Fluid and Electrolytes

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Fluid and Electrolytes

• CSON
• Spring 2009
• PREPARED BY CARLA HILTON, MSN, RN
• PRESENTED AND REVISED BY REBECCA POWERS, MSN, RN
• 15 questions from all of powers stuff

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Water Balance Homeostasis

• Water in the body is used to or for
• Transporting nutrients oxygen to cells
• Removing waste from cells
• Provides medium in which electrolyte
  chemical reactions can occur
• Regulation of body temperature
• Lubricates joints and membranes
• Provides medium for food digestion
• liter of water weighs 2.2 lbs
• The most accurate way to measure fluid status in
  a person is daily weights, not IO!!!

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Water Distribution

• ICF Intracellular fluid
• ECF Extracellular fluid (lymph system,
  interstitial fluid, intravascular fluid or
  plasma)
• TCF Transcellular fluid (cerebral spinal fluid,
  fluid in joints, GI tract, and peritoneal fluid)
• Third spacing (a condition where fluid
  accumulates in a pocket that isnt really serving
  a purpose. Acieties (sp?)- where fluid hangs out
  in your abd. The fluid is coming from somewhere
  else.)
• More fluid in intracellular than anywhere else in
  the body!

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Osmolarity / Osmolality

• Osmole
• the amount of substance that dissociates in
  solution to form one mole of osmotically active
  particles
• Concentration of solution measured in osmoles

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Osmolarity / Osmolality

• Osmolality is measured in milliOsmols/Kg
  (mOsm/Kg)
• Osmolarity is measured in milliOsmols/L (mOsm/L)
• Evaluates serum and urine in clinical practice
• Normal serum osmolality 275 295 mOsm/K
• Lality total volume will equal 1 L plus the
  amount of volume taken up by the solids! The
  koolaid and water equal a L
• Larity volume is going to be less than 1 L. The
  koolaid minus the water.

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Concentrations of Solutions

• Isotonic Same osmolarity as blood plasmano
  osmotic pull
• Hypotonic Less concentration than blood
  plasmalower osmotic pressure
• Hypertonic More concentration than blood
  plasma.higher osmotic pressure

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Movement of Water

• Intracellular extracellular approximately same
  osmolality
• Solvent (water) and solutes (electrolytes)
• move across selectively permeable membranes
  (compartments) in the body
• (the bigger the particle, the slower they move,
  and they may need a little boost)

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Review of Terms

• Osmosis
• Diffusion
• Active transport
• Passive transport
• Filtration
• Hydrostatic pressure

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Osmosis Review

• Movement of water only
• Speed of movement affected by
• temperature of fluid
• concentration of fluid
• electrical charge of particles in solution
• The higher the solute concentration, the greater
  the osmotic pressure is.

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Other Mechanisms of Movement

• Diffusion Solute (or gas) moves from area of
  higher concentration to area of lower
  concentration
• Facilitated diffusion Solute moves against
  concentration gradient (passive transport)
• Active transport Solute moved against
  concentration gradient using ENERGY

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Active Transport

• Na/K pump Maintains the higher concentrations
  of extracellular Na and intracellular K
• In the cell, K is King. i.e. K is the major
  cation of the cell, Na is outside the cell.

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Continued

• Filtration solutes solvent move together in
  response to fluid pressure moves from area of
  high pressure (hydrostatic pressure) to area of
  low pressure
• Hydrostatic pressure The force within a fluid
  compartment (as in the vascular system) The
  pressure that forces the fluid out of your
  capillaries.
• Colloidal Osmotic Pressure pulls it back into
  the capillaries.

