Fluid Volume Flashcards
Fluid balance is influenced by which three hormones?
antidiuretic hormone (ADH)-takes water from renal system and puts back into body -Renin-angiotensin-aldosterone system (RAAS)-influences how much urine and output is excreted in the body, angiotensin2 is a powerful vasoconstrictor,
-Atrial natuiuretic peptides (ANPs)
Hypovolemia
Decreased intravascular volume
Dehydration
loss of water from the body without loss of electrolytes
Results in hemoconcentration INCREASESES in hematocrit, serum electrolytes and urine specific gravity.
Hypervolemia
can lead to heart failure or pulmonary edema, this is due to the extra strain and work put on both heart and lungs
-retention of water and sodium
Overhydration
Gain of more water than electrolytes
Clinical dehydration
EFC deficit and hypernatremia combined
Volume imbalances
Too much or too little fluids with the same solute concentration
osmolality imbalances
too much or too little solutes with the same concentration of water
Clinical manifestations of Fluid Volume Deficit (FVD)
- Thirst
- Weight loss (1kg=1L)
- Dry Mucous membranes-sunken eyes,
- Oliguria-decrease in urine output
- weak, thready pulse,
- Orthostatic hypotension: >15% increase in HR and >15mmHg drop in systolic bp (or >10 mmHg drop in diastolic bp) when rising from supine to stand
- Confusion
- Decreased turgor
- decreased venous filling
Nursing assesments for FVD
- assess Intake and output
- assess cause of loss
- daily weights
- IV fluuids-requires an order
- Asses vital signs
Hyponatremia
caused by too little Na+ in the body, too much water. This is an example of a osmolality imbalance.
Causes of Hyponatremia
- gain of more salt than water by; excessive hypotonic IV fluids, tap water enemas, heart failure, SIADH-too much ADH
- loss of more salt than water caused by salt wasting disease.
Symptoms of Hyponatremia
-Musculoskeletal(occurs early in presentation):fatigue, weakness, muscle cramps
-Gastrointestinal (occurs after musculoskeletal); anorexia, nausea, vomiting, cramping, diarrhea, hyperactive bowel sounds.
-CNS (only in sever cases mEq in 120’s or rapid onset);
lethargy, confusion, seizures.
-cardiovascular; r/t hypo, hypervolemia
Nursing interventions for Hyponatremia
Monitor- I&O, daily weights, lab values, neuro status, muscle tone and strength
Treatment for Hyponatremia
- Administer PO Salt tabs, or Na+ containing fluids
- Administer IV hypertonic saline such as 3-5% saline (only if Na+ dangerously low)
- Restrict free water intake
- Replace other electrolytes lost
Hypernatremia
Too much salt in body fluids
Causes of hypernatremia
- loss of more water than salt caused by; osmotic diuresis (increased urination), and Diabetes insipidus
- Gain of more salt than water caused by; difficulty swallowing fluids, dehydration, too much salt intake (salt tabs, hypertonic saline)
Symptoms of Hypernatremia
extreme thirst, dry flushed skin
-CNS (if onset is rapid);confusion, agitation, coma, seizures.
Treatment of Hypernatremia
Oral free water intake or IV replacement of fluids
Potassium
main component of IFC, constantly excreted by kidneys and replaced by diet. 40-60 mg needed daily.
- aid in nerve impules conduction and muscle (cardiac, smooth, and skeletal) function.
- main electrolyte available at renal tubules. so K+ loss is increased when pt is given a high loop diuretic.
Hypokalemia
Serum potassium is <3.5mEq/L
loss of potassium
Causes of hypokalemia
- Diarrhea
- Vomiting
- NG tube drainage
- Medications: diuretics (lasix), corticosteroids
- Trauma: Burns, Wounds
Symptoms of hypokalemia
- Skeletal muscle; fatigue, weakness, cramps, heaviness in legs.
- Smooth muscle; decreased bowel motility, nausea/vomiting( secondary to abdominal distention), constipation.
- Cardiac muscle; irregular pulse, ectopic beats, ECG changes-flat/depressed T-waves
- Respiratory muscles; shallow, ineffective respirations.
- CNS; vertigo, drowsiness, confusion, decreased deep tendon reflex, change in mental state.
What happens if hypokalemia is left untreated?
