assessment for Fluid Overload

Answer 13

1. Cardiovascular Changes:
   o Increased pulse rate
   o Bounding pulse quality
   o Elevated blood pressure
   o Distended neck and hand vein
   o Weight Gain
2. Respiratory Changes:
   o Increased RR
   o Shallow Respirations
   o Shortness of Breath
   o Crackles
3. Skin and Mucous Membrane Changes
   o Pitting Edema
   o Skin pale and cool to touch
4. Neuromuscular Changes:
   o Altered LOC
   o Headache
   o Visual Disturbances
   o Skeletal muscle weakness
   o Parethesias
5. GI Changes
   o Increased motility
   o Enlarged Liver

Question 14

Interventions for Fluid Overload (Safety)

Answer 14

1. Patient Safety is the FIRST PRIORITY
   o Assess skin pressure areas daily for signs of redness or open areas (coccyx, elbows, hips and heels)
   o Change position every 2 hours

Question 15

Intervention for Fluid Overload (Drug Therapy)

Answer 15

1.Diuretics
 Monitor WEIGHT LOSS and URINE OUTPUT
 Observe for electrolyte imbalances
 Assess sodium and potassium levels

Question 16

Intervention for Fluid Overload (Nutrition Therapy)

Answer 16

1. Restriction of sodium
    Teach patient and family how to check food labels for sodium content and how to keep a daily record of sodium ingested
2. Fluid Restriction

Question 17

Intervention for Fluid Overload (Monitoring Intake and Output)

Answer 17

1. Intake and Output and Weight provides information on therapy effectiveness
2. Measurements need to be accurate and not estimated
3. Check urine color and report findings

Question 18

Intervention for Fluid Overload (Daily Weights)

Answer 18

1. Weigh patient at the same time each day using the same scale
2. Teach patient to record daily weights at home
3. Teach patient to call healthcare provider for more than a 3lb weight gain in a week or more than a 2lb gain in 24 hours