Fluid Volume Disorders Flashcards

1
Q

Fluid Volume Deficit Disorders

A

dehydration
hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dehydration causes:
Might not drink enough fluids because of:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Last cause of dehydration

A

Kidney malfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Danger Signs of Dehydration

A

• Seizure
• Impaired mental status
• Coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnostics for Dehydration

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

Blood sugar level to check for diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypovolemia can be?

A

Subtle as the body tries to compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hypovolemia can progress to?

A

Hypovolemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Signs of Life Threatening Complications in Hypovolemia

A

Petechiae
Bruising
Bleeding
Blood oozing from the gums

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risks for Hypovolemia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

Abdominal cavity
pleural cavity
pericardial sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Assessment of Hypovolemia:
Urine output will be?

A

30ml/hr - below 10ml/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Assessment of Hypovolemia: Percentages of weight loss
5% - 10%: Mild to moderate loss Above 10%: Severe loss
26
Typical Laboratory Findings for Hypovolemia
• 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
Diagnostic findings that confirm Hypovolemia
There is no single diagnostic findings that can confirm hypovolemia
28
Laboratory values of Hypovolemia
Laboratory values may vary depending on the underlying cause and other factors
29
Treatment for Hypovolemia
• Replacing lost fluids - same concentration (isotonic fluids) • Fluid challenge • Multiple fluid challenge • Blood transfusion • Vasopressor • Oxygen therapy • Surgery
30
Treatment for Hypovolemia: Examples of Isotonic fluids
PNSS or PLRS
31
Treatment for Hypovolemia: Example of vasopressor
dopamin
32
Nursing management of Hypovolemia
• 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
Documentation for Hypovolemia
• 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
Fluid Volume Excess Disorders
water intoxication hypervolemia
35
This occurs when excess fluid moves from the ECS to the ICS
water intoxication
36
Etiology of water intoxication
• 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
Signs and Symptoms of Water Intoxication: Increase ICP (initial s&sx)
• headache • personality changes • change in behavior and LOC • Nausea and vomiting • Cramping and muscle weakness • Twitching • Thirst • Dyspnea on exertion • Dulled sensorium
38
Signs and Symptoms of Water Intoxication: Increase ICP (initial s&sx)
• 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
Signs and Symptoms of Water Intoxication: Increase ICP (late s&sx)
• pupillary and VS changes • seizures and coma • Weight gain.
40
Laboratory findings for Water Intoxication
• Serum Na level - 125mEq/L • Serum osmolality < 280 mOsm/Kg
41
Normal serum Na level
135-145 mEq/L
42
Normal serum osmolality
285-295 mOsm/kg
43
Management of water intoxication
• Correcting the underlying cause • Restrict oral and parenteral fluid intake • Avoid use of hypotonic solution • Hypertonic solution in severe situation
44
Best management of water intoxication
prevention
45
Nursing management for Water Intoxication
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
This is the excess of isotonic fluid in the extracellular compartments
hypervolemia
47
This is usually affected in hypervolemia
osmolality
48
Causes of Hypervolemia
• Excessive fluid and Na intake • Fluid and Na retention • Fluids shift into the intravascular spaces
49
Causes of Hypervolemia: Intervention for Excessive fluid and Na intake
IV replacement therapy using NSS or LR solution
50
Causes of Hypervolemia: Fluid and Na retention will result to?
o heart failure o cirrhosis of the liver o nephrotic syndrome
51
Causes of Hypervolemia: Intervention for fluids that shift into the intravascular spaces
Administration of hypertonic solutions
52
Signs and Symptoms of Hypervolemia
• 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
Signs and Symptoms of Hypervolemia: What is the compensatory mechanism s&sx?
increased cardiac output
54
Signs and Symptoms of Hypervolemia: Progress of edema
o Initially: dependent areas, sacrum and buttocks.leg and feet. o Then generalized edema or anasarca
55
Signs and Symptoms of Hypervolemia: What happens if the heart fails?
o BP and Cardiac output drops o Third heart sound gallop develops o Distended veins: head and neck
56
Laboratory findings for Hypervolemia
• Low HCT • Normal serum Na Level • Low serum Potassium and BUN • Decrease serum osmolality • Low oxygen • Pulmonary congestion of chest X-ray
57
Management for Hypervolemia
• Fluid restriction and Na restriction • Meds to prevent complication • Treat the cause of hypervolemia • Diuretics
58
Management for Hypervolemia with pulmonary edema
morphine and nitroglycerin
59
Management of Hypervolemia with risk for heart failure
digoxin oxygen bed rest
60
Management of Hypervolemia with kidney problems
hemodialysis CRRT
61
Nursing Management for Hypervolemia
• 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
Signs and symptoms of Hypervolemia: Why does weight gain occur?
due to fluid retention 17 oz = 1 lb wt gain