Podcast
Questions and Answers
Which of the following best describes the location of most of the body's fluid?
Which of the following best describes the location of most of the body's fluid?
- Intracellular space (correct)
- Extracellular space
- Interstitial space
- Intravascular space
A patient's lab results show a serum osmolality of 305 mOsm/kg. How would you interpret this result?
A patient's lab results show a serum osmolality of 305 mOsm/kg. How would you interpret this result?
- Hypotonic
- Hypertonic (correct)
- Normotonic
- Isotonic
The body regulates fluid and electrolyte balance through several mechanisms. Which of the following is NOT a primary mechanism for regulating output?
The body regulates fluid and electrolyte balance through several mechanisms. Which of the following is NOT a primary mechanism for regulating output?
- Increased thirst (correct)
- Antidiuretic hormone (ADH)
- Aldosterone
- Renal excretion
A patient is diagnosed with clinical dehydration. Which of the following lab findings is most consistent with this condition?
A patient is diagnosed with clinical dehydration. Which of the following lab findings is most consistent with this condition?
An elderly patient is admitted with dehydration. What factor in older adults contributes to an increased risk of dehydration?
An elderly patient is admitted with dehydration. What factor in older adults contributes to an increased risk of dehydration?
A patient with clinical dehydration is being treated with IV fluids. Which of the following assessments is most important for the nurse to monitor?
A patient with clinical dehydration is being treated with IV fluids. Which of the following assessments is most important for the nurse to monitor?
A patient has a fluid volume deficit. Which assessment finding is the nurse most likely to observe?
A patient has a fluid volume deficit. Which assessment finding is the nurse most likely to observe?
What is the primary difference between fluid volume deficit and dehydration?
What is the primary difference between fluid volume deficit and dehydration?
A patient with fluid volume deficit is receiving IV fluids. Which of the following interventions is most important for the nurse to implement?
A patient with fluid volume deficit is receiving IV fluids. Which of the following interventions is most important for the nurse to implement?
A patient with heart failure is at risk for fluid volume excess. What assessment finding would indicate fluid volume excess?
A patient with heart failure is at risk for fluid volume excess. What assessment finding would indicate fluid volume excess?
A patient with fluid volume excess is prescribed a diuretic. What nursing intervention is most important to include in the patient's plan of care?
A patient with fluid volume excess is prescribed a diuretic. What nursing intervention is most important to include in the patient's plan of care?
A patient with a history of heart failure is admitted with fluid volume overload. Which intervention is most appropriate for the nurse to implement?
A patient with a history of heart failure is admitted with fluid volume overload. Which intervention is most appropriate for the nurse to implement?
What serum osmolality range is considered a normal value?
What serum osmolality range is considered a normal value?
What blood concentration value represents optimal extracellular fluid volume?
What blood concentration value represents optimal extracellular fluid volume?
Which of the following signs and symptoms are associated with dehydration? (Select all that apply)
Which of the following signs and symptoms are associated with dehydration? (Select all that apply)
A nurse is teaching a client about the importance of preventing dehydration. Which of the following instructions should the nurse include in the teaching?
A nurse is teaching a client about the importance of preventing dehydration. Which of the following instructions should the nurse include in the teaching?
A nurse is caring for a patient with a serum sodium level of 120 mEq/L. Which of the following interventions is most appropriate for the nurse to implement?
A nurse is caring for a patient with a serum sodium level of 120 mEq/L. Which of the following interventions is most appropriate for the nurse to implement?
An older adult with a history of heart failure is admitted with shortness of breath and edema. Which electrolyte imbalance is the client at risk for developing?
An older adult with a history of heart failure is admitted with shortness of breath and edema. Which electrolyte imbalance is the client at risk for developing?
A client with hypernatremia is being treated with hypotonic IV fluids. Which nursing assessment is most important to monitor during this treatment?
A client with hypernatremia is being treated with hypotonic IV fluids. Which nursing assessment is most important to monitor during this treatment?
Which set of lab values is most concerning?
Which set of lab values is most concerning?
Which client is likely having fluid overload due to their electrolyte imbalances?
Which client is likely having fluid overload due to their electrolyte imbalances?
What electrolyte imbalance is associated with post-op thyroidectomy?
What electrolyte imbalance is associated with post-op thyroidectomy?
