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fluid volume deficit and fluid volume excess
Terms in this set (58)
occur when water and electrolytes are lost or gained in equal proportion so that the osmolality of body fluids remain constant.
involves the loss or gain of only water so that the osmolality of the serum os altered.
4 categories of fluid imbalance
a. isotonic loss of water and electrolytes(fluid volume deficit)
b. an isotonic gain of water and electrolytes(fluid volume excess).
c. hyperosmolar loss of water only(dehydration)
d. hypo-osmolar gain of water only.(overhydration)
fluid volume deficit
a. decrease in intravascular interstitial or intracellular fluid in the body.
b. relatively common, may exist alone or in combination with acid base imbalance or electrolutes.
c. dehydration used interchangeably with this.
fluid volume deficit
Dry mouth/thirst (thirst center stimulated when serum osmolality increases)
High specific gravity
Fluids - oral or IV
Strict I & O
Meds - anti-diarrheals, antipyretics
b. fluid loss is not balanced by intake and the losses of water and sodium are in proportion.
c. manifested through such symptoms such as diarrhea and vomiting.
b. fluid loss is characterized by a proportionately greater loss of sodium than water.
c.result from severe and prolnged vomiting and diarrhea burns and renal disease.
d. administering IV without electrolutes as tx for dehydration increases client risk for this.
b. sodium loss is proportionately less than water loss.
c. result from health problems such as diabetes insipidus, administration of IV fluids or tube feedings with high electrolyte levels.
a shift of fluid from the vascular space into an area where it is not available to support normal physiological processes .
fluid volume deficit
result of excessive fluid losses, insufficient fluid intake or failure of regulatory mechanisms and fluid shifts within the body.
fluid volume deficit
a. caused by excessive loss of GI fluids(the most common cause) which can result from
*vomiting, diarrhea, GI suctioning, intestinal fistulas or intestinal drainage.
B. excessive renal losses of water and sodium from diuretic therapy, renal disorders or endocrine disorders.
C. Water and sodium losses during sweating from excessive exercise or increased environmental temperature.
e. chronic abuse of laxatives and/or enemas.
fluid volume deficit
other causes are:
a. inadequate fluid intake from lack of access to fluids
b. inability to request or to swallow fluids oral trauma or altered thirst mechanisms.
c. altered intake such as nothing by mouth (NPO)
d. third spacing such as peritonitis intestinal obstruction ascites burns
fluid volume deficit
dehydration causes by
Enteral feeding without sufficient water intake.
fluid volume deficit
pediatric clients could be caused by
radiant heat (phototherapy)
low birth weight infants
overuse of diuretics is most often seen in adolscents with bulimia.
primary cause in children is the rotavirus
major source of morbidity and hospitalization in children younger than 5 yrs of age.
older adults dehydration risk factors
a. physical changes of aging
-decreased total body water
-decreased lean body mass
-decreased thirst from aging medication or disease
impaired angiotensin production.
b. lack of free access to fluids
-dependency on others
c. voluntary fluid restriction to manage
-diuretic side effect
-limited physical movement due to mobility or pain issues
d.increased insensitive fluid losses
-sweating from fever or climate
-increased respiratory rate
-vomiting, diarrhea, polyuria exudative wound or fistula.
darkened urine decreased urine output
sunken eyes dry mucous membranes
dry axillae long tongue furrows
postural changes in pulse and blood pressure.
FVD s/s vital signs.
thready pulse hypotension,
decreased Central venous pressure,
tachypneic (increased respirations),
dizziness,syncope, confusion, weakness, fatigue.
FVD s/s Gastrointestinal
thirst dry furrowed tongue nausea vomiting anorexia acute weight loss.
oliguria( decreased production and concentration of urine.
urine specific gravity is high
Low urinary output
cardio FVD other signs
diminished capillary refill
cool clammy skin
flattened neck veins
poor skin turgor and tenting.
