Fluid Balances Flashcards
Risk Factors for Fluid Deficit?
GI Loss (vomiting, NG Suctioning, diarrhea)
Skin Loss (sweating without sodium and water replacement)
Renal System Loss (Diuretics, Kidney Disease, Adrenal Insufficiency)
Burns
Hemorrhage or Plasma Loss
Altered Intake
Excessive Sodium Intake
Prolonged Fever
Symptoms of Fluid Deficit?
Tachycardia + Weak Pulse + Hypotension + Tachypnea + Hypoxia + Dizziness + Syncope + Thirst + Dry Mouth + Decreased Cap Refill + Clammy Skin + Flattened Neck Veins + Poor Skin Turgor + Oliguria + Hyperthermia + Seizures
What should Nursing Care for Fluid Deficit look like?
Monitor I&O, Vitals, LOC, Daily Weight
Provide Oral or IV Hydration
What do pt’s with Fluid Deficit need to be educated about?
Drink plenty of fluids
Monitor I&O
Call for assistance when getting up
Change positions slowly
What Complication can be caused as a result of Fluid Deficit?
Hypovolemic Shock
What should be done to treat a pt in Hypovolemic Shock?
Administer Oxygen
Monitor O2 Sat + Vitals (Q15 min)
Provide Fluid Replacement
STAY WITH PT
What are some Risk Factors for Fluid Overload?
HF + Kidney Disease + Cirrhosis + Overdose of Fluids + Burns + Prolonged Use of Corticosteroids + Severe Stress + Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
What are the symptoms of Fluid Overload?
Tachycardia + Bounding Pulse + Hypertension + Tachypnea + Weakness + Visual Changes + Hyponatremia + Crackles + Cough + Dyspnea + Peripheral & Pitting Edema + Weight Gain + Distended Neck Veins + Increased Urine Output + Skin Cool to Touch + Pallor + Pulmonary Congestion
What should nursing care look like for a pt with Fluid Overload?
Monitor I&O + Daily Weights + Edema + Sodium & Potassium Levels
Encourage Rest
Place into Semi-Fowler’s
Fluid Restrictions
Assess Breath Sounds
What should pt’s with Fluid Overload be educated about?
Daily Weights.
Report if there’s a 2-3 lb gain in 24 hrs OR if there’s a 3 lb gain in a week.
High Sodium Diet + Read Food Labels.
Keep a record of Sodium Intake.
Adhere to Fluid Restrictions.
What Complication can be caused by Fluid Overload?
Pulmonary Edema
What are the symptoms of Pulmonary Edema?
Anxiety + Tachycardia + Neck & Hand Vein Distention + Dyspnea at rest + Crackles + Cough (With Frothy Pink Blood-Tinged Sputum)
How should Pulmonary Edema be treated?
Position the pt into High Fowler’s.
Administer O2 and Diuretics as Prescribed.
Monitor Vitals.
