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NCM 112 MIDTERMS > Fluid Volume Disorders > Flashcards

Fluid Volume Disorders Flashcards

1
Q

Fluid Volume Deficit Disorders

A

dehydration
hypovolemia

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2
Q

Risks of Dehydration

A
  1. In ability to obtain fluid without help
  2. Inability to express feeling of thirst
  3. Highly concentrated Tube feedings
  4. Loss of fluid because of perspiration
  5. Loss of fluid through diarrhea and vomiting
  6. Inaccurate assessment of output: wearing of diapers
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3
Q

Dehydration causes:
Body may lose too much fluids from?

A

✓ Fever
✓ Excessive urine output, such as with uncontrolled diabetes or diuretic use
✓ watery diarrhea

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4
Q

Dehydration causes:
Might not drink enough fluids because of:

A

✓ Loss of appetite due to illness
✓ Sore throat or mouth sores

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5
Q

Last cause of dehydration

A

Kidney malfunction

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6
Q

Signs and Symptoms of Dehydration

A

Dry or sticky mouth
Lethargy or coma
Low or no urine output
No tears
Sunken eyes
Sunken fontanelles
Change in mental status
Dizziness
Weakness
Extreme thirst
weight loss
Physical Examination
Physical Examination
Blood pressure that drops
Delayed capillary refill
Low blood pressure
Poor skin turgor
Rapid heart rate

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7
Q

Danger Signs of Dehydration

A

• Seizure
• Impaired mental status
• Coma

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8
Q

Diagnostics for Dehydration

A

• Blood chemistries
• Blood urea nitrogen (BUN)
• Complete blood count (CBC)
• Creatinine
• Urine specific gravity

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9
Q

Other tests may be done to determine the cause of the dehydration

A

Blood sugar level to check for diabetes

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10
Q

Possible Nursing Dx for Dehydration

A

• Fluid volume deficit related to excessive output, less intake.
• Risk for ineffective tissue perfusion related to decreased blood flow.
• Risk for impaired skin integrity related to decreased skin turgor.
• Activity intolerance related to physical weakness.
• Risk for Decreased cardiac output related to a decrease in systemic vascular resistance

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11
Q

Treatment for Dehydration

A

✓ Oral Fluids: Salt Free since serum Na is elevated
✓ IV Hypotonic Solution:
• Dextrose 5% in water (D5W) in severe dehydration.
• Low Na fluids

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12
Q

Nursing Management for Dehydration:
1. Monitor ________.
2. Accurate __________.
3. Maintain ______. Monitor _______.

  1. Administer ______.
  2. Monitor _______.
  3. Insert _______.
  4. Provide ________.
  5. Obtain __________.
  6. Provide ________.
A
  1. Monitor symptoms and vital signs
  2. Accurate record the patient’s I and O
  3. Maintain IV access as ordered. Monitor IV infusions.
    • Watch out for the signs and symptoms of cerebral edema.
  4. Administer vasopressin
  5. Monitor serum sodium levels, urine osmolality, specific gravity to assess fluid balance
  6. Insert urinary catheter,
  7. Provide a safe environment
  8. Obtain daily weights
  9. Provide skin and mouth care
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13
Q

What to document in patients with dehydration?

A

• Assessment findings
• Intake, output and daily weight
• IV therapy
• Patients response to intervention
• Associated diagnostic results
• Patients teaching performed and the patient understanding.

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14
Q

Health Teachings for Dehydration

A
  1. Explanation of dehydration and its treatment
  2. Warning signs and symptoms
  3. Prescribed medications
  4. Importance of complying with therapy.
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15
Q

Hypovolemia can be?

A

Subtle as the body tries to compensate

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16
Q

Hypovolemia can progress to?

A

Hypovolemic shock

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17
Q

Causes of hypovolemia

A

Blood loss
Diarrhea and vomiting:
Large burns
Diaphoresis
Drugs
Inadequate fluid intake.
Diabetes Mellitus
Naso gastric drainage
Renal Failure with increase urination.
Hypovolemic Shock

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18
Q

Signs of Life Threatening Complications in Hypovolemia

A

Petechiae
Bruising
Bleeding
Blood oozing from the gums

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19
Q

Risks for Hypovolemia

A

Excessive fluid loss
Third Space Fluid Shifting
Third Space Fluid Shift Conditions

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20
Q

Risks for Hypovolemia:
Where does third space fluid shifting occurs in the body?

