FLUIDS AND ELECTROLYTES Flashcards
Thid-Spacing
Third-spacing is the accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury.
The trapped fluid represents a volume loss and is unavailable for normal physiological processes.
Fluid may be trapped in body spaces such as the pericardial, pleural, peritoneal, or joint cavities; the bowel; the abdomen’ or within soft tissues after trauma or burns.
Assessing the intravascular fluid loss caused by third-spacing is difficult The loss may not be reflected in weight changes or intake and output records and may not become apparent until after organ malfunction occurs
EDEMA
Edema is an excess accumulation of fluid in the interstitial space’ it occurs as a result of alterations in oncotic pressure, hydrostatic pressure, capillary permeability, and lymphatic obstructions.
Localized edema occurs as a result of traumatic injury from accidents or surgery, local inflammatory processes, or burns.
Generalized edema, also called anasarca, is an excessive accumulation of fluid in the interstitial space throughout the body and occurs as a result of conditions such a cardiac, renal, or liver failure.
BODY FLUID
Body fluids transport nutrients to the cells and carry waste products from the cells.
Total body fluid (intracellular and extracellular) amounts to about 60% body weught in the adult, 55% in the older adult, and 80% in the infant.
Thus infants and older adults are at a higher risk for fluid-related problems than younger adults; children have a greater proportion of body water than adults,, and the other older adult has the least proportion of body water.
Body fluids consist of water and dissolved substances.
The largest single fluid constituent of the body is water.
Some substances, such as glucose, urea, and creatining, do not dissociate in solution; that is, they do not separate from their complex forms into simpler substances when they are in solution.
Other substances do dissociate; for example, when sodium chloride is in a solution, it dissociates, or separates, into 2 parts or elements.
INFANTS AND OLDER ADULTS NEED TO BE MONITORED CLOSELY FOR FLUID IMBALANCES.
Body fluid transport - DIFFUSION
Diffusion is the process whereby a solute (substance that is dissolved) may spread through a solution or solvent (solution in which the solute is dissolved).
Diffusion of a solute spreads the molecules from an area of higher concentration to an area of lower concentration.
A permeable membrane allows substances to pass through it without restriction.
A selectively permeable membrane allows some solutes to pass through without restriction but prevents other solutes from passing freely.
Diffusion occurs within fluid compartments and from one compartment to another if the barrier between the compartments is permeable to the diffusing substances.
BODY FLUID TRANSPORT - OSMOSIS
Osmosis is the movement of solvent molecules across a membrane in response to a concentration gradient,
usually from a solution of lower to one of higher solute concentration.
Osmotic pressure is the force that draws the solvent from a less concentrated solute through a selectively permeable membrane into a more concentrated solute, thus tending to equalize the concentration of the solvent.
If a membrane is permeable to water but not to all solutes present, the membrane is a selective or semipermeable membrane.
When a more concentrated solution is on one side of a selectively permeable membrane and a less concentrated solution is on the other side, a pull called osmotic pressure draws the water through the membrane to the more concentrated side, or the side with more solute.
BODY FLUID TRANSPORT - Filtration
Filtration is the movement of solutes and solvents by hydrostatic pressure.
The movement is from an area of higher pressure to an area of lower pressure.
BODY FLUID TRANSPORT - Hydrostatic pressure
Hydrostatic pressure is the force exerted by the weight of a solution.
When a difference exists in the hydrostatic pressure on two sides of a membrane, water and diffusible solutes move out of the solution that has the higher hydrostatic pressure by the process of filtration.
At the arterial end of the capillary, the hydrostatic pressure is higher than the osmotic pressure; therefore, fluids and diffusible solutes move out of the capillary.
At the venous end, the osmotic pressure, or pull, is higher than the hydrostatic pressure, and fluids and some solutes move into the capillary.
The excess fluid and solutes remaining in the interstitial spaces are returned to the intravascular Compartment by the lymph channels.
BODY FLUID TRANSPORT - Osmolality
Osmolality refers to the number of osmotically active particles per kilogram of water; it is the concentration of a solution.
In the body, osmotic pressure is measured in milliosmoles (mOsm).
The normal osmolality of plasma is 275 to 295 mOsm/kg (275 to 295 mmol/kg).
