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Fluid Imbalances

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27 views28 pages

Fluid Imbalances

Uploaded by

michaeljetc
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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HYPOVOLEMIA

Loss Isotonic fluid (around the cells and vessels)


and solutes from the Extracellular space
water and electrolytes are lost in the same
proportion
EFFECT: HYPOVOLEMIC SHOCK
CAUSES
Excessive fluid loss- Abdominal surgery,
Diarrhea, Diuretic therapy, Laxative use,
Excessive sweating, Fever, Fistulas,
Hemorrhage, Vomiting, NG tube drainage,
GI suctioning
Prolonged inadequate intake of fluids
Third space shifting
Third Space Fluid Shifting
movement of fluids from intravascular to
interstitial compartment and to other body
spaces
Common sites: 3P’s: Pleural cavity, Peritoneal
cavity, Pericardial sac
Increase Capillary
HYPOVOLEMIA permeability/ Decrease
Plasma Colloid pressure
With Third Space
Shifting
Fluids moves out of the
intravascular space

Fluid shift into the abdominal


cavity ,pleural cavity, pericardial sac

Signs and sx
Causes of Third Space Shifting
Burns,
Liver and kidney disease
Acute peritonitis
Crush injuries
Hypoalbuminemia
Acute intestinal obstruction
Pleural effusion,
Sepsis, surgery
CLINICAL MANIFESTATIONS
(DEHYDRATED)
Dry mucous membranes Refill to capillaries sluggish
(greater than 3 seconds)
Early sign: increased heart
Attitude changes: restless,
rate (pulse will feel weak) confused, lethargic, and progress
Hypotension to seizures (mental status changes
means severe case of dehydration)
Young babies: sunken
Thirsty (not all patients will have
fontanelles
this)
Decreased skin turgor (skin Experience weight loss
elasticity)/ U O Diagnostic increased
CLINICAL MANIFESTATIONS
 Concentrated urine  Decrease CVP
 Cool, pale skin  Decreased BP
 Flat jugular veins
 Dizziness and weakness
Diagnostic Test
Increased Hgb and hct level
Elevated BUN and creatinine
Increased urine specific gravity and
osmolality
Increased sodium level
NURSING DIAGNOSIS
Fluid volume deficit
Altered Tissue Perfusion due to
decrease CO
NURSING INTERVENTIONS
Identify the cause or the risk
Fluid replacement small oral fluid volumes.
ORS such as Rehydralyte, Pedialyte
Weighing the patient DAILY.
Monitor I and O, VS, CVP, LOC, skin turgor,
lab result, sodium levels
NURSING INTERVENTIONS
Lower the head of the bed or Elevate the foot
of the bed
Isotonic solutions (Plain LR/ 0.9 Na Cl)
Anti emetics, Anti diarrheal drugs
Vasopressor- Dopamine
Blood transfusion- Bleeding or Hemorrhage
Oxygen
FLUID OVERLOAD
Overhydration or too much fluids in
the body
Types: Hypertonic, Hypotonic, Isotonic
TYPES OF FLUID OVERLOAD
HYPERTONIC FLUID VOLUME OVERLOAD
AKA Extracellular Fluid Volume Overlaod
Pulling of fluid from intracellular to
extracellular compartment and overloads the
extracellular compartment.
Effect: Cell shrinks
CAUSES OF HYPERTONIC FLUID
OVERLOAD
Excessive intake of sodium
Excessive administration of hypertonic IV
solutions
Hypotonic Fluid Volume Overload
AKA Water intoxication/ ICFVE
occurs due to movement of water from
extracellular to intracellular
compartment.
Effect: Cell swell and rupture
Causes of Hypotonic Fluid Overload
Hyperaldosteronism
Excessive intake of free water orally-
Polydipsia
SIADH- too much ADH
Isotonic Fluid Volume Overload
isotonic fluids excess or overload in
the extracellular compartment
(intravascular or interstitial)
Causes of Isotonic Fluid Overload

Too much isotonic IV solutions


Corticosteroids over usage
Compromised regulation of fluid
movement and excretion
CLINICAL MANIFESTATIONS
Neuro
Confusion (Early sign) headache, lethargy,
seizures and coma (late signs), Bradycardia-
widening pulse pressure- Classical sign IICP
Respiratory
Dyspnea, Crackles, increased respiratory
rate, cough (Early signs), dry, hacking cough
(can progress to frothy blood-tinged)-
CLINICAL MANIFESTATIONS
Cardiovascular
Bounding pulse, Sinus tachycardia,
hypertension, jugular venous distention (JVD)
Peripheral
Weight gain- best indicator of edema
Pitting Edema on feet and sacrum
Cool skin, ascites, liver enlargement
Diagnostics
Decreases osmolality than 280 mOsm/Kg
Decreased sodium level
Decreased Hematocrit
Decreased Urine specific gravity less than
1.010
Decreased BUN level less than 8mg/dl
Chest X Ray- Pulmonary Edema
NURSING DIAGNOSIS
Fluid Volume Excess
Impaired Gas Exchange
Altered LOC
Disturbed Body Image-least priority
NURSING INTERVENTIONS
Diuretics-DOC- loop, osmotic, thiazides
Dialysis-renal insufficiency-last resort
Restrict sodium and fluid: 1-2 L and low sodium
Assess signs of fluid overload- weights and edema
I and O- strict measurement and record.
Na+ level monitored along with other electrolytes
NURSING INTERVENTIONS
Assess LOC, oxygen saturation, VS
Safety precautionary measures
Oxygen therapy
Digoxin, Morphine and Nitroglycerine
NURSING INTERVENTIONS
ACE inhibitors and Angiotensin II
receptor blockers,
Aldactone antagonist
Monitor K

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