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Regulation of Body Fluids

• Intake osmoreceptors sense osmolality of
  serum, signals the hypothalamus, stimulates
  thirst
• Impact on intake Age (decreases desire to
  drink), conciousness, ability to take in fluids
• Output kidneys, lungs, GI tract, skin
• Sensible measurable.urine output,
  excessive perspiration, diarrhea, vomiting
• Insensible immeasurablenormal
  perspiration, normal breathing
• Output for adults should be one mL/kg (of body
  weight) an hour

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Role of the Kidneys

• Filter approx 180 Liters of blood per day GFR
  (glomerular filtration rate)
• Produces urine between 1-2 Liters/day
• If loss of 1 to 2 of body water, will conserve
  water by reabsorbing more water from filtrate
  urine will be more concentrated
• If gain of excess body water, will excrete more
  water from filtrate urine will be more diluted

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Hormonal Control

• Antidiuretic hormone (ADH) Prevents diuresis
  water saving
• Question Osmoreceptors sensing a/an increase in
  osmolality will cause the release of ADH
• ADH acts on kidneys via the renal tubules. Makes
  them more permeable to water. The water will move
  from the tubes back into your body.

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Hormonal Control

• RAA (Renin-angiotensin-aldosterone) cascade
  initiated by decrease in renal perfusion or low
  Na
• If extracellular volume is decreased
  renal perfusion decreases renin secreted
  by kidneys renin acts to produce
  angiotensin I which then converts to angiotensin
  II results in massive vasoconstriction
  increases renal arterial perfusion and
  causes increased thirst, a release of aldosterone
  (causes the retention of Na and Water)

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Hormonal Control

• Aldosterone
• Angiotensin II causes the adrenal gland to
  release aldosterone
• Aldosterone causes the kidneys to retain Na and
  water
• Volume regulator.released if Na is low and K
  is high increases reabsorption of Na (where
  salt goes, water follows) and the excretion of K

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ANP

• Atrial Natriuretic Peptide (ANP) secreted from
  atrial cells of heart (in response to too much
  volume in the blood)
• acts as diuretic
• inhibits thirst mechanism
• suppresses the RAA cascade

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Thirst Mechanism

• Regulated by the hypothalamus
• Stimulates thirst
• increased osmolality of ECF
• decreased ECF
• dry mucous membranes
• Causes eating salty foods, inadequate intake,
  excessive water loss

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Pressure Sensors

• Baroreceptors Nerve receptors that sense
  pressure in blood vessels (think barometer
  measures pressure in the atmosphere, this
  measures pressure in the blood vessels)
• Low pressure sensors in the cardiac
  atria stimulate SNS (sympathetic nervous system)
  inhibits PSNS (parasympathetic nervous system)
  (sns will increase heart rate and BP)
• High pressure sensors in the aortic
  arch, carotid sinus, and the juxtaglomerular
  apparatus in the kidney stimulates PSNS and
  inhibits the SNS (psns will decrease your heart
  rate and lower BP)

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Pressure Sensors

• Osmorecptors Sense Na concentration
• Positioned on surface of hypothalamus
• Increase in Na concentration stimulates release
  of ADH
• Decrease in Na concentration inhibits release
  of ADH

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• ELECTROLYTES and OTHER LABS RELATED TO FLUID
  VOLUME STATUS

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Electrolytes

• Minerals and salts electrolytes
• Cations Positively charged sodium, potassium,
  calcium, magnesium
• Major cation in ECF is sodium
• Anions Negatively charged chloride,
  bicarbonate, sulfate
• Major cation in ICF is potassium

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HyponatremiaUsually loss of Na w/o loss of fluid

• Physical Exam
• Apprehension
• Personality change
• Postural hypotension
• Tachycardia
• Convulsions/coma
• NVD
• Anorexia

• Causes
• Salt wasting fr. Kidney
• Adrenal insufficiency
• GI losses
• Profuse sweating
• Diuretics
• SIADH
• Syndrome of inappropriate Anti-Diruetic Hormone
• Inadequate Na intake

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Hyponatremia contd

• Labs
• Serum Na below 135 mEq/L
• Serum Osmolality below 280 mOsm/kg
• Urine specific gravity below 1.010

• Treatment
• Restrict water
• Sodium replacement

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Hypernatremia

• Causes
• ? ingestion of salt
• Iatrogenic (we caused it)
• ? aldosterone
• Water deprivation