Movement of body fluid
Cell membranes and capillary walls separate body compartments.
Cell membranes are selectively permeable; that is, the cell membrane and the capillary wall allow water and some solutes free passage through them.
Several forces affect the movement of water and solutes through the walls of cells and capillaries; for example, the greater the number of particles within the cell, the more pressure exists to force the water through the cell membrane out of the cell.
If the body loses more electrolytes than fluids, as can happen in diarrhea, then the extracellular fluid contains fewer electrolytes or less solute than the intracellular fluid.
Fluids and electrolytes must be kept in balance for health; when they remain out of balance, death can occur.
Isotonic solutions
When the solutions on both sides of a selectively permeable membrane have established equilibrium or are equal in concentration, they are isotonic.
Isotonic solutions are isotonic to human cells, and thus very little osmosis occurs; isotonic solutions have the same osmolality as body fluids.
Hypotonic solutions
When a solution contains a lower concentration of salt or solute than another, more concentrated solution, it
is considered hypotonic.
A hypotonic solution has less salt or more water than an isotonic solution; these solutions have lower osmolality than body fluids.
Hypotonic solutions are hypotonic to the cells; therefore, osmosis would
continue in an attempt to bring about balance or equality.
Hypertonic solutions
A solution that has a higher
concentration of solutes than another, less concentrated solution is hypertonic; these solutions have a higher osmolality than body fluids.
Osmotic pressure
The amount of osmotic pressure is determined by the concentration of solutes in solution.
When the solutions on each side of a selectively permeable membrane are equal in concentration, they are isotonic.
A hypotonic solution has less solute than an isotonic solution, whereas a hypertonic solution contains more solute.
Active transport
If an ion is to move through a membrane from an area of lower concentration to an area of higher concentration, an active transport system is necessary.
An active transport system moves molecules or ions against concentration and osmotic pressure.
Metabolic processes in the cell supply the energy for active transport.
Substances that are transported actively through the cell membrane include ions of sodium, potassium, calcium, iron, and hydrogen; some of the sugars; and the amino acids.
Body fluid intake
Water enters the body through 3 sources—orally ingested liquids, water in foods, and water formed by oxidation of foods.
About 10 mL of water is released by the metabolism of each 100 calories of fat, carbohydrates, or proteins.
Body fluid output
Water lost through the skin is called insensible loss (the individual is unaware of losing that water).
The amount of water lost by perspiration varies according to the temperature of the environment and of the body.
Water lost from the lungs is called insensible loss and is lost through expired air that is saturated with water vapor.
The amount of water lost from the lungs varies with the rate and the depth of respiration.
Large quantities of water are secreted into the gastrointestinal tract, but almost all of this fluid is reabsorbed.
A large volume of electrolyte-containing liquids moves into the gastrointestinal tract and then returns again to the extracellular fluid.
Severe diarrhea results in the loss of large quantities of fluids and electrolytes.
The kidneys play a major role in regulating fluid and electrolyte balance and excrete the largest quantity of fluid.
Normal kidneys can adjust the amount of water and electrolytes leaving the body.
The quantity of fluid excreted by the kidneys is determined by the amount of water ingested and the amount of waste and solutes excreted
As long as all organs are functioning normally, the body is able to maintain balance in its fluid content.
Maintaining Fluid and Electrolyte Balance
Homeostasis is a term that indicates the relative stability of the internal environment.
Concentration and composition of body fluids must be nearly constant.
When one of the substances in a client is deficient— either fluids or electrolytes—the substance must be replaced normally by the intake of food and water or by therapy such as intravenous (IV) solutions and medications.
When the client has an excess of fluid or electrolytes, therapy is directed toward assisting the body to eliminate the excess.
Maintaining Fluid and Electrolyte Balance
The kidneys play a major role in controlling balance in fluid and electrolytes.
Maintaining Fluid and Electrolyte Balance
The adrenal glands, through the secretion of aldosterone, also aid in controlling extracellular fluid volume by regulating the amount of sodium reabsorbed by the kidneys.
Maintaining Fluid and Electrolyte Balance
Antidiuretic hormone from the pituitary gland regulates the osmotic pressure of extracellular fluid by regulating the amount of water reabsorbed by the kidneys.