FVD possible complication
Dx / lab test FVD
A. serum electolyte panel for dehydration
-serum electrolytes, creatinine glucose test
B. serum osmolarity
- checked for dehydration increased hemoconcentration osmolarity > than 300 mOsm/l
-increased protein, blood urea nitrogen (BUN), electrolytes glucose.
C. urine specific gravity- increased concentration in dehydration.( not effective in younger dehydrated child).
D.serum sodium-increased hemoconcentration.
hematocrit (Hct) increased in hypovolemia.
FVD clinical therapies
oral rehydration-safest and most effective tx for alert clients in FVD.
IV fluids for clients unable to ingest fluids.
FVD IV fluids tx
A. isotonic electrolytes (0.9 NaCl or ringers solution)
- given for clients who are hypotensive or to replace abnormal losses which are usually isotonic in nature
B. if ringers lactate is given , it is followed by dilute saline such as 1/2 or one quarter normal saline.
c. 5% dextrose in water (D5W) or 0.45 NaCl ( one half normal saline. given to provide water to tx total body water deficits.
1.Check urinalysis, oxygen saturation, CBC and electrolytes.
2. monitor lab values (electrolytes, BUN, creatinine, osmolality, and urine specific gravity).
3.monitor and record intake and output.
4.weigh clients daily with the same scale and clothing
5.take vital signs ,CVP, and peripheral pulses volume at least q4hrs.
6.administer IV fluids using an electronic infusion pump with isotonic solutions such as lactated ringers normal saline blood transfusion.
7. monitor level of consciousness and maintain client safety.
8. reposition every 2 hrs if client is unable to move independently.
9. initiate safety precautions to avoid falls secondary to dizziness.
FVD ;client education during care and after discharge
1.teach client and family how to reduce orthostatic hypotension.
2.teach importance of maintaining adequate fluid intake ( at least 1500 ml a day).
3. teach how to prevent fluid deficit.
4. teach parents not to give diet beverages(contains no sugar). for oral rehydration because sugar facilitates sodium absorption.
5. juice and cola should be diluted to half-strnegth when given to a child who has diarrhea.
FVD nursing diagnoses
1. deficient fluid volume
2. ineffective peripheral tissue perfusion related to hpovolemia.
3. risk for injury related to postural hypotension
5. activity intolerance.
how to reduce orthostatic hypotension
a. move from one position to another in stages. ex. raise the head of the bed before sitting up and sit for a few minutes before standing.
b. avoid prolonged standing
c. rest in a recliner rather in bed during the day.
d. use assistive devices to pick up objects from the floor rather than stooping.
how to prevent fluid deficit
a. avoid exercising during extreme heat
b. increase fluid intake during hot weather
c. if vomiting take small frequent amounts of ice chips or clear liquids such as flat cola or ginger ale.
d. reduce intake of coffee tea and alcohol which increase urine output and can cause fluid loss.
fluid volume excess
a. result when both water and sodium are retained in the body.
b. may be caused by fluid overload(excess water and sodium intake )
c. or caused by impairment of the mechanisms to maintain homeostasis leading to excess intravascular fluid (hypervolemia) and excess interstitial fluid (edema)
abnormal increase in the volume of blood plasma (liquid part of the blood and lymphatic fluid) in the body
abnormally low circulating blood volume
Destruction of blood (breakdown of red blood cells with release of hemoglobin).
extracellular fluid volume excess
a. occurs when there is too much fluid in the extracellular compartment (vascular and interstitial).
b. saline excess or extracellular volume overload.
interstitial fluid volume excess
is also called edema
b. is an abnormal increase in the volume of the interstitial fluid.
c. it may be caused by an extracellular FVE.
net result of forces that tend to move fluid in opposing directions.
is caused by these 4 alterations in fluid balance.
a. increased blood hydrostatic pressure.
b. decreased blood colloid osmotic pressure.
c. increased instertitial fluid osmotic pressure.
d. blocked lymphatic drainage.
causes swelling localized or generalized may cause pain or restrict motion.
b. result from extracellular fluid volume excess
c. or right sided heart failure occurs in dependent portion of the body, often observed in ankles. scrotal area or sacral area for patients in supine postion.
d. it often appears thin and shiny over an edematous area.
