Fluid Imbalances (Deficit & Excess) Flashcards
What is diffusion?
the movement of molecules from an area of high concentration to low concentration
What is osmosis?
the movement of water “down” a concentration gradient, that is, from a region of low solute concentration to one of high solute concentration, across a semipermeable membrane.
Another name for Colloidal Osmotic Pressure
Oncotic Pressure
Albumin is the _______ power.
Pulling
What is the result of low Albumin?
Fluid will leak into the interstitium and third space because there is no pulling power in the intravascular space
What is Colloidal Osmotic Pressure?
the osmotic pressure caused by plasma colloids (large molecules) in solution
What is Albumin?
Protein that is a major colloids in the vascular system contributing to osmotic pressure.
What is hydrostatic pressure?
the force of fluid in a compartment pushing against a cell membrane or vessel wall.
Hydrostatic pressure is the ______ power.
Pushing
An increase in hydrostatic pressure causes a shift of fluids from the __________ space into the _______ space.
(From the Heart failure example– if you have fluid backed up because the heart cannot pump it out as it should)
Intravascular, Interstitium
If you have adequate albumin levels, fluid should remain where?
Intravascular space
Two types of Fluid Volume Imbalance (FVI)
Fluid Volume Excess (FVE)
Fluid Volume Deficit (FVD)
Why would someone have FVE? (Excess) -Causes
- Excess isotonic or hypotonic IV fluids
- Heart failure (inadequate CO-backed up fluid into interstitium and lungs)
- Renal failure (inability to void/urinate)
- Primary polydipsia (drinking excess amounts of water-rare)
- SIADH (endocrine issue)
- Cushing syndrome (endocrine issue)
- Long-term use of corticosteroids (cause fluid retention)
- TACO (blood transfusion administered too quickly)
Why would someone have FVD (deficit)- Causes
- Increase in insensible water loss or perspiration (high fever, heatstroke)
- Diabetes insipidus (endocrine)
- Osmotic diuresis (diuretics that pull excess water out by osmosis–ex: Mannitol(
- Hemorrhage (internal bleeding)
- GI losses: vomiting, NG suction, diarrhea, fistula drainage
- Overuse of diuretics (example: Heart failure Pt)
- Inadequate fluid intake
- Third-space fluid shifts: burns, pancreatitis
Too much fluid in the lungs is ________ _________.
Pulmonary edema
Too much fluid in the ankles is ______ _______.
Peripheral edema
Fluid that collects in an area that serves no purpose and does not belong is called:
a) 2nd Spacing
b) Mitral Spacing
c) 3rd spacing
d) 8th spacing
c) 3rd Spacing
examples: Pleural effusion [PE], peritoneum, pericardium
Two most common Med-Surg co-morbidities in adults for FVE (excess)?
Heart Failure
Renal Failure
Who has a greater risk for FVE, especially due to heart failure?
Elderly/Older adults
Manifestations of Fluid Volume Excess
- Headache, confusion, lethargy
- Peripheral edema
- Jugular venous distention
- S3 heart sound
- Bounding pulse, ↑ BP, ↑ CVP
- Polyuria (with normal renal function)
- Dyspnea, crackles, pulmonary edema
- Muscle spasms
- Weight gain
- Seizures, coma
What part of the body does peripheral edema usually occur? Why?
Ankles, because the ankles are a “dependent” part of the body. It is harder for the blood to pump back up to the heart, especially when standing all day.
Dependent position is…
any area of the body below the level of the heart
S3 heart sound is considered what type of sound?
a) clicking
b) gallop
c) no sound
d) skipping
b) gallop
d/t overload on the heart
With regards to FVE and FVD, is the weight gain/loss due to water or nutrition?
Water weight
The feeling of thirst is a ____ mechanism
protective
_____ patients experience a ______ in their thirst mechanism
Elderly, decrease
d/t losing the trigger to drink
Who is likely to have an increased risk of dehydration?
Older adults
CO stands for?
Cardiac output
CO =
HR x SV
Stroke Volume (SV) is the amount of _____ that is ejected from the ____ ventricle every time it _____.
blood
Left
pumps
In a FVD patient, their CO will likely reflect: (circle one for each)
increase/decrease in SV
and
increase/decrease in HR
decrease = SV
increase = HR
the heart is trying to maintain the CO. if the HR is trending up, find out why!
Seizures and coma in both FVE and FVD are likely due to which imbalance?
a) calcium
b) potassium
c) sodium
d) magnesium
c) Sodium (discussed further in the Sodium section)
Daily monitoring of _____ is key to a patient’s fluid volume status and is the most reliable measure.
weight (body)
In order to obtain a reliable and consistent measure of body weight, these 3 components must stay the same:
Scale
Clothes
Time of day
_ & _ are a measure of FV, but are often inconsistent and unreliable
I & Os
Labs that are monitored because they impact FV: (4)
BUN
Na+
Hct
Urine & Serum Osmolality
What does the Urine and serum osmolality measure?
how concentrated the blood and urine are
A patient who is considered hemodiluted (too much fluid) might show what in their lab results for BUN, Na+, Hct?
a) True-low results
b) False-low results
c) False-high results
d) True-high results
B) False low lab results
A patient who is considered dehydrated (too little fluid) might show what in their lab results for BUN, Na+, Hct?
a) True-low results
b) False-low results
c) False-high results
d) True-high results
C) False high lab results
Someone who is dehydrated has an increase/decrease in plasma levels (choose one)
decrease
Nursing Management/Care for FVD patient:
1) mild– increase oral hydration
2) severe– replace volume with blood products (ex: PRBC if due to blood loss)
3) severe– replace volume with balance IV solutions (e.g., 0.9% sodium chloride or LR)
Nursing Management/Care for FVE patient:
May need to restrict fluids, especially those with heart failure, kidney disease, or liver failure
Nursing management for FV imbalances (Cardiovascular Risks):
- Monitor VS (watch for trending)
FVE: bounding
FVD: faint pulse, Tachycardic, Orthostatic hypotension, amplitude = weak/thready
Why is a FVD patient tachycardic?
the heart is trying to raise the BP and keep it WNL
Nursing Management/Care for FV imbalances (Respiratory risks):
FVE: risk for Pulmonary edema
fluid trapped in the aveoli and can cause SOB
BP is the _____measure of ____ ____.
indirect, Cardiac Output
Equation for Cardiac Output
CO = HR x SV
Nursing management for FV imbalances (Patient Safety Risk):
- Change in LOC
- Orthostatic hypertension (be sure to assist Pt)
Nursing management for FV imbalances (Skin Care Risk):
- Dry (FVD)
- Pitting edema (FVE)
Nursing management for FV imbalances (Fluid Therapy):
Know your patient!
Give fluids if deficient (HCP order dependent)
Restrict fluids if overload (HCP order dependent)
What can be delegated to UAP?
- Obtain daily weights and vital signs.
- Offer frequent oral care.
- Record accurate intake and output.
- Perform skin care and frequent position changes.
- Elevate edematous extremities.
- Encourage oral fluids as appropriate