A

Abdominal cavity
pleural cavity
pericardial sac

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21
Q

Risks for Hypovolemia:
Why does third space fluid shifting occurs?

A

✓ increase permeability of the capillary membrane
✓ decrease plasma colloid osmotic pressure

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22
Q

Risks for Hypovolemia:
Third Space fluid shift can result from any number of conditions such as:

A

o acute intestinal obstruction
o acute peritonitis
o burns (during the initial phase
o crush injuries
o heart failure
o hypoalbuminia
o liver failure
o pleural effusion

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23
Q

Assessment of Hypovolemia

A

• Watch for signs and symptoms of hypovolemia and impending shock
• deterioration in mental status
• thirst
• tachycardia
• delayed capillary refill
• orthostatic hypo tension progressing to marked hypotention
• urine output
• cool,pale skin over the arms and legs
• weight loss
• flat jugular veins
• decrease
• weak or absent peripheral pulse

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24
Q

Assessment of Hypovolemia:
Urine output will be?

A

30ml/hr - below 10ml/hr

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25
Q

Assessment of Hypovolemia:
Percentages of weight loss

A

5% - 10%: Mild to moderate loss
Above 10%: Severe loss

26
Q

Typical Laboratory Findings for Hypovolemia

A

• Normal or high serum Na level
• Decrease hemoglobin levels and hematocrit level
• Elevated blood urea nitrogen (BUN) and creatinin ratio
• Increase specific gravity
• Increase serum osmolality

27
Q

Diagnostic findings that confirm Hypovolemia

A

There is no single diagnostic findings that can confirm hypovolemia

28
Q

Laboratory values of Hypovolemia

A

Laboratory values may vary depending on the underlying cause and other factors

29
Q

Treatment for Hypovolemia

A

• Replacing lost fluids - same concentration (isotonic fluids)
• Fluid challenge
• Multiple fluid challenge
• Blood transfusion
• Vasopressor
• Oxygen therapy
• Surgery

30
Q

Treatment for Hypovolemia:
Examples of Isotonic fluids

A

PNSS or PLRS

31
Q

Treatment for Hypovolemia:
Example of vasopressor

A

dopamin

32
Q

Nursing management of Hypovolemia

A

• Monitor mental status and vital signs
• Ensure patent airway
• Apply and adjust Oxygen Therapy
• Lower the head part of the bed
• If patient is bleeding?
• if BP doesn’t respond to intervention
• Maintain patent IV access:
• Administer IV fluids
• Draw blood for typing and crossmatching
• Monitor quality of peripheral pulse and skin temperature.
• Obtain diagnostic tests
• Offer emotional support to patient and family
• Encourage fluid intake as appropriate
• Insert urinary catheter as ordered.
• Auscultate breath sounds
• Monitor for increase oxygen requirement:
• Observe for development of complications such as disseminated intra vascular coagulation, MI, Respiratory distress syndrome.
• Weight patient
• Provide effective skin care

33
Q

Documentation for Hypovolemia

A

• Mental status
• Vital signs
• Strength of peripheral pulse
• Appearance and temperature of the skin
• IV therapy administered
• Blood products infused
• Doses of vasopressor used
• Breathsounds and oxygen therapy used
• Hourly urine output
• Laboratory results
• Daily weight
• Intervention and patients response
• Patient teaching

34
Q

Fluid Volume Excess Disorders

A

water intoxication
hypervolemia

35
Q

This occurs when excess fluid moves from the ECS to the ICS

A

water intoxication

36
Q

Etiology of water intoxication

A

• SIADH : Hyper secretion of the ADH
• Rapid infusion of hypotonic solution D5W.
• Excessive use of tap water as NGT irrigant
• Enema in some cases
• Psychogenic polydipsia

37
Q

Signs and Symptoms of Water Intoxication:
Increase ICP (initial s&sx)

A

• headache
• personality changes
• change in behavior and LOC
• Nausea and vomiting
• Cramping and muscle weakness
• Twitching
• Thirst
• Dyspnea on exertion
• Dulled sensorium

38
Q

Signs and Symptoms of Water Intoxication:
Increase ICP (initial s&sx)

A

• SIADH : Hyper secretion of the ADH
• Rapid infusion of hypotonic solution D5W.
• Excessive use of tap water as NGT irrigant
• Enema in some cases
• Psychogenic polydipsia

39
Q

Signs and Symptoms of Water Intoxication:
Increase ICP (late s&sx)

A

• pupillary and VS changes
• seizures and coma
• Weight gain.