• Signs Sxms
• Thirst, sticky tongue
• Dry, flushed skin
• Fever
• Convulsions, irritability

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Hypernatremia contd

• Labs
• Serum Na above 145 mEq/L
• Serum Osmolality above 295 mOsm/kg
• Urine specific gravity above 1.030

• Treatment
• Hypotonic IV solution
• or D5W

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Urine Na Studies

• Urine Na
• Assesses volume status
• Aids in diagnosing hyponatremia acute renal
  failure
• Random normal range 50 -130 mEq/L
• 24 hour 75-200 mEq/L

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Hypokalemia

• Causes
• Diuretics that waste potassium
• D, V, gastric suction
• ? aldosterone
• Polyuria, sweating
• Iatrogenic K poor solutions

• Signs Sxms
• Weakness, fatigue
• ? muscle tone
• Hypoactive bowel sounds and distention
• Weak, irregular pulse
• Paresthesias
• SOMETHING ABOUT CARDIAC FUNCTION

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Hypokalemia contd

• Labs
• K below 3.5 mEq/L
• ECG abnormalities

• Treatment
• Oral K or IV solution w/K
• Increased dietary K

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Hyperkalemia

• Causes
• Renal failure
• Fluid vol. deficit
• Massive cellular injury (trauma/burns)
• Iatrogenic
• Potassium sparing diuretics
• Addisons disease

• Signs Sxms
• Anxiety
• Dysrrhythmias
• Paresthesia (numbness, pins needles feeling)
• Weakness
• Diarrhea

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Hyperkalemia contd

• Labs
• Serum K above 5.0 mEq/L.
• ECG abnormalities can lead to arrest (if too
  high or too low)

• Treatment
• Kayexalate
• IV Na bicarb
• IV Ca gluconate
• Regular insulin and hypertonic dextrose IV
• Limit via diet
• Possible dialysis

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Hypocalcemia

• Causes
• Rapid admin of blood w citrate
• Hypoalbuminemia
• Hypoparathyroidism
• Vit. D deficiency
• Pancreatitis
• Stuff that relates back to preexisting conditions

• Signs Sxms
• Numbness, tingling of fingers mouth
• Hyperactive reflexes
• Tetany- a muscle contraction that stays
  contracted
• Muscle cramps
• Pathological fractures

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Hypocalcemia contd

• Labs
• Serum Ca below 4.5 mEq/L
• ECG abnormalities

• Treatment
• Increase dietary intake
• IV calcium gluconate
• Ca vit D supplements

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Hypercalcemia

• Causes
• Hyperparathyroidism
• Osteometastasis
• Pagets disease
• Osteoporosis
• Prolonged immobilization

• Signs Sxms
• Anorexia, N V
• Weakness, lethargy
• Low back pain (stones)
• Decreased LOC
• Personality changes
• Cardiac arrest

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Hypercalcemia contd

• Labs
• Serum Ca above 5.5 mEq/L
• X-rays showing osteoporosis
• Stones ? BUN / creatinine fr. FVD or renal
  damage

• Treatment
• Lasix (diuretic)
• Increased fluids

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Hypomagnesemia

• Causes
• Inadequate intake
• Alcohol, Malnutrition
• Inadequate absorption
• VD, Gastric aspirate
• Fistulas, Sm. Bowel
• Loss fr. Diuretics
• Polyuria

• Signs Sxms
• Tremors
• Hyperactive deep tendon reflexes
• Confusion
• Dysrhythmias

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Hypomagnesemia contd

• Labs
• Serum Mg below 1.5 mEq/L

• Treatment
• Mag sulfate IV
• Oral replacement
• Increase dietary intake

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Hypermagnesemia

• Causes
• Renal failure
• Excess intake of magnesium

• Signs Sxms
• Most frequently seen in acute
• Hypoactive deep tendon reflexes drowsiness
• Decreased depth and rate of resp.
• Hypotension
• flushing