IF THE CLIENT HAS A FLUID OR AN ELECTROLYTE IMBALANCE, THE NURSE MUST CLOSELY MONITOR THE CLIENT’S CARDIOVASCULAR, RESPIRATORY, NEUROLOGICAL, MUSCULOSKELETAL, RENAL, INTEGUMENTARY, AND GASTROINTESTINAL STATUS.
Fluid Volume Deficit
Dehydration occurs when the fluid intake of the body
is not sufficient to meet the fluid needs of the body.
The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit.
Isotonic dehydration
a. Water and dissolved electrolytes are lost in equal proportions.
Known as HYPOVOLEMIA, isotonic dehydration is the MOST COMMON type of dehydration.
Isotonic dehydration results in decreased circulating blood volume and inadequate tissue perfusion.
CAUSES OF FLUID VOLUME DEFICITS
a. Inadequate intake of fluids and solutes
b. Fluid shifts between compartments volume deficits
C. Excessive losses of isotonic body fluids
Hypertonic dehydration
Water loss exceeds electrolyte loss.
The clinical problems that occur result from alterations in the concentrations of specific plasma electrolytes.
Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces, causing cellular dehydration and shrinkage.
CAUSES OF FLUID VOLUME DEFICITS– conditions that
increase fluid loss, such as excessive perspiration,
hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage kidney disease, and diabetes
insipidus
Hypotonic dehydration
Electrolyte loss exceeds water loss.
The clinical problems that occur result from fluid shifts between compartments, causing a decrease in plasma volume.
Fluid moves from the plasma and interstitial fluid spaces into the cells, causing a plasma volume deficit and
causing the cells to swell.
CAUSES OF FLUID VOLUME DEFICITS
a. Chronic illness
b. Excessive fluid replacement (hypotonic)
c. Kidney disease
d. Chronic malnutrition
Fluid Volume Deficit
Interventions
1. Prevent further fluid losses and increase fluid compartment volumes to normal ranges.
- Provide oral rehydration therapy if possible and IV fluid replacement if the dehydration is severe; monitor intake and output.
- In general, isotonic dehydration is treated with isotonic fluid solutions, hypertonic dehydration with hypotonic fluid solutions, and hypotonic dehydration with hypertonic fluid solutions.
- Administer medications, such as antidiarrheal, antimicrobial, antiemetic, and antipyretic medications, as prescribed to correct the cause and treat any symptoms.
- Monitor electrolyte values and prepare to administer medication to treat an imbalance, if present.
Fluid Volume Excess
- Fluid intake or fluid retention exceeds the fluid needs of the body.
- Fluid volume excess is also called overhydration or fluid
overload. - The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload.
Isotonic overhydration
Known as HYPERVOLEMIA, ISOTONIC overhydration results from excessive fluid in the extracellular fluid compartment.
Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and intracellular compartments.
Isotonic overhydration causes CIRCULATORY OVERLOAD and interstitial edema; when severe or when it occurs in a client with poor cardiac function, heart failure and pulmonary edema can result.
CAUSE:
a. Inadequately controlled IV therapy
b. Kidney disease
c. Long-term corticosteroid therapy
Hypertonic overhydration
a. The occurrence of hypertonic overhydration is rare and is caused by an excessive sodium intake.
b. Fluid is drawn from the intracellular fluid compartment; the extra-cellular fluid volume expands, and the intracellular fluid volume contracts.
CAUSES;
a. Excessive sodium ingestion
b. Rapid infusion of hypertonic saline
c. Excessive sodium bicarbonate therapy
Hypotonic overhydration
Hypotonic overhydration is known as WATER INTOXICATION
.
The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
Electrolyte imbalances occur as a result of dilution.
CAUSES;
a. Early kidney disease
b. Heart failure
c. Syndrome of inappropriate antidiuretic hormone secretion
d. Inadequately controlled IV therapy
e. Replacement of isotonic fluid loss with hypotonic fluids
f. Irrigation of wounds and body cavities with hypotonic fluids
A CLIENT WITH ACUTE KIDNEY INJURY, CHRONIC KIDNEY DISEASE, AND HEART FAILURE IS AT HIGH RISK FOR FLUID VOLUME EXCESS
Fluid Volume Excess - Interventions
- Prevent further fluid overload and restore normal fluid balance.