A nurse is reviewing a client's lab work with a fever and diarrhea. Which of the following electrolyte values is most concerning?
A nurse is reviewing a client's lab work with a fever and diarrhea. Which of the following electrolyte values is most concerning?
What are the typical laboratory disturbances linked to over-diuresis? (Select all that apply)
What are the typical laboratory disturbances linked to over-diuresis? (Select all that apply)
A nurse working on CNA reports symptoms but forgot associated symptoms to cause. Help the CNA. Feels Like their "heart is skipping a beat." What electrolyte imbalance would correlate?
A nurse working on CNA reports symptoms but forgot associated symptoms to cause. Help the CNA. Feels Like their "heart is skipping a beat." What electrolyte imbalance would correlate?
Chvostek's Sign is linked with which Electrolyte imbalance?
Chvostek's Sign is linked with which Electrolyte imbalance?
A person with hypernatremia would correlate with which symptoms or presentation?
A person with hypernatremia would correlate with which symptoms or presentation?
Mr. Sodhi presented with Sodium to be 167 mEq/L, what type of symptoms would the nurse associate, and anticipate?
Mr. Sodhi presented with Sodium to be 167 mEq/L, what type of symptoms would the nurse associate, and anticipate?
It is important to not rapidly shift sodium in order to prevent:
It is important to not rapidly shift sodium in order to prevent:
Select all of Lona's presentating symptoms: (Select all that apply)
Select all of Lona's presentating symptoms: (Select all that apply)
3% Normal Saline is what type of solution?
3% Normal Saline is what type of solution?
Which electrolyte imbalances could be from diuretic?
Which electrolyte imbalances could be from diuretic?
When administering any Potassium (K+) products why would the nurse verify urine output?
When administering any Potassium (K+) products why would the nurse verify urine output?
A hospitalized patient on oral Furosemide (Lasix), what type of muscle-related condition should the Nurse education client to check with HCP?
A hospitalized patient on oral Furosemide (Lasix), what type of muscle-related condition should the Nurse education client to check with HCP?
A nurse reviewing lab work is most concerned by these lab test results?
A nurse reviewing lab work is most concerned by these lab test results?
What electrolyte change is caused by Kayexalate?
What electrolyte change is caused by Kayexalate?
Nurse see client with a higher than normal Potassium, and EKG showing Peaked T Wave. What type of monitoring is priority?
Nurse see client with a higher than normal Potassium, and EKG showing Peaked T Wave. What type of monitoring is priority?
Mr. Kyper is presenting an evelated potassium level of 6.9. Choose all appropriate interventions:
Mr. Kyper is presenting an evelated potassium level of 6.9. Choose all appropriate interventions:
What is the primary mechanism by which fluid moves between the interstitial and intracellular compartments?
What is the primary mechanism by which fluid moves between the interstitial and intracellular compartments?
Which of the following best explains why older adults are at higher risk for dehydration?
Which of the following best explains why older adults are at higher risk for dehydration?
A patient with heart failure is prescribed a sodium-restricted diet. What is the primary rationale for this intervention?
A patient with heart failure is prescribed a sodium-restricted diet. What is the primary rationale for this intervention?
A patient is receiving intravenous fluids at a rate of 200 mL/hr. Which assessment finding would be most indicative of fluid volume overload?
A patient is receiving intravenous fluids at a rate of 200 mL/hr. Which assessment finding would be most indicative of fluid volume overload?
Which of the following physiological responses would the nurse expect to see in a patient experiencing hypovolemia?
Which of the following physiological responses would the nurse expect to see in a patient experiencing hypovolemia?
A patient with severe diarrhea is at risk for which of the following acid-base imbalances?
A patient with severe diarrhea is at risk for which of the following acid-base imbalances?
Which of the following intravenous solutions would be appropriate to administer to a patient with hypernatremia and signs of dehydration?
Which of the following intravenous solutions would be appropriate to administer to a patient with hypernatremia and signs of dehydration?
A patient with chronic kidney disease is at risk for hyperkalemia. Which dietary instruction is most important for this patient?
A patient with chronic kidney disease is at risk for hyperkalemia. Which dietary instruction is most important for this patient?
A patient is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which electrolyte imbalance is most likely to occur in this patient?
A patient is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which electrolyte imbalance is most likely to occur in this patient?
Which of the following nursing interventions is crucial when administering intravenous potassium chloride to prevent complications?