- kidney damage
- Paralytic ileus (absent bowel sounds)
- Paralysis
- Death secondary to cardiac and respiratory arrest (muscles cease to function)
Nursing implications of Hyopkalemia
- Assess kidney function (kidnesy excrete 90% of K+); monitor output-watch for decrease in urine output
- Impaired renal function may cause k+ intoxication
Treatment of Hypokalemia
Oral Potassium supplements: cost-effective, safest method
-Dosing – 40-80 mEq/day in equally divided doses
Major S/E of K+ replacement are GI – N/V/D, bad taste
dilute in full glass H2O, juice/take with meals
sip slowly-Don’t crush enteric coated/extended release tablets
-IV Potassium Replacement; K+ is a vesicant-burns vein pathway, may cause tissue damage, assess for phlebitis frequently
-change IV site if problems maintaining flow rate occur, skin above IV site is cool, taught, and painful
-administer slowly using IV pump, max 10mEq/1hr
**NEVER GIVE K+ IV BOLUS PUSH!!!!
Hyperkalemia
Too much K+ in fluids
>5 mEq/L
Causes of Hyperkalemia
- large amounts of K+ admistration
- acute or chronic Oliguria
- potassium sparing diuretics
- hemolysis of blood sample ( always re-draw to check)
Symptoms of Hyperkalemia
Abdominal cramps
Diarrhea
CARDIAC DYSRHYTHMIAS, CARDIAC ARREST
(ski off the T—peaked T waves, early sign of hyperkalemia)
Treatment of Hyperkalemia
- IV calcium-stabilize myocardium by reducing threshold potential
- Insulin-shifts K+ from EFC into IFC
- Glucose- to avoid drop in blood sugar
- Kayexalate-pull K+ into feces,
- Potassium Wasting Diuretics
- Dialysis (last resort)
Calcium
- essential for muscle contraction
- regulates heart rate and BP
- Necessary for synaptic release of neurotransmitters for transmission of nerve impulses
- bone growth and function
- Maintains cell membrane and capillary permeability
Calcium regulation
Serum calcium level is regulated by parathyroid hormone (released from parathyroid) and calcitonin (released from thyroid)
- Release of parathyroid hormone increases serum calcium
- release of calcitonin decreases serum calcium
Vitamin D
Necessary for calcium absorption from GI tract
Hypocalcemia
<8.4 mg/dl
Too little Ca++
increases neuromuscular excitability
Causes of Hypocalcemia
-Renal failure (CKD)
-Endocrine disorders
-Hypoparathyroidism, thyroid cancer, pancreatitis
-Surgery
-Parathyroidectomy – can be life-threatening
Any neck surgery w/ injury to thyroid or parathyroids
-Vit D deficiency
-Drugs
Symptoms of Hypocalcemia
- CNS; Seizures, Paresthesias, Tetany, Positive Chvostek’s sign (contraction of facial muscles when facial nerve is tapped), Positive Trousseau’s sign (carpal spasm with hypoxia-inflate bp cuff above systolic bp to create hypoxia and carpal spasm will occur)
- CV; Cardiac dysrhythmias
- GI; N&V, Increased peristalsis
- Skeletal; Osteoporosis
Nursing interventions for Hypocalcemia
- Monitor Ca levels; report abnormals
- Observe for signs of hypocalcemia; notify MD
Treatment for Hypocalcemia
-Oral calcium
-IV calcium replacement (if emergent); IV Ca gluconate or calcium chloride
Watch for phlebitis, can cause cardiac dysrhythmia
Hypercalcemia
too much Ca++ in fluids
>10.5 mg/dl
Causes of Hypercalcemia
- Excessive intake of Vit D or calcium
- Hyperparathyroidism
- Malignancies (lymphoma, multiple myeloma)-Results in bone destruction and subsequent calcium release
Symptoms of Hypercalcemia
- CNS:Lethargy, Decreased LOC
- MS; Decreased deep tendon reflexes
- CV; Dysrhythmias,Cardiac arrest
- Renal Stones
Nursing interventions for Hypercalcemia
Implement measures to promote calcium excretion by kidneys
Treatments for Hypercalcemia
-Emergency treatment w/ IV fluids and w/ loop diuretics
-Mild cases – increase fluid intake to 3-4L/day
-Drugs:
IV Calcitonin
IV Bisphosphonates
IV Glucocorticoids
Magnesium
- helps in transmission of nerve impulses and muscular excitability,
- draws water into GI tract- stimulates peristalsis
Uses for magnesium
- treatment for eclampsia/ pre-eclampsia
- used as a laxative
- used to evacuate colon prior to procedures
Hypomagnesemia
too little magnesium in fluids
<1.5 mg/dl
Causes of Hypomagnesemia
- inadequate dietary intake due to; alcoholism, malabsorption, inflammatory bowel disease.
- excessive gastric or intestinal drainage
- renal disease
- rapid administration of blood from a blood bank
- loop diuretics
Hypomagnesemia Symptoms
- Result from increased neuromuscular excitability (similar to calcium!)
- CV: Tachycardia, Hypertension, Dysrhythmias
- CNS: Tetany-like symptoms, Hyperactive reflexes, Positive Chvostek’s and Trousseau’s
- GI: Anorexia, N&V-nausea and vomiting
Nursing interventions for Hypomagnesemia
Diet – encourage Mg in diet Green, leafy vegetables Whole grains Fish Nuts
Treatment for Hypomagnesema
Administer Magnesium – p.o., IM, IV
-IV- monitor closely, test reflexes before administering, if reflexes absent hold does, high levels Mg depress reflexes
Hypermagnesemia
Too much Mg
>2.5 mg/dl
rare!