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Hypermagnesemia contd

• Labs
• Serum Mg levels above 2.5 mEq/L

• Treatment
• IV calcium gluconate
• Loop diuretics
• NS or LR IV solutions
• Dialysis

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Additional Lab Data

• Hematocrit
• Measures the volume of RBCs in whole blood
• Normal M 40-50 F 37-47
• Increases with dehydration (hemoconcentration)
• Decreases with overhydration (hemodilution)

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Hematocrit Fluid Volume StatusFrom Fluids
Electrolytes Made Incredibly Easy 4th ed.
Fluids Electrolytes Made Incredibly Easy
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Lab Data (contd)

• Blood urea nitrogen (BUN)
• Measures kidney function
• Normal range 7-20mg/dL
• Varies with protein intake, fever, dehydration,
  GI bleeding, liver failure, etc.

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Lab Data (contd)

• Creatinine
• End product of muscle metabolism
• Better indicator of renal function than BUN
• Doesnt vary w protein intake or metabolic state
• Normal range 0.7-1.5mg/dL in 24 hr urine
  collection
• Serum adult female 0.5 to 1.1mg/dL
• adult male 0.6 to 1.2mg/dL

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Lab Data (contd)

• Urine Specific Gravity
• Measures ability of kidney to excrete or
  conserve water
• Normal range 1.010 - 1.025
• Increased S.G. concentrated urine
• Decreased S.G. dilute urine

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Lab Data (contd)

• Serum Osmolarity
• Most accurate for kidney function
• Remember norm?
• 280-295 mOsm/L
• Measured directly through blood
• Indirectly using Serum Osmolarity Formula

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Maintaining Fluid Balance
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Fluid Imbalances

• Isotonic
• Deficit water, electrolytes and solutes lost in
  equal proportions to body solutions
• Excess water, electrolytes and solutes gained
  in equal proportions to body solution
• FVD - fluid volume deficit-HYPOVOLEMIA
• FVE - fluid volume excess-HYPERVOLEMIA

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Fluid Disturbances

• Osmolar Imbalances
• Hyperosmolar Dehydration
• Hypoosmolar Water excess
• Loss or excesses of water only
• Leads to alteration in concentration of serum

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• ISOTONIC FLUID DISTURBANCES

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Fluid Volume Deficit (FVD)

• Water AND solutes lost in equal proportion.
• Diarrhea, vomiting, fistulas, drains
• Bleeding, burns
• Fever, excessive perspiration
• Inadequate fluid intake
• Diuretics
• GI suctioning

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FVD Signs Symptoms

• Mild
• Dry mouth, furrowed tongue
• Orthostatic or postural hypotension
• Restlessness anxiety
• Tachycardia
• Less than 5 weight loss

• Moderate
• Confusion, irritability, thirst, cool clammy
• Urine output 30cc/hr or less
• Rapid weight loss
• Slowed vein filling

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FVD Signs Symptoms (contd)

• Severe
• Pale
• Flattened neck veins, delayed capillary refill
• Urine output less than 10cc/hr
• Marked hypotension, tachycardia, weak or absent
  pulses (shock)
• Can lead to unconsciousness

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FVD Labs

• Lab findings vary depending on the cause
• Decreased H/H with hemorrhage
• Increased Hct
• Elevated BUN
• Urine specific gravity greater
• than 1.030

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FVD Nursing Diagnosis Statement

• Example
• Fluid volume deficit r/t active fluid volume loss
  as evidenced by decreased blood pressure (90/50
  mmHg), thirst, fever (102), rapid heart rate
  (110 bpm), urine output less than or equal to 25
  mL/hr, urine specific gravity of 1.040.