Which of the following nursing interventions is crucial when administering intravenous potassium chloride to prevent complications?
A patient presents with muscle weakness, constipation, and confusion. Lab results show a serum calcium level of 13 mg/dL. Which condition is most likely causing hypercalcemia?
A patient presents with muscle weakness, constipation, and confusion. Lab results show a serum calcium level of 13 mg/dL. Which condition is most likely causing hypercalcemia?
A patient with hypocalcemia is experiencing muscle spasms and cramps. Which nursing intervention is most appropriate to implement?
A patient with hypocalcemia is experiencing muscle spasms and cramps. Which nursing intervention is most appropriate to implement?
A patient with a history of alcohol abuse is admitted for malnutrition. Which electrolyte imbalance is the patient most at risk for during the initial stages of refeeding?
A patient with a history of alcohol abuse is admitted for malnutrition. Which electrolyte imbalance is the patient most at risk for during the initial stages of refeeding?
A patient is prescribed magnesium sulfate intravenously for the treatment of preeclampsia. Which assessment finding indicates magnesium toxicity?
A patient is prescribed magnesium sulfate intravenously for the treatment of preeclampsia. Which assessment finding indicates magnesium toxicity?
A patient who is post-operative is ordered to be on I&Os. What does the nurse want to track in order to track the patient's fluid status?
A patient who is post-operative is ordered to be on I&Os. What does the nurse want to track in order to track the patient's fluid status?
A client exhibits a urine specific gravity of 1.035. How should the nurse interpret this?
A client exhibits a urine specific gravity of 1.035. How should the nurse interpret this?
A nurse caring for a client who is experiencing hypovolemia. Which of the following findings should the nurse identify as the priority to report to the provider?
A nurse caring for a client who is experiencing hypovolemia. Which of the following findings should the nurse identify as the priority to report to the provider?
A nurse is reviewing the prescriptions for a client who needs intravenous fluid replacement therapy due to vomiting and diarrhea. Which of the following fluid prescriptions should the nurse expect to initiate?
A nurse is reviewing the prescriptions for a client who needs intravenous fluid replacement therapy due to vomiting and diarrhea. Which of the following fluid prescriptions should the nurse expect to initiate?
A nurse caring for client who is experiencing extracellular fluid excess. Which of the following findings should the nurse identify associated with this condition? (Select all that apply)
A nurse caring for client who is experiencing extracellular fluid excess. Which of the following findings should the nurse identify associated with this condition? (Select all that apply)
A nurse is caring for a client who has hyponatremia. Which of the following findings or interventions should the nurse expect? (Select all that apply)
A nurse is caring for a client who has hyponatremia. Which of the following findings or interventions should the nurse expect? (Select all that apply)
A nurse in the ER reviews a client's labs. The results indicate a sodium leve of 151 mEq/L. Which of the following should the nurse recognize as the reason for these results?
A nurse in the ER reviews a client's labs. The results indicate a sodium leve of 151 mEq/L. Which of the following should the nurse recognize as the reason for these results?
You anticipate an order for IV fluids. Which of the following IV fluid orders would you question on the basis that it may be inappropriate given Lona's conditions?
You anticipate an order for IV fluids. Which of the following IV fluid orders would you question on the basis that it may be inappropriate given Lona's conditions?
You are caring for a client with a serum Potassium level of 3.2 mEq/L. The provider has ordered potassium replacement. Which of the following orders would you question?
You are caring for a client with a serum Potassium level of 3.2 mEq/L. The provider has ordered potassium replacement. Which of the following orders would you question?
The provider has ordered an IV infusion containing potassium for K-Lo. Which assessment is most important for the nurse to perform before administering the fluids?
The provider has ordered an IV infusion containing potassium for K-Lo. Which assessment is most important for the nurse to perform before administering the fluids?
The nurse provides care for a client who is hospitalized for excessive fluid retention. The client is being discharged home on oral Furosemide (Lasix), a diuretic. Which potential side effect from the above medications should the nurse teach the client requires priority notification to the healthcare provider (HCP)?
The nurse provides care for a client who is hospitalized for excessive fluid retention. The client is being discharged home on oral Furosemide (Lasix), a diuretic. Which potential side effect from the above medications should the nurse teach the client requires priority notification to the healthcare provider (HCP)?