FVE risk factors
conditions such as
a. chronic stimulus to the kidney such as heart failure, cirrhosis, increased glucocorticosteroids).
b. abnormal renal function with reduced excretion of sodium and water (renal failure).
c. interstitial to plasma fluid shifts ( hypertonic fluids, burns).
d. age related changes in cardiovascular and renal function.
e. excessive sodium intake.
f. hypertension, diabetes, preeclampsia.
FVE vital signs s/s
tachycardia full bounding pulse
increased central venous pressure.( >11-12 cm of water).
FVE neuromusculoskeletal s/s
confusion, muscle weakness, headache.
FVE respiratory s/s
dyspnea, orthopnea, crackles, diminished breath sounds. cough, if severe pulmonary edema.
FVE gastrointestinal s/s
weight gain (5% over body weight ) over a short period of time
FVE other S/s/
edema, peripheral edema, cerebral edema, distended neck veins and peripheral veins, pale and cool skin,
-decreased hematocrit and BUN.
is not only a potential cause of fluid volume excess,
it is also a potential complication of the condition if the heart is unable to increase its workload to handle the excess blood volume.
severe fluid overload and heart failure
can lead to pulmonary edema , a medical emergency.
Dx Fluid volume excess
a. serum electrolytes (sodium are within expected range)
serum osmolarity- less than 270 mOsm/l
b. serum hematocrit and hemoglobin- often are decreased because of plasma dilution from excess extracellular fluid.
c. renal and liver function test (serum creatinine, BUn, liver enzymes) are decreased.
d.respiratory alkalosis- decreased PACO2 less than 35 mm Hg, increased PH >7.45.
Dx procedures of FVE
chest x-ray reveals possible pulmonary congestion.
FVE pharmacologic therapy
diuretics commonly used to treat fluid volume excess.
-it inhibits sodium and water reabsorption increasing urine output
3 major classes of diuretics
a. loop diuretics
b, thiazide -type diuretics
c. potassium-sparing diuretics
it acts in the ascending loop of henle.
which act on the distal convoluted tubule
which affest the distal nephron.
1.weigh the client daily
2. maintain intake and output records
3.administer oral fluids carefully
4. perform oral hygiene at least every 2 hours.
5.teach client and significant others about sodium-restricted diet.
6.administer prescribed diuretics and monitor response to therapy.
7.report significant changes in serum electrolytes. and osmolality, CBC and chest x-rays.
8. teach client how to self-administer diuretics after discharge
9. reposition client every 2 hours
10. provide a low pressure alternative mattress, foot cradle, heel protectors, and other devices to reduce pressure on tissues.
11. place in fowler position if dyspnea or orthopnea is present.
12. monitor oxygen saturation and arterial blood gas results
13. elevate area of edema if possible to encourage fluid reabsorption into extracellular fluid compartment.
14. auscultate lung sounds(listen for crackles)
15. monitor vital signs and heart rhythm
FVE client teaching
low sodium diet
1. reduce sodium intake helps the body to excrete excess sodium and water.
2. body needs less than one tenth of a tsp of salt per day.
3. 1/3 of sodium intake comes from salt added to foods during cooking and at the table, 1/4 to 1/3 comes from food and water naturally high in sodium.
4. many nonprescription drugs such as analgesics cough medicine laxatives antacids toothpaste mouthwash contains high amounts of sodium
5. low sodium salt substitutes are not really sodium free; may contain half as much sodium as regular salt.
6. use salt substitute sparingly, larger amts taste bitter instead of salty.
7. preference of salt will eventually diminish, read labels
8. in place of salt substitute use herbs spices lemon juice vinegar and wine as flavoring when cooking/
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