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FVD Goal Statement

• Client will achieve fluid balance AEB
• urine output equal to or greater than 30 mL/hr
• Elastic skin turgor and moist mucous membranes

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FVD Medical Interventions

• Treat cause
• Replacing fluids intravenously
• isotonic if hypotensive (expand plasma
  volume)
• hypotonic if normotensive (provides
  electrolytes and water)
• Encourage fluids
• Ensure adequate O2 and perfusion
• Increase blood counts, BP, albumin levels
• Teaching

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FVD Nursing Interventions

• Ensure patent airway, adjust O2 levels as ordered
• Lower HOB if tolerated or not contraindicated
• Direct pressure to bleeding, if present
• Administer meds, blood, albumin, IV fluids

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FVD Nursing Interventions (contd)

• Weigh patients daily
• Provide skin care
• Maintain strict IO
• Monitor vital signs
• Monitor lab work

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FVD Teaching

• Nature of condition causes
• Warning S/S
• Treatments importance of compliance
• Change positions slowly
• Monitor BP pulse rate
• Give prescribed medications

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Fluid Volume Excess (FVE)

• Water AND solutes gained in excess of normal body
  levels
• Causes
• Isotonic fluid overload
• Excess sodium intake
• CHF, renal failure, cirrhosis
• Increase in steroids or serum aldosterone

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FVE Signs Symptoms

• Generalized
• Acute weight gain
• Mild-mod 5-10
• Severe gt 10
• Edema
• dependent, sacral, pulmonary

• Cardiovascular
• Tachycardia, bounding pulse, distended neck
  veins, increased BP
• Respiratory
• Dyspnea, tachypnea, crackles, frothy cough

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FVE Lab Values

• Decreased hematocrit
• Decreased BUN
• Low O2 levels

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FVE Nursing Diagnosis Statement

• Fluid volume excess r/t excess fluid intake aeb
  Hct of 23, 10 weight gain in two days, dyspnea
  (Pt states, I cant get enough air.), and
  crackles on inspiration and expiration in all
  lobes.

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FVE Related Nursing Diagnoses

• Ineffective breathing pattern r/t increased
  fluids
• Impaired skin integrity r/t excess fluids
• Confusion

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FVE Client Goals Outcomes

• Aimed at cause
• Decrease circulating fluid volume
• Lower BP and pulse
• Improve breathing status
• Maintain skin integrity
• Teaching

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FVE Goal Statement

• Client will achieve fluid balance manifest in
  following outcomes
• Clear breath sounds
• Denies dyspnea and affirms the ability to breathe
  adequately

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FVE Nursing Interventions

• Restrict Na fluid intake
• Watch for edema - dependent respiratory
• Provide measures to facilitate breathing
• Provide skin care for weeping edema

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FVE Nursing Interventions (contd)

• Monitor response to medications
• Accurate I/O, Consistent daily weight, VS,
  monitor labs
• Advise HCP if poor response to therapy
• Hemodialysis may be needed

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FVE Teaching

• Nature of condition and causes
• Signs and symptoms
• Treatments and importance of compliance
• Need to monitor BP, P, O2 Sat, weight
• Rationale for Na and fluid restrictions
• Medications

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Osmolar Imbalances
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Hyperosmolar Dehydration

• Loss of water increased serum osmolality
• increased serum Na
• Compensatory Mechanism water shifts out of cells
  (ICF) into the ECF..if not corrected, water
  continues to move out of cells (ICF) and into ECF
  causing the cells to shrink.shrunken cells dont
  function properly!!

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Causes of Dehydration

• Causes
• Diabetes insipidus, prolonged fever, watery
  diarrhea, hyperglycemia, failed thirst drive
• Iatrogenic hypertonic solutions (IV tube
  feeding)
• Diuresis of water alone

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Dehydration Signs Symptoms

• Irritability, confusion, weakness, dizziness
• Decreased urine output, darkened urine
• Dry, sticky mucous membranes, sunken eyeballs,
  poor turgor, extreme thirst !!!
• Fever (insensible continuous)
• Coma
• Tachycardia, weak, thready pulse, hypotension

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Dehydration Labs

• Elevated hematocrit
• Elevated serum osmolarity gt 295 mOsm/kg
• Elevated serum sodium gt 145 mEq/L
• Urine specific gravity gt 1.030

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Dehydration Nursing Diagnoses