The nurse is reviewing a client's laboratory results and notes the serum potassium level is 5.8 mEq/L. Which nursing action should be initiated immediately?
The nurse is reviewing a client's laboratory results and notes the serum potassium level is 5.8 mEq/L. Which nursing action should be initiated immediately?
Which of the following medications for the management of hyperkalemia is likely to cause loose stools?
Which of the following medications for the management of hyperkalemia is likely to cause loose stools?
Where is the location of most of the body's fluid?
Where is the location of most of the body's fluid?
Osmosis is best described as?
Osmosis is best described as?
A new nurse is trying to make a care plan for her client and doesn't understand all the ways the body works to maintain fluid homeostasis. Which mechanism would the charge nurse include?
A new nurse is trying to make a care plan for her client and doesn't understand all the ways the body works to maintain fluid homeostasis. Which mechanism would the charge nurse include?
A client who is chronically dehydrated, what assessment finding can be found?
A client who is chronically dehydrated, what assessment finding can be found?
A client was experiencing symptoms, and was diagnosed with dehydration. The provider is ordering interventions. Which should the nurse anticipate?
A client was experiencing symptoms, and was diagnosed with dehydration. The provider is ordering interventions. Which should the nurse anticipate?
Select which disease/conditions correlates with hypernatremia.
Select which disease/conditions correlates with hypernatremia.
A client with hypovolemia is ordered to have an intake of electrolytes given orally. Which item is provided to the client?
A client with hypovolemia is ordered to have an intake of electrolytes given orally. Which item is provided to the client?
A client is experiencing symptoms and is now diagnosed with a fluid volume deficit. Which of the following statements caused this?
A client is experiencing symptoms and is now diagnosed with a fluid volume deficit. Which of the following statements caused this?
A client is receiving excessive IV and PO intake of fluid. Select which condition correlates.
A client is receiving excessive IV and PO intake of fluid. Select which condition correlates.
What is the typical initial nursing intervention for someone with fluid in their lungs?
What is the typical initial nursing intervention for someone with fluid in their lungs?
What should the nurse do when a patient presents with excessive administration of isotonic IV solutions?
What should the nurse do when a patient presents with excessive administration of isotonic IV solutions?
Why are older adults more at risk for fluid and electrolyte imbalances?
Why are older adults more at risk for fluid and electrolyte imbalances?
A client with a serum sodium level of 120 mEq/L is prescribed 3% normal saline. What assessment finding would indicate that the treatment is effective?
A client with a serum sodium level of 120 mEq/L is prescribed 3% normal saline. What assessment finding would indicate that the treatment is effective?
An elderly client is admitted with dehydration and a serum sodium level of 155 mEq/L. Which intravenous fluid order would the nurse anticipate to address hypernatremia and dehydration?
An elderly client is admitted with dehydration and a serum sodium level of 155 mEq/L. Which intravenous fluid order would the nurse anticipate to address hypernatremia and dehydration?
A client with heart failure is prescribed furosemide (Lasix). The nurse should educate the client to promptly report which of the following symptoms to the healthcare provider?
A client with heart failure is prescribed furosemide (Lasix). The nurse should educate the client to promptly report which of the following symptoms to the healthcare provider?
A client with end-stage renal disease has a potassium level of 6.9 mEq/L and EKG changes with tall T waves. Which medication should the nurse administer first?
A client with end-stage renal disease has a potassium level of 6.9 mEq/L and EKG changes with tall T waves. Which medication should the nurse administer first?
The nurse is caring for a client with a history of running marathons and who has been experiencing persistent diarrhea. The client's potassium level is 2.7 mEq/L, and the provider prescribes potassium chloride (KCl) 10 mEq IVPB every hour times four doses. Which of the following actions is most important for the nurse to take?
The nurse is caring for a client with a history of running marathons and who has been experiencing persistent diarrhea. The client's potassium level is 2.7 mEq/L, and the provider prescribes potassium chloride (KCl) 10 mEq IVPB every hour times four doses. Which of the following actions is most important for the nurse to take?
