30 Questions
What laboratory data is used to evaluate fluid volume status?
BUN and its relation to serum creatinine concentration
What is the normal BUN to serum creatinine concentration ratio?
10:1
What can cause hypokalemia?
GI and renal losses
What can cause hyperkalemia?
Adrenal insufficiency
What can result in hypernatremia?
Increased insensible water losses and diabetes insipidus
What is the cause of hyponatremia?
Increased thirst and ADH release
What is the cause of hypovolemia in a volumedepleted patient?
BUN elevated out of proportion to the serum creatinine
Which laboratory data is useful in diagnosing Fluid Volume Excess (FVE)?
Decreased BUN and hematocrit levels due to plasma dilution
What is the medical management approach for Fluid Volume Excess (FVE)?
Discontinuing excessive sodium-containing fluids, administering diuretics, and restricting fluids and sodium
What is the primary action of thiazide diuretics in managing Fluid Volume Excess (FVE)?
Blocking sodium and water reabsorption at the distal tubule
What may result from diuretic side effects in the management of Fluid Volume Excess (FVE)?
Hypokalemia, hyperkalemia, hyponatremia, and decreased magnesium levels
What can occur in Fluid Volume Excess (FVE) due to decreased waste excretion and increased uric acid reabsorption by the kidneys?
Azotemia and hyperuricemia
What is the recommended approach for nutritional therapy in Fluid Volume Excess (FVE)?
Dietary sodium restriction, with mild sodium-restricted diets allowing only light salting of food and avoidance of high-sodium foods
When should salt substitutes be used in the management of Fluid Volume Excess (FVE)?
Seasoning substitutes can help decrease sodium intake, but caution is advised for patients taking potassium-sparing diuretics
What does low urine specific gravity indicate?
More water in urine
What is the recommended action for patients on sodium-restricted diets if the local water supply is very high in sodium?
Use distilled water
What is the effect of lack of ADH in diabetes insipidus?
Increased urine water content and decreased urine specific gravity
What should patients on sodium-restricted diets do before purchasing and drinking bottled water?
Carefully examine the label for sodium content
What is the role of aldosterone when fluid volume is low?
Causes reabsorption of sodium and chloride, resulting in decreased urinary sodium and chloride
What should patients on sodium-restricted diets be cautioned to avoid in relation to water softeners?
Water softeners that add sodium to water
Why is skin turgor assessment less valid in older adults?
Other measures like slowness in filling of veins become more useful in detecting fluid volume deficit (FVD) in older adults
What is the potential risk of using salt substitutes containing ammonium chloride for patients with liver damage?
Harmful effects
What is the primary provider's consideration when planning the correction of fluid loss for patients with FVD?
The patient's maintenance requirements and other influencing factors
What is the potential sodium content range in bottled water for patients on sodium-restricted diets?
0 to 1200 mg/L
What type of electrolyte solutions are frequently the first-line choice to treat the hypotensive patient with FVD?
Isotonic electrolyte crystalloid solutions
What is the potential sodium content range in drinking water from various sources for patients on sodium-restricted diets?
1 mg to more than 1500 mg per quart
What should be monitored to determine the rate of fluid administration and to avoid volume overload?
Accurate and frequent assessments of I&O, weight, vital signs, and other parameters
What is the purpose of increasing protein intake in patients with low serum protein levels?
To increase capillary oncotic pressure
What effect does increasing oncotic pressure in the bloodstream have on fluid movement?
Pulls fluid out of the tissues into vessels
What is the potential sodium content range in water from various sources for patients on sodium-restricted diets?
1 mg to more than 1500 mg per quart
Study Notes
Fluid and Electrolyte Imbalance in Older Adults
- Oliguria, the excretion of less than 400 mL urine per day in adults, may or may not be present in hypovolemia.
- Urine specific gravity changes in relation to the kidneys' attempt to conserve water, with low specific gravity indicating more water in urine and high specific gravity indicating concentrated urine.
- Lack of ADH in diabetes insipidus leads to increased urine water content and decreased urine specific gravity.
- Aldosterone is secreted when fluid volume is low, causing reabsorption of sodium and chloride and resulting in decreased urinary sodium and chloride.
- Older patients are more sensitive to fluid and electrolyte changes, requiring careful physical assessment, I&O measurement, daily weight assessment, and monitoring of medication side effects and interactions.
- Skin turgor assessment is less valid in older adults, and other measures like slowness in filling of veins become more useful in detecting fluid volume deficit (FVD) in older adults.
- Nurses perform a functional assessment of older patients' ability to determine fluid and food needs and to obtain adequate intake.
- Some older patients deliberately restrict their fluid intake to avoid urinary incontinence, requiring interventions to deal with incontinence.
- For older adults without cardiovascular or renal dysfunction, it is important to remind them to drink adequate fluids, particularly in warm or humid weather.
- When planning the correction of fluid loss for patients with FVD, the primary provider considers the patient's maintenance requirements and other influencing factors.
- Isotonic electrolyte crystalloid solutions are frequently the first-line choice to treat the hypotensive patient with FVD, while hypotonic electrolyte solutions are used once the patient becomes normotensive.
- Accurate and frequent assessments of I&O, weight, vital signs, and other parameters are monitored to determine the rate of fluid administration and to avoid volume overload.
Test your knowledge of fluid and electrolyte imbalance in older adults with this quiz. Explore concepts such as oliguria, urine specific gravity, ADH and aldosterone functions, assessment techniques for older adults, interventions for fluid intake, and treatment options for fluid volume deficit.
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