• Fluid volume deficit r/t fluid loss
• Deficient fluid volume r/t excessive fluid loss
  from GI tract
• Risk for impaired skin integrity r/t altered
  metabolic state
• If youve lost 20 of you initial weight from
  dehydration, youre probably dead

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Dehydration Potential Nursing Diagnoses

• Deficient knowledge unfamiliarity of disease
  process
• Disturbed thought processes r/t neurologic
  changes / decreased cardiac output
• Decreased cardiac output r/t excessive fluid loss

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Dehydration Client Goals Outcomes

• Aimed at correcting cause
• Replace fluids hypotonic, slowly re-hydrate
  over 48 hrs (if you go too quickly, you die)
• Maintain skin integrity
• Teaching

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Dehydration Nursing Interventions

• Replace fluids by PO route first
• SLOW admin. of salt-free IV solutions
• Monitor S/S cerebral pulmonary edema
• Monitor accurate I/O, VS, daily weights
• Monitor labs
• Provide skin and mouth care

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Dehydration Teaching

• Disease process of dehydration
• Treatments
• Warning signs and symptoms
• Medications / IV (Vasopressin D5W)
• Importance of compliance with therapy
• Fluid intake not based on thirst alone

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Hypoosmolar

• Water excess
• Causes
• SIADH or excess water intake
• Signs Sxms
• Decreased LOC, convulsions, coma
• Labs
• Serum Na below 135 mEq/L and Serum osmolality
  below 280 mOsm/kg

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Nsg Dx Goals - Interventions

• Similar to FVE
• Make relevant to underlying cause
• Is very acute illness

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Physical Assessment
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History

• Medical Acute Illness, surgery, burns
• Environment exercise, hot/cold/dry areas
• Diet proteins, lytes, fluids
• Lifestyle smoking/alcohol
• Medication history

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Areas of Concern in PA

• Mental status
• BP and pulse
• Skin
• I Os WEIGHT
• Lungs

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Geriatric Focus

• Body-water content (mass related)
• Kidney function
• Cardiac respiratory function
• Hormonal regulatory function
• Thirst sensation
• Medication Use
• Skin subcutaneous fat

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Assessment of Geriatric Clients

• Skin turgor
• Assessment is performed where?
• Cognition
• Physical being
• Continence

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Laboratory Data

• BMP / CMP
• Serum osmolarity
• Urine specific gravity
• Urine sodium
• Hematocrit
• Blood urea nitrogen (BUN)
• Creatinine

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Clients at Risk for FE Imbalances

• Age
• Very young
• Very old
• Chronic Diseases
• Cancer
• Cardiovascular disease, such as congestive heart
  failure
• Endocrine disease, such as Cushing's disease and
  diabetes

• Malnutrition
• Chronic obstructive pulmonary disease
• Renal disease, such as progressive renal failure
• Changes in level of consciousness

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Clients at Risk for FE Imbalances

• Trauma
• Crush injuries
• Head injuries
• Burns
• Major surgery
• Therapies
• Diuretics
• Steroids
• Intravenous (IV) therapy
• Total parenteral nutrition (TPN)

• Gastrointestinal losses
• Gastroenteritis
• Nasogastric suctioning
• Fistulas

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Fluid Electrolytes Nursing DXs

• Risk for imbalanced Body temperature
• Ineffective Breathing pattern
• Decreased Cardiac output
• Deficient Fluid volume
• Risk for deficient Fluid volume
• Excess Fluid volume
• Impaired Gas exchange

• Knowledge deficient regarding disease management
• Impaired Mobility
• Impaired Oral mucous membrane
• Impaired Skin integrity
• Risk for impaired Skin integrity
• Ineffective Therapeutic regimen management
• Impaired Tissue integrity
• Ineffective Tissue perfusion

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Intravenous Fluid Therapy in Fluid Balance
Disorders
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ISOtonic solutions

• Same osmolarity as body fluids
• 280 - 300 mOsm/kg
• Expands the IVC without pulling fluids from other
  compartments
• Examples
• Normal saline (NS)
• Lactated Ringers (LR)