Flashcards
Intracellular fluid
Intracellular fluid
Fluid inside the cells
Extracellular fluid
Extracellular fluid
Fluid outside the cells, including intravascular, interstitial, and transcellular fluids
Intravascular fluid
Intravascular fluid
The liquid part of the blood, or plasma
Interstitial fluid
Interstitial fluid
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Transcellular fluid
Transcellular fluid
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Osmolality
Osmolality
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Osmosis
Osmosis
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Isotonic
Isotonic
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Hypotonic
Hypotonic
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Hypertonic
Hypertonic
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Normal fluid output
Normal fluid output
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Abnormal fluid output
Abnormal fluid output
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Antidiuretic hormone
Antidiuretic hormone
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Aldosterone
Aldosterone
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Clinical Dehydration
Clinical Dehydration
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Fluid Volume Deficit
Fluid Volume Deficit
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Fluid Volume Excess
Fluid Volume Excess
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Clinical dehydration
Clinical dehydration
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Extracellular volume deficit
Extracellular volume deficit
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Extracellular volume excess
Extracellular volume excess
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Normal serum osmolality
Normal serum osmolality
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Hypernatremia
Hypernatremia
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Hyponatremia
Hyponatremia
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Clinical Manifestation of Dehydration
Clinical Manifestation of Dehydration
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Fluid volume excess
Fluid volume excess
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Clinical Manifestation of Dehydration
Clinical Manifestation of Dehydration
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Clinical Manifestation of Dehydration
Clinical Manifestation of Dehydration
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Clinical Manifestations of severe dehydration
Clinical Manifestations of severe dehydration
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Goal for dehydration
Goal for dehydration
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Interventions for Dehydration
Interventions for Dehydration
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Associated with FVD
Associated with FVD
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General signs of FVD
General signs of FVD
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Severe signs of FVD
Severe signs of FVD
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Goal for Fluid volume deficit
Goal for Fluid volume deficit
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Manifestations of fluid volume overload
Manifestations of fluid volume overload
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Causes for fluid volume overload
Causes for fluid volume overload
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Goal for fluid volume excess
Goal for fluid volume excess
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Intervention for fluid volume overload
Intervention for fluid volume overload
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Increased risk for dehydration
Increased risk for dehydration
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Electrolytes
Electrolytes
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Sodium of 167 mEq/L
Sodium of 167 mEq/L
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Lack of hydration
Lack of hydration
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Potassium Chloride 40 mEq
Potassium Chloride 40 mEq
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Monitor Electrolyte in laboratory
Monitor Electrolyte in laboratory
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Hyperkalemia therapy
Hyperkalemia therapy
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Study Notes
- Complex Foundational Concepts I examines fluid and electrolytes
- The presentation is credited to Linnea Benike, DNP, RN, CNE, PCCN-K
Objectives
- To determine processes regulating fluid distribution, extracellular fluid volume (ECV), and body fluid osmolality
- To understand risk factors and causes of fluid imbalances, including fluid volume excess, fluid volume deficit, and dehydration
- To use clinical judgment when caring for patients with fluid imbalances such as hypovolemia, dehydration, and fluid volume excess (hypervolemia)
- To identify clinical findings, nursing interventions, patient management, and how to evaluate outcomes for these fluid imbalances
Practice Question: Fluid Terminology
- Intracellular fluid is fluid inside the cells
- Extracellular fluid is fluid outside the cells, including intravascular, interstitial, and transcellular fluids
- Intravascular fluid is the liquid part of the blood (plasma)
- Interstitial fluid is fluid between cells and outside blood vessels
- Transcellular fluid is fluid in areas such as cerebrospinal and pleural fluids
Regulating Fluid
- The body seeks to maintain homeostasis for fluid balance
- Most fluid is in the intracellular space (inside cells)
