N300- Fluid and Electrolytes Part II

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When people are ill, _____________ can occur which can lead to life threatening conditions

fluid and electrolyte inbalances

What causes protein deficiency?

-inadequate protein intake
-protein losses (caused by certain kidney diseases)
-decreased protein synthesis (liver failure)

What would a nurse expect to assess in a pt. with protein deficiency?

-anemia
-weight loss
-suppressed immune system
-edema
-atrophy
-decreased RBC
-weakness
-delayed wound healing
-fatigue

Interventions for PROTEIN DEFICIENCY:

-diet high in CHO (want to give for body to burn and turn into energy, otherwise it will burn up the protein stores which are already low!)
-diet high in protein
-tube feeding or IV with amino acids

Fluid shifts: PLASMA to INTERSTITIAL
-what happens?

fluid moves from inside vessels to tissues/interstitial space

What causes fluid to move from plasma to interstitial space?

-increased capillary hydrostatic pressure
-decreases plasma protein
-increased capillary permeability

Manifestations of fluid shift from plasma to interstitial space:

-Edema (pitting, dependent, weeping, anasarca, other) due to the fluid being pushed out into interstitial space
-tachycardia
-decreased blood volume
-decreased BP
-urine output is concentrated

What is dependent edema?

controlled by gravity (i.e. when a person stands up and they get edema in their feet/ankles)

What is weeping edema?

When the fluid leaks through the skin, usually happens when a person has anasarca edema....

So, what is anasarca edema then?

generalized edema, all over the body

Other kinds of edema:

some locations have unique names for edema (i.e. ascites)

Plasma to interstitial shift: INTERVENTIONS-

-If shock occurs (initially an increase in HR and decrease in BP), it's an emergency
-Must replace fluid and electrolytes CAUTIOUSLY (moniter closely so they don't shift the other way!)

Now let's look at the opposite scenario: Fluid shift from interstitial to plasma-- CAUSES:

-decrease in capillary hydrostatic pressure
-increase in colloidal osmotic pressure
-re-mobilization of fluid following burns or trauma

Re-mobilization of fluid following burn or trauma:

When a person is burned, that capillary is destroyed which leads to edema, then we give IV fluids to maintain BP and hydration. When capillaries heal, fluid in vascular dept is double--- think of a burn blister: after a couple days the fluid goes away back into the vessels.

Manifestations of fluid shift from interstitial to plasma:

-HR normal range, but BOUNDING pulse
-increase in BP
-increase in urine output
-diluted urine

Interventions for fluid shift from interstitial to plasma

-If healthy heart and kidney, fluid is excreted naturally (via kidney)
-complications arise if the heart and kidney cannot handle the fluid load
-diuretics, dialysis

If you think a pt. has a fluid overload problem, what will you assess first?

the LUNGS. an increase in hydrostatic pressure causes the fluid to go out. the first place it goes is into the lungs! if a pt. has peripheral edema, they will likely have fluid in their lungs too.

What is a kind of diuretics we give?

Lasix IV Push: it works very easily, and quickly

Osmolarity

-"number of dissolved particles per unit of water"
- determines the movement of fluid inside or outside of cells based on concentration

When the amount of water decreases in relation to the # of particles, the osmolarity _________ and becomes more ____________.

When the amount of water decreases in relation to the # of particles, the osmolarity increases, and becomes more concentrated.

When the amount of water increases, relative to the solutes, the osmolarity __________, and becomes more _______________.

When the amount of water increases, relative to the solutes, the osmolarity decreases, and becomes more diluted.-

Hyper-osmolar

-Too many particles, too little water
-Results in cell shrinking-- pt. becomes dehydrated

What causes hyperosmolarity?

-decreased water intake
-extracellular solute excess

What manifestations would you expect to find in a pt. with hyperosmolarity?

-dehydration
-confusion
-dizziness
-HR increases (after a while)
-BP decreases (after a while)
-thirst

Interventions for hyperosmolarity

-eliminate the cause
-replace water orally or IV

Hypo-osmolar

-too little particles or too much water
-results in cellular swelling
-water intoxication!

What causes hypo-osmolarity?

-replacing H2O and Na+ losses with only water (this is why athletes should drink gatorade, instead of water to replenish the stuff they sweat out)
-inability to excrete urine (CRF, renal failure)

Manifestations of hypo-osmolarity:

-cells burst which would lead to edema
-moist skin
-dizziness
-HR stronger
-Kidneys increase output to try to get rid of fluid

Interventions for hypo-osmolarity:

-replace loss with Na+ and H2O (isotonic)
Utilize oral liquids with electrolyes

Isotonic conditions

-When Na+ and H2O increase or decrease todether in the same proportion
-Cells do not shrink or swell
-Volume of ECF changes but the concentration of solutes remains the same

"iso" means:

The same; or the same as blood

Isotonic deficit- What would the nurse assess?
(remember, this is when there is excess fluid loss- both water and electrolytes)

- an increase in HR
- a decrease in BP
- kidneys retaining fluid
-urine concentration

How to treat an isotonic deficit:

- treat the underlying cause
- carefully administer isotonic solutions

Isotonic dehydration is when:

the Na+ level is normal but isotonic solutions are lost

Isotonic excess

excess fluid in the vessels

What would the nurse assess in a pt. with possible isotonic excess?

-increase in BP
-bounding HR
-assess LUNGS for fluid

Treatment for isotonic excess:

restrict fluids, carefully monitor fluids, diuretics

Fluid-spacing

used to describe the distribution of body water

First Spacing

normal distribution of ICF and ECF

Second Spacing

Abnormal accumulation of fluid in interstitial space (edema)

Third Spacing

-Trapped fluid which is essentially unavailable
-A distributional shift of fluid in a space that is not easily exchanged with the ECF (peritonitis)
-Often has to be drained out by physician
-i.e. some ascites

Hypernatremia

High Na+ level caused by taking in too much salt

What would a nurse expect to assess in a pt. with possible hypernatremia?

Same as hyperosmolarity; dehydration

Interventions for hypernatremia:

-restrict sodium intake
-gradual lowering of sodium to prevent cerebral edema

Hyopnatremia

Same manifestations as hypo-osmlarity (cells swell with water)

Interventions for hyponatremia

Give an iotonic or hypertonic solution w/ hi concentration of Na+

A person who is hyponatremia is at risk for ___________.

seizures

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