- Administer diuretics; osmotic diuretics may be prescribed initially to prevent severe electrolyte imbalances.
- Restrict fluid and sodium intake as prescribed.
- Monitor intake and output; monitor weight.
- Monitor electrolyte values and prepare to administer medication to treat an imbalance if present.
FLUID VOLUME DEFICIT ASSESSMENTS
CARDIOVASCULAR
Thready, Increased Pulse Rate
Decreasedd blood pressure and orthostatic (postural) hypotension
Flat Neck and hand veins in dependent positions
Diminished peripheral pulses
Decreased central venous pressure
Dysrhythmias
RESPIRATORY
Increased rate and depth of respirations
Dyspnea
NEUROMUSCULAR
Decreased central nervous system activity from lethargy to coma
Fever, depending on the amount of fluid loss
Skeletal muscle weakness
RENAL
Decreased urine output
INTEGUMENTARY
Dry skin
Poor turgor, tenting
Dry mouth
GASTROINTESTINAL Decreased motility and diminished bowel sounds Constipation Thirst Decreased body weight
LABORATORY FINDINGS Increased serum osmolality Increased hematocrit Increased Blood Urea Nitrogen (BUN) level Increased serum sodium level Increased urinary specific gravity
FLUID VOLUME EXCESS ASSESSMENTS
CARDIOVASCULAR Bounding, increased pulse rate Elevated blood pressure Distended neck and hand veins Elevated central venous pressure Dysrhythmias
RESPIRATORY
Increased respiratory rate (shallow respirations)
Dyspnea
Moist crackles on auscultation
NEUROMUSCULAR Altered level of consciousness Headache Visual disturbances Skeletal muscle weakness Paresthesias
RENAL
Increased urine output if kidneys can compensate; decreased urine output if kidney damage is the cause
INTEGUMENTARY
Pitting edema in dependent areas
Pale, cool skin
GASTROINTESTINAL Increased motility in the GI tract Diarrhea Increased body weight Liver enlargement Ascites
LABORATORY FINDINGS Decreased hematocrit Decreased Blood Urea Nitrogen (BUN) level Decreased serum sodium level Decreased urinary specific gravity
FLUID VOLUME OVERLOAD Interventions
- Prevent further fluid overload and restore normal fluid balance.
- Administer diuretics; osmotic diuretics may be prescribed initially to prevent severe electrolyte imbalances.
- Restrict fluid and sodium intake as prescribed.
- Monitor intake and output; monitor weight.
- Monitor electrolyte values and prepare to
administer medication to treat an imbalance if
present.
HYPOKALEMIA
- Hypokalemia is a serum potassium level lower than 3.5 mEq/L (3.5 mmol/L)
- Potassium deficit is potentially life-threatening because every body system is affected
Causes
1. Actual total body potassium loss
a. Excessive use of medications such as
diuretics or corticosteroids
b. Increased secretion of aldosterone, such as in Cushing’s syndrome
c. Vomiting, diarrhea
d. Wound drainage, particularly gastrointestinal
e. Prolonged nasogastric suction
f. Excessive diaphoresis
g. Kidney disease impairing reabsorption
of potassium
- Inadequate potassium intake: Fasting; nothing by mouth status
- Movement of potassium from the extracellular fluid to
the intracellular fluid
a. Alkalosis
b. Hyperinsulinism - Dilution of serum potassium
a. Water intoxication
b. IV therapy with potassium-deficient
solutions
ASSESSMENTS CV Thready, weak, irregular pulse Weak peripheral pulses Orthostatic Hypotension Dysrhythmias
RESPIRATORY
Shallow, ineffective respirations that result from profound weakness of the skeletal muscles of respiration
Dimished breath sounds
NEUROMUSCULAR Anxiety, lethargy, confusion, coma Skeletal muscle weakness, leg cramps Loss of tactile discrimination Paresthesias Deep Tendon Hyporeflexiaa
GI
Decreased motility, hypoactive to absent bowel sounds
Nausea, vomiting, constipation, abdominal distention
Paralytic Ileus
LABORATORY FINDINGS
Serum Potassium level lower than 3.5 mEq/L
ECG: ST depression; shallow, flat, or inverted T wave, and prominent U wave
INTERVENTIONS
1. Monitor electrolyte values.
- Administer potassium supplements orally or
intravenously, as prescribed. - Oral potassium supplements
a. Oral potassium supplements may cause nausea and vomiting and should not be taken on an empty stomach; if the client complains of abdominal pain,
distention, nausea, vomiting, diarrhea, or gastrointestinal bleeding, the supplement may need to be discontinued.
b. Liquid potassium chloride has an
unpleasant taste and should be taken
with juice or another liquid.