- The remaining fluid is in the extracellular space
- Vascular space is the liquid part of blood
- Interstitial space is fluid between cells and outside of blood vessels
- Transcellular fluid includes cerebral spinal fluid and synovial fluid
Osmolality and Osmosis
- Osmolality is the concentration of fluid
- Osmosis involves fluid moving from a high concentration area to a low concentration area
- Isotonic fluid has the same concentration as blood
- Hypotonic fluid has less concentration than blood
- Hypertonic fluid has more concentration than blood
- Hypertonic solutions are concentrated (like dark urine)
- Hypotonic solutions are less concentrated (like light urine)
Intake and Output Regulation
- Intake should match output to maintain fluid balance
- Mechanisms maintain fluid/electrolyte balance, triggered by raised serum osmolality
- Intake includes oral, IV, and nasogastric routes
- Intake is regulated by thirst response, which decreases in older adults
- Output includes normal losses (urine, feces, skin/sweat, lungs)
- Output includes abnormal losses (emesis, hemorrhage, wound drainage)
- Output is regulated by renal excretion, antidiuretic hormone, and aldosterone
- Antidiuretic hormone retains more water in the kidneys, resulting in concentrated urine
- Aldosterone pulls equal amounts of water and sodium from the kidney back into the blood
Types of Fluid Imbalances
- Clinical dehydration involves a loss of water
- Clinical dehydration may or may not cause the loss of sodium
- Fluid volume deficit involves the loss of both water and electrolytes
- Fluid volume excess involves too much isotonic fluid
Fluid Imbalances: Another View
- Clinical dehydration involves extracellular volume deficit and hypernatremia (high sodium)
- Low volume and high concentration are characteristics of clinical dehydration
- Loss of water or lack of water intake without sodium loss can cause clinical dehydration
- Extracellular volume deficit (or fluid volume deficit/hypovolemia) means the extracellular fluid holds more sodium
- Output of isotonic fluid of sodium-containing fluids exceeds intake in fluid volume deficit
- There is a loss of both water and electrolytes during fluid volume deficit
- Extracellular volume excess or fluid volume overload occurs when isotonic fluid is too high in the extracellular space
- Intake of sodium-containing isotonic fluid exceeds output in fluid volume excess
Serum Osmolality
- Normal serum osmolality ranges between 285-295 mOsm/kg
Lab Values
- Optimal extracellular fluid volume (ECV) is indicated by sodium levels of 136-145 mEq/L and osmolality of 285-295
- Too dilute: Na< 136 & Osm <285
- Too concentrated: Na> 145 & Osm >295
- Blood concentration is measured by serum osmolality, with a normal range of 285-295 mOsm/kg
- Hemoconcentration indicates less fluid and is determined by hematocrit
- Hematocrit normal range is 42-52% for males and 37-47% for females
- Kidney labs help evaluate fluid status. Remember BUN: 10-20 mg/dL & Creatinine: 0.5-1.1 mg/dL & Urine specific gravity: 1.005-1.030
Clinical Dehydration
- Clinical dehydration: decreased fluid and too concentrated
- Extracellular volume deficit and hypernatremia are involved in clinical dehydration
- Low volume and high concentration are characteristics of clinical dehydration
- Loss of water or lack of water intake > Na+ loss occurs during clinical dehydration
- Water shifts from inside the cell to the extracellular space during clinical dehydration, causing cell shrinkage
Recognizing Clinical Dehydration
- Risk factors for clinical dehydration include lack of water intake and poor thirst response
- Gastrointestinal losses with sodium replacement w/o enough water is a risk factor
- Prolonged fever, excessive sweating, working outside in hot weather are risk factors
- Medications like Benzodiazepines (decreasing thirst sensation), diuretics are risk factors
Clinical Dehydration Cues
- Manifestations of clinical dehydration include postural hypotension, increased heart rate, and a thready pulse
- Sudden weight loss, dry mucous membranes, poor skin turgor, and flat neck veins are signs of clinical dehydration
- Dark yellow urine, decreased mentation (LOC), thirst, and seizures are signs of clinical dehydration
- With severe clinical dehydration, observe decreased BP, oliguria (UO<30mL/hr), cold clammy skin
- Labs seen with clinical dehydration include Na+ >145mEq/L, serum osmolality > 295mOsm/kg
- High hematocrit and BUN, and high urine specific gravity may be seen in lab reports
- Loss of more water than Na+ results in movement of fluid from cells, causing shriveled brain cells and cerebral dysfunction (e.g. seizures)
Interventions for Clinical Dehydration
- The goal is to restore water balance and address underlying cause of clinical dehydration
- Solutions containing isotonic sodium AND extra water include oral or IV fluids
- Treating the underlying cause involves antipyretics (acetaminophen or ibuprofen) for fever or antiemetics for vomiting
- Closely monitor fluid status by closely monitoring Intake and Output (I&O)
- Safety (fall prevention) is also essential for treating clinical dehydration
Causes vs. Findings vs. Interventions
- The causes of clinical dehydration are often water intake loss than sodium intake: prolonged fever, poor intake, increased GI or renal output or massive sweating
- The clinical manifestations are postural hypotension, increased HR pulse, sudden weight loss, decreased LOC and rapid change of Temp
- Interventions include daily weights, measuring I&O carefully, rehydration and cause and safety precautions
Fluid Volume Deficit: What is it?