40
Q

Laboratory findings for Water Intoxication

A

• Serum Na level - 125mEq/L
• Serum osmolality < 280 mOsm/Kg

41
Q

Normal serum Na level

A

135-145 mEq/L

42
Q

Normal serum osmolality

A

285-295 mOsm/kg

43
Q

Management of water intoxication

A

• Correcting the underlying cause
• Restrict oral and parenteral fluid intake
• Avoid use of hypotonic solution
• Hypertonic solution in severe situation

44
Q

Best management of water intoxication

A

prevention

45
Q

Nursing management for Water Intoxication

A
  1. closely assess his neurologic status: personality
    and LOC
  2. monitor V/S and I and O
  3. Maintain oral and IV fluid restrictions, as
    prescribed
  4. Alert the dietician and patients’ family to the
    restrictions.
  5. Post a sign in the patients room to alerts staff
    to fluid restriction
  6. Insert an IV catheter and maintain it, as
    ordered
  7. Administer diuretics as prescribe
  8. Observe patients response to therapy
  9. Weight patient
  10. Monitor laboratory tests
  11. Provide Safe Environment
  12. Institute seizure Precautions to severe cases
  13. Document assessment and intervention
46
Q

This is the excess of isotonic fluid in the extracellular compartments

A

hypervolemia

47
Q

This is usually affected in hypervolemia

A

osmolality

48
Q

Causes of Hypervolemia

A

• Excessive fluid and Na intake
• Fluid and Na retention
• Fluids shift into the intravascular spaces

49
Q

Causes of Hypervolemia:
Intervention for Excessive fluid and Na intake

A

IV replacement therapy using NSS or LR solution

50
Q

Causes of Hypervolemia:
Fluid and Na retention will result to?

A

o heart failure
o cirrhosis of the liver
o nephrotic syndrome

51
Q

Causes of Hypervolemia:
Intervention for fluids that shift into the intravascular spaces

A

Administration of hypertonic solutions

52
Q

Signs and Symptoms of Hypervolemia

A

• Increased Cardiac output
• Rapid pulse and bounding
• Blood pressure, CVP, PAP, and PAWP rises.
• Edema: hydrostatic pressure
• Weight gain
• Edema in the lungs
• The Heart Fails

• When patient raises his hand above the heart, the veins remain distended for more than 5 seconds.

53
Q

Signs and Symptoms of Hypervolemia:
What is the compensatory mechanism s&sx?

A

increased cardiac output

54
Q

Signs and Symptoms of Hypervolemia:
Progress of edema

A

o Initially: dependent areas, sacrum and buttocks.leg and feet.
o Then generalized edema or anasarca

55
Q

Signs and Symptoms of Hypervolemia:
What happens if the heart fails?

A

o BP and Cardiac output drops
o Third heart sound gallop develops
o Distended veins: head and neck

56
Q

Laboratory findings for Hypervolemia

A

• Low HCT
• Normal serum Na Level
• Low serum Potassium and BUN
• Decrease serum osmolality
• Low oxygen
• Pulmonary congestion of chest X-ray

57
Q

Management for Hypervolemia

A

• Fluid restriction and Na restriction
• Meds to prevent complication
• Treat the cause of hypervolemia
• Diuretics

58
Q

Management for Hypervolemia with pulmonary edema

A

morphine and nitroglycerin

59
Q

Management of Hypervolemia with risk for heart failure

A

digoxin
oxygen
bed rest

60
Q

Management of Hypervolemia with kidney problems

A

hemodialysis
CRRT

61
Q

Nursing Management for Hypervolemia

A

• Assess patient’s vital signs and hemodynamic status:
• Monitor respiratory patterns for worsening distress.
• Watch for distended veins
• Record I and O every hour
• Listen to breath sounds regularly
• Follow ABG result
• Monitor other laboratory test result for changes
• Raise the head of the bed
• Administer oxygen as ordered.
• Make sure the patient restricts fluids if necessary.
• Insert urinary catheter,as ordered ,
• Maintain IV access as ordered administering of too much fluid.
• Diuretics as ordered
• Watch for edema: dependent areas
• Check for S3; signs of overload; hearts apex in mitral area.
• Provide frequent mouth care
• Obtain daily weight.
• Provide skin care
• Offer emotional support to patient and family.
• Document assessment and intervention

62
Q

Signs and symptoms of Hypervolemia:
Why does weight gain occur?

A

due to fluid retention
17 oz = 1 lb wt gain

NCM 112 MIDTERMS (2 decks)

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