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Fluids & Electrolytes

Terms in this set (37)

Oncotic (colloidal) pressure
The pull exerted by substances with a high molecular weight (i.e. Colloids - albumin), which draws water towards itself, thus keeping fluid within the intravascular space
Osmotic pressure
The pull exerted by electrolytes, which draws the solvent through the semipermeable membrane. Determined by the relative number of particles on the side with the greatest concentration
osmolality
the number of osmotically active particles per kilogram of water (a measure of the osmotic pull
The osmotic pull is determined mainly by
Serum Na+
A person older in age will have a __ amount in total body water.
lower
A person younger in age has a ___ amount in total body water
higher
Cardinal rule between intake and output
should be close to or equal in 24hrs
Sensible fluid loss
fluid loss that can be measured by ordinary means.
Anti Diuretic Hormone function
Increased osmolality detected by hypothalamus which releases adh which tells the kidney to retain h20
Aldosterone
decrease in perfusion of kidney->renin=>angiotensiogen->angiotensin I-> angiotensin II->aldosterone->sodium & h20 retained
Atrial natriuretic peptide
secreted by over stretched heart, which blocks renin, which results in increased urine and na+ output
Contributing factors to fluid volume deficit
-Inadequate fluid intake (n/v insensitivity to thirsty, severe mental illness, neuro conditions, anxiety, jaws wired, oral trauma, various surgeries, NPO.
-Fluid Loss>fluid intake (prolonged or excessive vomiting, diarrhea, hemorrhage, wound, fistula, & ostomy drainage, GI suction, burns, profuse urination, perspiration r/t.
Clinical manifestations of fluid deficit
-Thirst, poor skin turgor (tenting), cracked skin & mucuous membranes, sunkey eyes
-Urine output decreased, increase in specific gravity, weight loss, orthostatic hypotension
-increased hr, weak pulse, increased resp. rate, decreased bp, decreased cap refill, decreased pulse pressure
-cold clammy skin if severe shock
-apprehension, restlessness, fatigue, lethargy, decreased loc & mentation.
Diagnostic tests fluid deficit
increased osmolarity
increased bun
increased specific gravity
serum electrolytes may be increased r/t hemoconcentration
cbc shows increased hct r/t
hemoconcentration
A decrease in the fluid content of the blood (plasma), resulting in an increase concentration. This is determined by an increase in the hematocrit. Caused by a filtration of plasma into the body tissue and often created by dehydration
Complications of fluid volume deficit
-shock
-ATN due to decreased perfusion
-increased clotting r/t increased blood viscosity
-nephrolithiasis: kidney stones
r/t waste build up.
-angina r/t decreased Cardiac output
good outcomes in treatment of fvd
-skin warm and dry
-cap refill will be less than 3 sec
- V.s. will return to pt baseline
UO will be >30-50ml/hr or 1500ml/day
Third spacing
movement of fluid into interstitium or body cavity where it becomes trapped and useless to the body
(may be localized or generalized)
places where third spacing happen
peritoneal, pericardial, pleural, synovial, general interstitium.
Third spacing is associated with
-low albumin
-increased cap permeability
(trauma, disease)
-inflammation
-lymphatic blockage
-complications (hypovolemia, hypotension, shock & death.
first phase of third spacing
-fluid moves from intravascular space -> interstitial space
-average duration 48-72 hrs
-results in dfv
second phase (resorption) of third spacing
-fluid moves from interstitium->intravascular space
-usually gradual
-may result in efv, if iv rate not decreased or if pt has chf, renal failure, pulmonary disease.
Anasarca
severe generalized edema
(entire body very edematous)
Brawny edema
(so excessive that fluid cannot be displaced, no pitting.)
management of third spacing
restore intravascular volume
-iv fluid
-iv colloids

Nursing:
same as hypovolemia & hypervolemia
-watch for abrupt (FVE) hypervolemia.
Fluid volume excess
hypervolemia - high volume of fluid in intravascular space.
Contributing factors to FVE
-fluid intake > fluid output
-excessive oral intake -mental illness
-rapid infusion of iv fluid
-heart failure, renal disease, adrenal disease
-excessive salt intake
-steroid drugs
Complications of FVE
-circulatory overload
-HTN increased force of contractions
-Pitting Edema (>= 3 L excess)
Diagnostic tests for FVE (fluid volume excess)
May have ↓serum electrolytes (esp. Na+) r/t hemodilution
↓ urine specific gravity
↓ serum osmolarity
↓ hct
Clinical Manifestations early signs of FVE
Crackles
Wt. Gain > 1kg/day
Htn, bounding pulse (may ↑ as heart fails), ↓pulse pressure
Dilute urine (unless anuric)
Dependent edema, jvd, puffy eyelids
Distended hand veins
Put hands down → veins distend
Put hands up → veins should flatten in 20 sec.
↓ activity tolerance, restlessness, fatigue
Clinical manifestations late signs of FVE
Resp. Distress, ↑resp. Rate, pulmonary edema
Pitting edema
↓ mentation, anxiety
Heart failure
Shock
Death
Management FVE
-treat underlying cause
-if r/t heart disease (chf) use 3 d's
(digoxin, diuretics, diet low na+)
-if r/t renal disease use diuretics, dialysis, fluid restriction
-restrict fluids
-restrict sodium intake
-diuretics
Nursing diagnosis of EFV
EFV r/t intake>output or decreased fluid loss in relation to intake
EFV good outcomes.
Lungs will be clear & resp. Will be nonlabored
Pt. Will lose 1 lb./day & edema will decrease
Electrolyte values will be normal
Hr. & bp will be normal
Urine output will be at least 2000 cc/day
Interventions for EFV
-Assess for s/s & response to rx.
I&o, wt. Qd, v.s., o2 sat, breath sounds, jvd, edema
-Administer meds as ordered
-Assist pt. To manage fluid restriction
(Cup of ice instead of h2o pitcher)
-Maintain & teach pt. Low na+ diet
-Avoid very sweet or dry foods r/t they cause thirst
Oral care, nursing diagnosis
altered comfort, dry mouth r/t fluid restriction.
Oral care outcome
pts mouth will be moist & pt. will deny discomfort.
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