Causes of Hypermagnesemia
- Usually R/T IV administration
- Renal insufficiency or failure
- Excessive intake of OTC antacids or laxatives containing Mg;Maalox, milk of magnesia, Mylanta, Di-Gel, epsom salts
Hypermagnesemia Symptoms
Result from decreased neuromuscular excitability
- CV; Cardiac arrest, Hypotension
- Musculoskeletal; Muscular weakness, Decreased reflexes
- CNS; Apprehension
- Integumentary; Flushing, Excessive perspiration
Nursing interventions for Hypermagnesemia
Administer IV calcium
IVF
Renal dialysis if dangerously high
Phosphates/Phosphorus
Inverse relationship to Calcium Functions: Metabolism of protein, calcium, and glucose Muscle contraction Conversion of glycogen to glucose Transportation of fatty acids Maintaining acid-base balance Acidifying urine Proper functioning of RBC’s
Hypophosphatemia
PO deficiency
<2.7 mg/dl
Causes of Hypophosphatemia
- Inadequate intake due to; Alcoholism, Hyperalimentation, Eating disorders
- Increased excretion due to; Diuresis w/ loop diuretics, Decreased absorption, Chronic diarrhea
- Chronic use of phosphate-binding antacids (Amphogel, Alternagel)
Symptoms of Hypophosphatemia
- GI-anorexia
- Musculoskeletal; weakness, bone pain
- CNS; decreased reflexes, confusion
Treatment of Hypophosphatemia
-Severe:IV potassium phosphate or sodium phosphate
-Mild;Increase dietary sources-Milk, cheese, egg yolk, meat, fish, fowl, nuts
Administer oral supplements-K-phosphate, Neutra-Phos K, Phospha-Soda
-Disadvantages of supplements
Diarrhea, volume overload, hyperkalemia
Hyperphosphatemia
Too much PO
>4.5 mg/dl
Causes of Hyperphosphatemia
-Renal insufficiency is the most common cause may also be caused by; overuse of laxatives or enemas containing PO, or increased cell breakdown caused by;Rhabdomyelosis, Trauma, burns, crush injuries,Severe infections, Cancer, Acidosis
Symptoms of Hyperphosphatemia
- CNS; twitching, tetany, Positive Chvostek’s and Trousseau’s, Confusion
- Musculoskeletal; weakness, fatigue
- CV- ECG changes, dysrhythmias, tachycardia
Treatment of Hyperphosphatemia
- Limit oral intake of foods high in phosphorus (Milk, cheese, egg yolk, meat, fish, fowl, nuts)
- Administer aluminum-based antacids (binds w/ phosphorus in GI tract)ex;Amphogel, Alternagel
- Administer diuretics
Normal Aging Changes Affecting Fluid and electrolyte balance
Decreases in; total body weight, thirst mechanism, number of glomeruli in kidneys, ability to concentrate urine, aldosterone secretion, ability to correct acid/base balance, skin elasticity, sweat glands, cardiac output, renal plasma flow, elasticity of arteries, number of alveoli, lung elasticity, muscle strength, saliva, gastric juice, calcium absorption
Possible nursing diagnoses for patients with fluid, electrolyte, and acid-base alterations
- Decreased cardiac output
- Impaired oral mucous membrane
- impaired skin integrity
- risk for injury
- acute confusion
- risk for electrolyte imbalance
- deficient fluid volume
- deficient knowledge regarding disease managment
- impaired gas exchange
- ineffective tissue perfusion
- excess fluid volume
ADH
Anti Diuretic Hormone
-released from posterior pituitary
Monitors serum osmolality and serum volume and then reabsorbs water or excretes water (urine) from kidneys based on these values
-Diuretic means to excrete or promote urine production, there fore anti-diuretic means the opposite (with holds/decreases urine production)
-Two pathologic variations can occur: SIADH and Diabetes Insipidus
SIADH
Syndrome of Inappropriate Anti-diuretic Hormone=too much ADH
- causes water which would normally be excreted by kidneys to be reabsorbed into circulation.
- Results in; decreased serum osmolality, decreases serum Na+, increased urine specific gravity
- Caused by; brain tumors, head injury, pituitary surgery
- May lead to cerebral edema and death
Diabetes Insipidus
- too little ADH
- water which would normally be reabsorbed into circulation is excreted,
- results in; increased serum osmolality, increased serum Na+, decreased specific gravity of urine.
- Caused by; transphenoidal pituitary resection for pituitary tumors
- symptoms; Excessive thirst, severely diluted urine, LOTS of urine output
