Nursing Fluid and Volume Imbalances

Fluid and Volume Imbalances

• Fluid Volume Deficit (FVD): Characterized by abnormal fluid loss. Dehydration specifically refers to water loss without sodium loss.
• Manifestations (FVD): Decreased capillary refill and skin turgor; confusion, restlessness, lethargy; concentrated (dark) urine; tachypnea, tachycardia, weight loss, seizures, low-grade fever; postural hypotension.
• Fluid Volume Excess: Results from excess fluid intake or abnormal fluid retention.
• Manifestations (FVD): Bounding pulse, hypertension; confusion, headache, lethargy, weakness; edema; dyspnea, pulmonary crackles; tachycardia.
• Nursing Management (FVD): Treat the underlying cause; administer fluids and medications as prescribed; encourage oral fluids; replacement therapy based on severity and type of loss.
• Nursing Management (FVE): Treat the underlying cause; administer diuretics; restrict fluids; consider paracentesis or thoracentesis for ascites or pleural effusion. Offer frequent oral care and record intake and output; elevate edematous extremities; protect skin. Prioritize patient safety.

Electrolyte Imbalances

Sodium Imbalances

• Sodium (Na+): Important for ECF volume and concentration; nerve impulse transmission; muscle function; acid-base balance. Normal value: 135-145 mEq/L.
• Hypernatremia: Caused by inadequate water intake or excess water loss. Manifestations include mental status changes, seizures, coma. Management: replace water using isotonic solutions; if Na+ is elevated, administer 5% dextrose in water and promote Na+ excretion with diuretics.
• Hyponatremia: Caused by sodium loss in fluids, excess water, or both. Common causes: draining wounds, diarrhea, vomiting, NG tube suction, burns. Manifestations: headache, irritability, difficulty concentrating; severe cases: irreversible brain damage. Management: stop diuretics, replace fluid with isotonic sodium solution.

Potassium Imbalances

• Potassium (K+): Crucial for nerve and muscle function; intracellular osmolality regulation; glycogen storage. Normal value: 3.5-5.0 mEq/L.
• Hyperkalemia: Caused by impaired kidney function, excessive K+ intake, or shift from ICF to ECF. Manifestations: cardiac conduction issues (loss of P wave, peaked T wave), ventricular fibrillation, standstill, irregular pulse, paresthesia, tetany, confusion. Management: stop K+ intake; increase K+ excretion (diuretics, dialysis, Kayexalate); stabilize cardiac membranes.
• Hypokalemia: Caused by excessive K+ loss, or shift from ECF to ICF. Manifestations: peaked P waves, shallow T waves, U waves, constipation, hyperglycemia, irregular pulse, paresthesia, shallow respirations, fatigue. Management: administer oral or intravenous K+; consume K+-rich foods.

Calcium Imbalances

• Calcium (Ca++): Essential component of bones and teeth; plays a role in blood clotting, nerve impulses, muscle contractions, and myocardial contractions. Normal value: 9.0-10.5 mg/dL.
• Hypercalcemia: Caused by hyperparathyroidism and some cancers. Manifestations: increased blood pressure, bone pain/fractures, confusion, kidney stones, depressed reflexes, dysrhythmias. Management: mild: low-calcium diet; stop medications contributing to hypercalcemia; hydration; severe: intravenous isotonic saline, bisphosphonates, calcitonin.
• Hypocalcemia: Caused by conditions associated with PTH deficiency or multiple blood transfusions. Manifestations: decreased blood pressure, tetany (muscle spasms), Chvostek's sign, Trousseau's sign, confusion, weakness, numbness/tingling. Management: mild: Ca+-rich diet, vitamin D supplements; severe: intravenous calcium gluconate.

Magnesium Imbalances

• Magnesium (Mg++): Crucial for cellular processes, energy production (ATP), sodium-potassium pump, muscle/neuro function. Normal value: 1.3-2.1 mEq/L.
• Hypermagnesemia: Caused by increased intake (esp. with renal insufficiency/failure), hypothyroidism, some metastatic cancers, IV magnesium for eclampsia. Manifestations: decreased reflexes, nausea/vomiting, decreased pulse/blood pressure, flushed warm skin. Management: stop magnesium containing medication; limit magnesium foods; if kidneys functioning, use diuretics; if compromised, dialysis; intravenous calcium gluconate to oppose magnesium effects.
• Hypomagnesemia: Caused by limited magnesium intake, increased losses (GI/renal), prolonged fasting, starvation, chronic alcohol use, some medications. Manifestations: similar to hypocalcemia, muscle cramps, tremors, Chvostek/Trousseau signs, confusion, vertigo, seizures. Management: mild: supplements and diet; severe: intravenous magnesium.

