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Questions and Answers
What is a potential cause of potential dehydration?
What is a potential cause of potential dehydration?
Which of the following is a symptom of dehydration?
Which of the following is a symptom of dehydration?
What can be a contributing factor to dehydration?
What can be a contributing factor to dehydration?
What is a possible consequence of dehydration?
What is a possible consequence of dehydration?
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What is the most invasive treatment option for dehydration?
What is the most invasive treatment option for dehydration?
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What is a complication associated with prolonged dehydration?
What is a complication associated with prolonged dehydration?
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Which of the following is NOT a sign of dehydration?
Which of the following is NOT a sign of dehydration?
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What is the most likely reason for increased water movement out of the cell in a concentrated solution?
What is the most likely reason for increased water movement out of the cell in a concentrated solution?
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What is the main reason why dehydration can be a dangerous condition?
What is the main reason why dehydration can be a dangerous condition?
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What is the purpose of administering electrolytes along with fluids when treating dehydration?
What is the purpose of administering electrolytes along with fluids when treating dehydration?
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Study Notes
Fluid and Electrolytes
- Homeostasis is the state of equilibrium in the body, naturally maintained by adaptive responses.
- Body fluids and electrolytes are maintained within narrow limits.
Fluid and Electrolyte Imbalances
- Imbalances can be directly caused by illness or disease (e.g., burns, heart failure).
- They can also result from therapeutic measures like IV fluid replacement or diuretics.
- A chart shows the percent of body weight that is water for different age groups (preterm neonate, child, adult, older adult).
Effects of Water Status on Red Blood Cells (RBCs)
- A hypotonic solution causes water to move into the RBCs, enlarging them.
- An isotonic solution maintains the normal size of RBCs.
- A hypertonic solution draws water out of the RBCs, shrinking them.
Gerontologic Considerations
- Structural changes in the kidneys decrease glomerular filtration rate (GFR) and renal blood flow, impacting waste product filtration and electrolyte balance maintenance.
- Subcutaneous tissue loss increases moisture loss.
- Reduced thirst mechanism leads to decreased fluid intake.
- Functional changes affect the ability to independently obtain fluids.
Extracellular Fluid Volume Imbalances: Deficit (Hypovolemia)
- ECF volume deficit (hypovolemia) is characterized by abnormal loss of body fluids, inadequate fluid intake, or fluid shifts between plasma and interstitial spaces.
- Clinical manifestations include loss of vascular volume, CNS effects (dry mucous membranes, thirst, poor skin turgor, low urine output, low blood pressure).
- Treatment involves oral or intravenous (IV) replacement of water and electrolytes with balanced IV solutions (e.g., isotonic saline or lactated Ringer's solution).
Extracellular Fluid Volume Imbalances: Excess (Hypervolemia)
- Fluid volume excess (hypervolemia) is caused by excessive fluid intake, abnormal fluid retention, or fluid shifts.
- Clinical manifestations include weight gain, increased jugular venous pressure (JVP), high blood pressure, headaches, bounding pulse, and edema.
- Treatment includes removing fluid (e.g., diuretics) without altering electrolyte composition or osmolality.
Nursing Interventions
- Intake and output (I&O) monitoring, including specific gravity (1.003-1.030), is essential to assess hydration status.
- Vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) are monitored for changes.
- Orthostatic vital signs are crucial to identify potential hypovolemia.
- Neurologic changes, laboratory findings, and daily weights are also crucial for assessment.
- Skin assessment evaluates skin turgor.
Electrolytes: Sodium - Hypernatremia (>145 mEq/L)
- Excess sodium intake (e.g., IV fluids, tube feedings without adequate water, near drowning in salt water) contributes to hypernatremia.
- Insufficient water intake in unconscious or cognitively impaired individuals contributes to this condition.
- Excess water loss (e.g., high fever, heat stroke, osmotic diuretic therapy, diarrhea) can increase sodium levels.