4. Intravenously administered potassium
- Institute safety measures for the client experiencing muscle weakness.
- If the client is taking a potassium-losing diuretic, it may be discontinued; a potassium-sparing (retaining) diuretic may be prescribed.
- Instruct the client about foods that are high in
potassium content.
POTASSIUM IS NEVER ADMINISTERED BY IV PUSH, IM OR SUBCUTANEOUS ROUTES. IV POTASSIUM IS ALWAYS DILUTED USING AN INFUSION DEVICE.
HYPERKALEMIA
- Hyperkalemia is a serum potassium level that exceeds 5.0 mEq/L (5.0 mmol/L)
- Pseudohyperkalemia: a condition that can occur due to methods of blood specimen collection and cell lysis; if an increased serum value is obtained in the absence of clinical symptoms, the specimen should be redrawn and evaluated.
Causes
1. Excessive potassium intake
a. Overingestion of potassium-containing
foods or medications, such as potassium chloride or salt substitutes
b. Rapid infusion of potassium-containing
IV solutions
- Decreased potassium excretion
a. Potassium-sparing (retaining) diuretics
b. Kidney disease
c. Adrenal insufficiency, such as in Addison’s disease
- Movement of potassium from the intracellular fluid to the extracellular fluid
a. Tissue damage
b. Acidosis
c. Hyperuricemia
d. Hypercatabolism
ASSESSMENTS CV Slow, weak, irregular heart rate Decreased blood pressure Dysrhythmias
RESPIRATORY
Profound weakness of the skeletal muscles leading to respiratory failure
NEUROMUSCULAR
EARLY: Muscle twitches, cramps, paresthesias (tingling and burning followed by numbness in the hands and feet and around the mouth)
LATE: Profound weakness, ascending flaccid paralysis in the arms and legs (trunk, head and respiratory muscles become affected when the serum potassium level reaches a lethal level)
GI
increased motility, hyperactive bowel sounds
Diarrhea
LABORATORY FINDINGS
Serum Potassium level that exceeds 5.0 mEq/L
ECG: Tall peaked T waves, flat P waves, widened QRS complexes, and prolonged PR intervals
MONITOR THE CLIENT CLOSELY FOR SIGNS OF A POTASSIUM IMBALANCE. A POTASSIUM IMBALANCE CAN CAUSE CARDIAC DYSRHYTHMIAS THAT CAN BE LIFE-THREATENING, LEADING TO CARDIAC ARREST!
INTERVENTIOS
1. Discontinue IV potassium (keep the IV catheter patent) and withhold oral potassium supplements.
- Initiate a potassium-restricted diet.
- Prepare to administer potassium-excreting diuretics if
renal function is not impaired. - If renal function is impaired, prepare to administer sodium polystyrene sulfonate (oral or rectal route), a
cation-exchange resin that promotes gastrointestinal
sodium absorption and potassium excretion. - Prepare the client for dialysis if potassium levels are
critically high. - Prepare for the administration of IV calcium if
hyperkalemia is severe, to avert myocardial excitability. - Prepare for the IV administration of hypertonic
glucose with regular insulin to move excess potassium into the cells. - When blood transfusions are prescribed for a client
with a potassium imbalance, the client should receive
fresh blood, if possible; transfusions of stored blood
may elevate the potassium level because the breakdown of older blood cells releases potassium. - Teach the client to avoid foods high in potassium
- Instruct the client to avoid the use of salt substitutes or other potassium-containing substances.
- Monitor the serum potassium level closely when a
client is receiving a potassium-sparing (retaining) diuretic.
HYPONATREMIA
1Hyponatremia is a serum sodium level lower than
135 mEq/L (135 mmol/L).