- In extracellular fluid volume deficiency, the extracellular space holds more sodium.
- In extracellular fluid volume deficiency, output of isotonic fluid exceeds intake of sodium-containing fluids.
- Insufficient isotonic fluid describes extracellular fluid voulme deficit
- Loss of water and electrolytes occurs during extracellular fluid voulme deficit
Fluid Volume Deficit: Recognize Cues
- Risk factors for Fluid Volume Deficit include blood loss and GI losses (diarrhea and vomiting)
- Severe burns, excessive sweating, fever, and medications (diuretics) are risk factors
- Altered intake caused from impaired swallowing, prolonged NPO, or confusion are risk factors
Fluid Volume Deficit: Signs and Symptoms
- Thirst, dryness of mucosa, decreased skin turgor are signs of fluid deficit
- The person may show flat neck veins, dark urine, and decreased urine output
- Sudden weight loss and increased HR show fluid deficit
- Severe symptoms include an extreme thirst, restlessness, confusion, and increasing HR with worsening hypotension
- Cold clammy skin is a signs of fluic deficit
Differences Between FVD and Dehydration
- In Fluid Volume Deficit, sodium and osmolality both decrease
- In Dehydration, sodium and osmolality are the same
Interventions for FVD
- The goal is to treat underlying cause and restore fluid and electrolyte balance
- Oral rehydration with electrolytes is needed for mild cases
- For moderate to severe- IV fluids, like normal saline or lactated ringers
- Treat underlying cause and monitor weight
- Fall prevention is key
Extracellular volume deficit: Findings
- Weight loss (sudden), postural hypotension and increased HR
- Dry mucous membrane and dark yellow urine.
- Sever Cases: Thirst, confusion, low BP
Extracellular volume deficit: Interventions
- Daily weight -1kg is equal to 2.2lbs
- Ensure that intake and output should be balanced out
- Encourage fluid intake such as pedealyte
- Assess the tempurature per patient presences
Clinical Context
- A 70 year-old man is admitted. He is alert and orietned.
- The patient states that they have been recently vomiting
- He states that he is unable to eat or consume any fluids
- Labs are ordered and he states that he has not had a urination in 2 hours.
Fluid Volume Excess or Fluid Volume Overload
- There is too much isotinic fluid
- Intake sodium exceeds the outtake
Fluid volume overload: Recognize Cues
- Heart and Kidneyl failure are caused from fluid excess
- Cirrhosis is also a risk for fluid retention
- A sign is sudden weight gain, crackles in lungs and full neck veigns
- Labe will contain a decrease in Hematrocyit and BUN
Fluid volume overload: Interventions
- Goal is a restore of fluids- remove excecise
- Intake and out put is very important
- Lowering the legs helps with edema
Types of Fuilds
- Isotonic- no Impact on RBC
- Hypertonic- water leaves the cell
- Hypotonic- Water moves into the cell
Extracellular volume excess or Fluid volume overload with normal osmolality
- Manifestions: Weight gain and lung crackles
- Interventions are daily weights & maintain potassium levels
Older Adult Considerations
- Increase risk of EVC deficit and dehydration
- They have inconstince and there decreases thrist senses
- In Older adults, they has a lower chance of thirst
Summary fluid
- Water moves across to balance
- Extracellular volume defecit is insufficent
- Extracellular volume excess is an overload
- Hyperneermia water deficit is hypertonic fluid
- Hyponaetrim is hypotnoic fluid
- Clinical judgemnt needs to to know fluid imbalance.
Electrolyte
- Electrolytes homeostasis balance
Electrolyte: objective
- Describe clinical labs for causes and collabrative management
- What's nurses role when caring for a electrolyte imbalance
Electrolytes review
- Sodium
- Potassium
- Mg
- calcium
Lab result normal
- look at slide for WBC levels
Recognize Normal Lab Value
- Is your job as the new provider to make sure they are at healthy values
- Review results so if someone has a problem that there is awareness of the problems
Electrolytes Summary
- Electrolytes are impoartatn and play a huge part in a body
- They impact muscles
- Keep a look out for labs
- Treat electrolye and imbalance.
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