- Medical conditions like diabetes insipidus, hyperaldosteronism, and Cushing's syndrome can also cause hypernatremia.
Hypernatremia Treatment
- Determine if hypernatremia is caused by fluid loss or excess sodium intake.
- Water deficit requires preventing further water loss and providing free water replacement, possibly with hypotonic IV solutions.
- Excessive sodium intake may need diuretics to promote sodium excretion, sodium-restricted diets, and promoting adequate water intake.
Discharge Instructions for Hypernatremia
- Teach the importance of adequate fluid intake and normal sodium intake.
- Nutritional counseling for a low-sodium diet is essential.
- Educate about early signs of hypernatremia, such as polyuria, nausea, vomiting, and orthostatic hypotension.
- Encourage the patient and family to observe for changes in mental status.
- Advise notifying the primary care provider if symptoms or signs of hypernatremia occur post-discharge.
- Include monitoring for complications like seizures and recognizing associated risks.
Electrolytes: Potassium
- Potassium's normal range is 3.5 to 5.0 mEq/L.
- Potassium sources include fruits and vegetables (potatoes, bananas, leafy greens), salt substitutes, potassium medications (PO or IV), and stored blood.
- Kidneys eliminate approximately 90% of daily potassium intake.
- Assess for various levels of hyperkalemia and hypokalemia.
Hyperkalemia (Potassium >5.0 mEq/L)
- Excess potassium intake, including intravenous fluids and potassium-containing medications, can lead to this.
Hypokalemia (Potassium <3.5 mEq/L)
- Loss of potassium through GI losses (diarrhea, vomiting), renal losses (diuretics), or dialysis.
- Lack of potassium intake includes crash dieting, restrictive diets, and NPO (nothing by mouth) periods.
Calcium
- Calcium's normal range is 9.0 - 10.5 mg/dL.
- Calcium is obtained from ingested foods.
- Vitamin D is needed for calcium absorption.
- Most of the body's calcium is stored in bones and teeth.
- pH and serum albumin levels affect calcium levels.
- Parathyroid hormone (PTH) and calcitonin regulate calcium balance.
Hypercalcemia (>10.5 mg/dL)
- Increased Total Calcium is caused by hyperparathyroidism, excessive intake, immobilization, and thiazide diuretics.
Hypocalcemia (<9.0 mg/dL)
- Decreased total calcium level is caused by hypoparathyroidism, renal insufficiency, acute pancreatitis, high phosphate levels, vitamin D deficiency, low magnesium levels, diuretics, diarrhea, or chronic alcohol use
Magnesium
- Magnesium's normal range is 1.5 - 2.5 mEq/L.
- Hypermagnesemia (>2.5 mEq/L) is associated with factors including renal failure, excessive magnesium administration.
- Hypomagnesemia (<1.5 mEq/L) can result from malabsorption, alcoholism, diarrhea, vomiting, or certain medications.
Discharge of Fluid and Electrolytes
- Discharge teaching should focus on the specific electrolyte imbalance, addressing dietary and medication adjustments and risk factors specific to that electrolyte.
- Emphasize vital signs monitoring, notifying healthcare providers of concerning changes, ongoing preventative measures if possible based on the electrolyte balance.
Review
- Reviews for fundamental assessment, nursing care, and teaching prior to exams.
Priority Setting
- Prioritize patient needs based on immediate risk to patient survival or safety, assessing ABCs, vital signs, lab values, loss of consciousness (acute confusion).
- Intermediate priority addresses non-emergent needs such as mental status changes, acute pain, and lab value abnormalities.
- Low priority covers ongoing problems not directly life-threatening.
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Description
Test your understanding of fluid and electrolyte homeostasis, imbalances, and their effects on the body. This quiz covers various physiological concepts, including the impact of different solutions on red blood cells. Additionally, explore gerontologic considerations related to fluid balance.