Sodium imbalances usually are associated with fluid
volume imbalances.
CAUSES 1. Increased sodium excretion a. Excessive diaphoresis b. Diuretics c. Vomiting d. Diarrhea e. Wound drainage, especially gastrointestinal f. Kidney disease g. Decreased secretion of aldosterone
- Inadequate sodium intake
a. Fasting; nothing by mouth status
b. Low-salt diet - Dilution of serum sodium
a. Excessive ingestion of hypotonic fluids
or irrigation with hypotonic fluids
b. Kidney disease
c. Freshwater drowning
d. Syndrome of inappropriate antidiuretic
hormone secretion
e. Hyperglycemia
f. Heart failure
ASSESSMENT
CV
Symptoms vary with changes in vascular volume
NORMOVOLEMIC: Rapid pulse rate, normal blood pressure
HYPOVOLEMIC: Thready, weak, rapid pulse rate; hypotension; flat neck veins’ normal or low central venous pressure
HYPERVOLEMIC: Rapid, bounding pulse; blood pressure normal or elevated’ normal or elevated central venous pressure
RESPIRATORY
Shallow, ineffective respiratory movement is a late manifestations related to skeletal muscle weakness
NEUROMUSCULAR
Generalized skeletal muscle weakness that is worse in the extremities
Diminished deep tendon reflexes
CNS Headache Personality changes Confusion Seizures Coma
GI
Increased motility and hyperactive bowel sounds
Nausea
Abdominal cramping and diarrhea
RENAL
Increased urinary output
INTEGUMENTARY
Dry Mucous membranes
LABORATORY FINDINGS
Serum Sodium Level less than 135 mEq/L
Decreased urinary specific gravity
INTERVENTIONS:
1. If hyponatremia is accompanied by a fluid volume
deficit (hypovolemia), IV sodium chloride infusions
are administered to restore sodium content and fluid
volume.
- If hyponatremia is accompanied by fluid volume
excess (hypervolemia), osmotic diuretics may be
prescribed to promote the excretion of water rather
than sodium. - If hyponatremia is caused by inappropriate or
excessive secretion of antidiuretic hormone,
medications that antagonize antidiuretic hormone
may be administered. - Instruct the client to increase oral sodium intake as
prescribed and inform the client about the foods to
include in the diet. - If the client is taking lithium, monitor the
lithium level, because hyponatremia can cause
diminished lithium excretion, resulting in toxicity.
HYPONATREMIA PRECIPITATES LITHIUM TOXICITY IN A CLIENT TAKING THIS MEDICATION
HYPERNATREMIA
Hypernatremia is a serum sodium level that exceeds
145 mEq/L (145 mmol/L).
CAUSES
- Decreased sodium excretion
a. Corticosteroids
b. Cushing’s syndrome
c. Kidney disease
d. Hyperaldosteronism - Increased sodium intake: Excessive oral sodium
ingestion or excessive administration of sodium-
containing IV fluids - Decreased water intake: Fasting; nothing-by-mouth status
- Increased water loss: Increased rate of metabolism,
fever, hyperventilation, infection, excessive
diaphoresis, watery diarrhea, diabetes insipidus
ASSESSMENT
CV
Heart Rate and blood pressure respond to vascular volume status
RESPIRATORY
Pulmonary edema if hypervolemia is present
NEUROMUSCULAR
EARLY: Spontaneous muscle twitches; irregular muscle contractions
LATE: Skeletal muscle weakness; deep tendon reflexes diminished or absent
CNS
Altered cerebral function is the most common manifestation of hypernatremia
Normovolemic or hypovolemic: Agitation, confusion, seizures
Hypervolemic: Lethary, stupor, coma
GI
Extreme thirst
RENAL
Decreased urinary output
INTEGUMENTARY
Dry and flushed skin
Dry and sticky tongue and mucous membranes
Presence or absence of edema, depending on fluid volume changes
LABORATORY FINDINGS
Serum Sodium Level that exceeds mEq/L
Increased urinary specific gravity
INTERVENTIONS
1. If the cause is fluid loss, prepare to administer IV
infusions.
- If the cause is inadequate renal excretion of sodium, prepare to administer diuretics that promote sodium loss.
- Restrict sodium and fluid intake as prescribed.