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IVs Normal Saline (NS)

• Isotonic
• 0.9 Sodium Chloride
• Different amounts
• Sample order
• NS _at_ 75cc/hr

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IVs Lactated Ringers (LR)

• Isotonic Solution
• Contents
• Na, Cl-, K, Ca, Lactate in sterile water
• One strength, two common amounts
• Sample orders
• LR _at_ 100cc/hr
• RL _at_ 75cc/hr

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HypOtonic solutions

• Osmolarity less than serum
• Pulls fluid from the IVC into the ICC causing
  cells to expand
• Over hydration
• Rehydration
• Example
• ½ NS
• D5W - after absorbed into body

RISK
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IVs Dextrose Solutions

• Concentrations
• 5 in water (hypotonic after enters body)
• 10 in water (hypertonic)
• 50 in water (rescue solution small volume)
• As additive to NS or LR
• D5NS or D5LR

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HypERtonic solutions

• Osmolarity of solution is higher than serum
  osmolarity
• gt300 mOsm/kg
• Pulls fluid from ICC into IVC causing cells to
  shrink
• dehydrate
• Examples
• D51/2 NS - D5NS - D5LR
• 3 NS (CRITICAL Strength)

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IVs Common Additives

• Potassium (never add to a bag!)
• Multivitamins
• Additives makes the solution hypertonic to some
  extent depends on amount

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IV Additives Potassium

• Available as KCl (potassium chloride)
• NEVER add K to a bag of fluid
• Added by pharmacy or premixed
• Different strengths
• Sample orders
• NS c 20 mEq KCl _at_ 75 cc/hr
• LR c 40 mEq KCl _at_ 75 cc/hr

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Medications Used in Fluid Electrolyte Imbalance
Disorders
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Meds Antidiarrheals

• Assess I /O electrolytes
• Provide oral care
• Monitor for constipation
• Teaching
• Take as directed
• Avoid overdose
• Examples Lomotil Immodium

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Meds Antiemetics

• Assess VS emesis status before and after
• Monitor for extrapyriamidal side effects
• involuntary movement of eyes, face or limbs, flat
  affect, shuffled gait, drooling
• Provide fluid replacements
• Oral electrolyte solutions
• Water
• Sample Meds Zofran, Phenergan Vistaril

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Meds Diuretics

• Assess
• Weight, edema, skin turgor, mucus membranes,
  lung sounds
• Monitor
• weight, I /O, electrolytes
• Teaching
• diet, weigh daily, dosing times

• Examples
• Thiazides (HCTZ) HTN
• Potassium sparing (spironolactone)
• Osmotic (mannitol) decrease ICP
• Loop (lasix) pull fluids

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Meds Potassium

• Forms tablets (SR), effervescent, EC, IV
• Administration considerations
• PO Give on a full stomach at mealtime am/pm
• IV NEVER give as bolus, follow protocol, dilute
  for IV administration, can burn lead to
  infiltration
• Monitor K levels monitor EKG if elevated

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Meds Kayexelate

• Removes K from system
• Available as enema or by PO route
• Retain enema for ½ to 1 hr
• Follow resin w 100 mL water
• After expulsion, rinse colon w 1 liter of water
  and drain out immediately

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Other Meds r/t F/E status

• Glucocorticosteroids
• Digoxin
• Electrolyte supplements

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Stuff To Add for the Test

• A L of fluid weighs 2.2 lbs
• 1 lb of fluid is 454 mL
• If a L of fluid weighs 2.2 lbs you need to be
  able to figure out how many mL a ½ lb is
• 10 fluid loss is serious, but 20 loss is mostly
  death
• If you have someone who begins to have a
  transfusion reaction (hemolytic) watch for
• Fever, low back pain, itching, hypotension, N/V,
  drop in urine output, chest pain, dyspnea
• If you are doing VS for these people and they
  have these symptoms, GO FIND THE NURSE
  IMMEDIATELY! They dont need any more blood
  whatsoever!