Fluid Balance Disturbances Flashcards
risk factors for fluid balance disturbances
renal failure
liver failure
severe diarrhea
vomitting
elderly
obese
babies
DKA
GI bleed
fluid balance disturbances varies with
age, body size, gender, body fat
obese have more or less fluid
less fluid
water intake
diet, food, feeding
water loss
kidney
sensible/insensible
sensible
loss that can be seen
insensible
loss that cannot be seen
ex: breathing
serum osmolality normal range
270-300
urine osmoloity normal range
200-800
urine specific gravity normal range
1.010-1.025
urine specific gavirty varies by
urine volume
increase in serum osmoloity
FVD
burns
diabetes inspidus
hypernat
stroke
head injury
advance liver disease
hyperglycemia
manitol
alcholism
decrease in serum osmolality
FVE
SIADH
AKI
diuretic
hyponat
parneoplastic syndrome
BUN normal range
10-20
BUN varies with
urine output
BUN is increased in
FVD
creatinine normal range
0.7-1.4
creatinine depends on
lean muscle mass
protein intake
person-person
hematocrit normal range
males: 42-52%
females: 35-47%
urine sodium normal range
75-200
hemaotocrit is elevated in
dehydrated people
organs involved in homeostasis
kidneys, lungs, heart, adrenal, parathyroid, pituitary
baroreceptors
RAAS
ADH/thirst
osmoreceptors
naturitic peptides
elderly considerations
reduced homeostatic mechanisms (cardiac, renal, respiratory)
decreased body fluid percentage
medication use
concomitant conditions
hypovolemia
FVD
loss of ECF volume exceeding the intake of fluid
FVD vs dehydration
dehydration is loss of water alone with increase sodium levels
FVD clinical mainfestitons
onset
rapid
FVD
severity depends on
degree of fluid loss
FVD
causes
vomit
diarrhea
GI suction
sweating
decrease intake
diabetes inspidus
adrenal insufficieny
hemorrhage
coma
FVD
clinical cues
urine
decrease
FVD
clinical cues
weight
loss
FVD
clinical cues
neck veins
flat
FVD
clinical cues
mental/neuro
weak
confused
anxious
restless
obtundic/lethargic
FVD
clinical cues
pulse
increased
FVD
clinical cues
RR
increased
FVD
clinical cues
skin
cool, clammy, pale
FVD
clinical cues
BP
LATE SIGN
decreased
FVD
lab findings
H&H
increase
FVD
lab findings
serum and urine osmolarity
increase
FVD
lab findings
glucose
increase
FVD
lab findings
protein
increase
FVD
lab findings
BUN
increase
FVD
lab findings
electrolytes
increase
FVD
lab findings
urine specific gravity
increase
FVD
lab findings
urine sodium
decrease
what is the only lab that is decreased in FVD
urine sodium
FVD
medical management
fluid replacement
if a patient has FVD and they are ordered IV solutions, what solution might you expect them to revive
isotonic
FVD
nursing management
monitor VS, mental status, I &O, daily weight
FVD
nursing management
IV
large bore and multiple
FVD
nursing management
airway
patent airway
O2 as needed
FVD
nursing management
auscultation
LS, for fluid volume overload
FVE
Hypervolemia
expansion of ECF
retention of water and sodium
who is at increased risk for FVE
elderly
- comorbities
- decrease homeostasis
FVE
at risk patients
heart failure
cirrhosis of liver
increase salt
administration of salt fluids/solutions (NS0.9)
medications (steroids)
FVE
clinical manifestions
lower extremities
edema
FVE
clinical manifestions
neck veins
distended
FVE
clinical manifestions
lung sounds
crackles
FVE
clinical manifestions
abdomen
ascites
FVE
clinical manifestions
weight
gain
FVE
clinical manifestions
RR depth
shortness of breath
FVE
clinical manifestions
BP
increased
FVE
clinical manifestions
pulse paramaters
bounding
FVE
clinical manifestions
RR
increased
FVE
clinical manifestions
pulse
increased
FVE
clinical manifestions
urine
increased
*unless renal impairment
FVE
lab values
BUN
decreased
FVE
lab values
hematocrit
decreased
FVE
lab values
serum osmolarity
decreased
FVE
lab values
oxygen levels
decreased
FVE
lab values
Xray
pulmonary congestion
FVE
medical management
IV
discontinue or KVO
KVO
keep vein open
10mL/hr
FVE medical management
symptom management
diuretics (won’t work if kidneys don’t work)
fluid restriction
sodium resirtction (OTC meds, electrolyte drinks, bottle water)
dialysis
FVE
nursing management
monitor VS, mental status, I&O, weight
reduce/restrict fluids
FVE
airway
patent airway
FVE
HOB
elevated