Acid-Base Regulation

• Normal ABG Values: pH 7.35-7.45; PaCO2 35-45 mmHg; HCO3 22-26 mEq/L; PaO2 80-100 mmHg; SaO2 >95%. Imbalances occur when acid/base ratio is disrupted (e.g., CO2 retention in lung disease).
• Respiratory Acidosis: Caused by hypoventilation; manifestations: lethargy, confusion, dizziness, headache, coma, decreased blood pressure, ventricular fibrillation, flushed skin. pH and PaCO2 are decreased.
• Respiratory Alkalosis: Caused by hyperventilation; manifestations: dizziness, lightheadedness, confusion, headache, nausea/vomiting, diarrhea, tachycardia, seizures, hyperreflexia, dysrhythmias, tetany. pH and PaCO2 are increased.
• Metabolic Acidosis: Caused by accumulation of non-carbonic acid or bicarbonate loss; manifestations: lethargy, confusion, dizziness, headache, coma, decreased blood pressure, dysrhythmias, cold/clammy skin, nausea/vomiting, diarrhea, muscle weakness, deep/rapid respirations. pH and HCO3 are decreased, PaCO2 may be decreased or normal.
• Metabolic Alkalosis: Caused by acid loss (prolonged vomiting) or bicarbonate gain (baking soda ingestion); manifestations: irritability, lethargy, confusion, headache, tachycardia, dysrhythmias, nausea/vomiting, anorexia, tetany, tremors, tingling, seizures, hypoventilation. pH and HCO3 are increased, PaCO2 may be increased or normal.

Cancer (Chapter 16)

Cancer Prevention and Detection

• Risk Factors: Smoking, physical inactivity, chemical exposure, obesity, family history, age, infections, diet, alcohol.
• Screening Recommendations: Colon (colorectal cancer): annual occult blood test, colonoscopy every 10 years starting at age 45; Breast: annual mammograms starting at age 40, pap smears every 3 years.

Lung Cancer

• Types: Non-small cell (NSCLC, 80%) and small cell (SCLC, 20%). NSCLC subtypes: squamous cell carcinoma (slow-growing), adenocarcinoma (most common in nonsmokers), large cell carcinoma (rapid-growing, highly metastatic).
• NSCLC Manifestations: Symptoms appear late; persistent cough, sputum production, hemoptysis (coughing up blood), dyspnea, wheezing, chest pain; later: anorexia, fatigue, weight loss, nausea/vomiting, hoarseness, unilateral diaphragmatic paralysis, dysphagia, superior vena cava syndrome, palpable lymph nodes, mediastinal involvement.
• SCLC Manifestations: Very rapid growth; early metastasis; associated endocrine disorders; chemotherapy and radiation; poor prognosis.

Colon and Rectal Cancer (CRC)

• Diagnostic Screening: Individual and family history; regular screening for polyps and cancer (ages 45-75); flexible sigmoidoscopy (every 5 years); colonoscopy (every 10 years); double-contrast barium enema (every 5 years); CT colonography (every 5 years); fecal occult blood test/FIT/stool DNA tests.
• Colonoscopy: Gold standard; entire colon examined; biopsy samples available; polyps removed; tissue biopsies confirm diagnosis; additional lab studies (CBC, liver function tests).
• CRC Staging: TNM (Tumor, Node, Metastasis); 5-year survival rate depends on those 3 indicators; stage dictates resection site (right/left hemicolectomy); various surgical options based on stage.

Prostate Cancer

• Risk factors: Age, ethnicity, family history; diets high in red/processed meat, high-fat dairy, decreased fiber, increased complex carbohydrates, obesity; environmental factors (pesticides). Slow-growing, androgen-dependent cancer.

Neutropenia

• Definition: Reduction in neutrophils (<1000/µL).
• Importance: Increased risk of infection (even from normal flora); normal inflammation signs may be absent; infection → sepsis → death.
• Priority: Neutropenic patient with fever is assumed infected; assessment, cultures, and antibiotics are needed immediately.

This quiz explores the key concepts related to fluid and volume imbalances in nursing, focusing on both Fluid Volume Deficit (FVD) and Fluid Volume Excess (FVE). Understand the manifestations, nursing management strategies, and underlying causes associated with these conditions. Perfect for nursing students looking to enhance their clinical knowledge.