Week 5 Edapts Part 1.pdf

Fluid Homeostasis and Balance The human body constantly strives for fluid homeostasis, with hundreds of feedback mechanisms regulating fluid balance. Critically ill patients are particularly susceptible to fluid and electrolyte imbalances due to the disruption of these m...

Fluid Homeostasis and Balance The human body constantly strives for fluid homeostasis, with hundreds of feedback mechanisms regulating fluid balance. Critically ill patients are particularly susceptible to fluid and electrolyte imbalances due to the disruption of these mechanisms, leading to compromised clinical outcomes. Fluid Compartments: o Intracellular fluid: Usually stable. o Intravascular fluid: Fluctuates based on fluid intake/loss. o Interstitial fluid: Acts as a reserve to replace fluid as needed. Kidney Function: o The kidneys are vital for water and electrolyte balance. o Regulated by hormones like aldosterone, antidiuretic hormone (ADH), and natriuretic peptides. Hormones: o Aldosterone: Retains sodium and increases potassium excretion; triggered by low blood pressure or fluid volume. o ADH: Promotes water reabsorption in response to low blood volume or high osmolarity. o Natriuretic Peptides: Triggered by heart stretching, leading to increased sodium and water excretion. Risk Factors for Fluid Imbalance Heart failure: Causes fluid overload due to reduced cardiac output. Renal dysfunction: Reduces the kidney's ability to remove excess fluids. Gastrointestinal losses: Vomiting, diarrhea, or suctioning can cause a fluid deficit. Blood loss: Severe hemorrhage leads to fluid loss. Medications: Diuretics or other medications can disrupt fluid balance. Surgery and mechanical ventilation: Both can result in fluid retention or loss. Sodium Imbalances Hyponatremia (Low Sodium): o Often due to fluid retention, compromised removal of excess fluid, renal impairment, or inappropriate administration of hypotonic fluids. o Treatment: Restrict water and sodium, or extracorporeal ultrafiltration for severe cases. Hypernatremia (High Sodium): o Indicates fluid depletion, often due to fever, wound drainage, gastrointestinal losses, or diuretics. o Treatment: Replenish fluids with isotonic solutions and treat the underlying cause of fluid loss. Monitoring Techniques and Values Pulmonary Artery (PA) Monitoring: Provides indirect measurement of left ventricular function by measuring pulmonary artery wedge pressure (PAWP). o Normal range: 6-12 mmHg. o High PAWP: Indicates fluid overload. o Low PAWP: Suggests fluid depletion. Direct Arterial Blood Pressure Monitoring: Continuous, accurate arterial blood pressure readings. Common sites: Radial, brachial, or femoral arteries. Blood oxygen saturation (SpO2) should be between 95-100%. Right Atrial Pressure (RAP) Monitoring: Measures pressure in the right atrium (CVP). o Normal range: 2-8 mmHg. o High RAP: Indicates fluid overload, severe vasoconstriction, or heart failure. o Low RAP: Suggests fluid depletion or vasodilation. Left Atrial Pressure (LAP) Monitoring: Measures pressure in the left atrium; mainly used in cardiac surgeries. o Normal range: 6-12 mmHg. o Requires careful monitoring due to risk of air embolism and obstruction of critical arteries. Venous Oxygen Saturation (SvO2) Monitoring: Reflects tissue oxygenation. o Central venous oxygen saturation (ScvO2): 70%. o Mixed venous oxygen saturation (SvO2): 60-80%. Nursing Role During Hemodynamic Monitoring Education: Teach patients and families about monitoring procedures. Consent: Ensure signed consent before invasive procedures. Monitoring: Set up equipment, assist with insertion, observe tracings, assess trends, and make clinical decisions based on data. Prevent complications: Check arterial waveforms, secure connections, and monitor for neurovascular compromise. Complications of Hemodynamic Monitoring Arterial Lines: Complications include hemorrhage, infection, thrombus formation, and neurovascular impairment. o Ensure secure connections, check waveforms, and maintain equipment. o Change pressure tubing, flush bags, and transducers every 96 hours to reduce infection risk. Venous Lines: Risk of dysrhythmias and infection. Confirm placement with a chest X-ray. Fluid Management in Critical Patients Hypovolemia (Fluid Deficit): Caused by blood loss, excessive fluid loss, or lack of intake. o Treatment: ▪ Fluid replacement (isotonic fluids). ▪ Medications to support blood pressure. ▪ Monitor urine output to ensure at least 0.5 mL/kg/hr. Hypervolemia (Fluid Overload): Associated with heart failure or excessive fluid intake. o Treatment: ▪ Fluid restriction. ▪ Diuretics or continuous renal replacement therapy (CRRT) in severe cases. Fluid Volume Resuscitation: Necessary for replacing intravascular volume deficits to restore cardiac output and prevent kidney injury. o Goal: Restore normal tissue perfusion and kidney function. Continuous Renal Replacement Therapy (CRRT) Used for fluid overload, kidney dysfunction, or toxins in the blood. CRRT vs. Hemodialysis: CRRT provides slower and more controlled fluid removal, enhancing hemodynamic stability. Nursing Role in CRRT: o Collect baseline data, monitor fluid volume status, assess electrolyte balance, prevent infection, and monitor circuit patency. Key Lab Values to Monitor in Fluid Management: Sodium (Na): 135-145 mmol/L.  Potassium (K): 3.5-5.0 mmol/L. Chloride (Cl): 96-106 mmol/L. Creatinine: 0.6-1.2 mg/dL (renal function indicator). Blood Urea Nitrogen (BUN): 7-20 mg/dL (renal function indicator). Glomerular Filtration Rate (GFR): 90 mL/min or higher indicates normal kidney function. Albumin: Reflects protein levels in the blood; low levels can indicate malnutrition or chronic disease. Nursing Considerations for Fluid Management: Monitor vital signs, lab values, and hemodynamic parameters. Be vigilant for complications related to fluid imbalance, including pulmonary issues (crackles in lungs), and changes in organ perfusion. Actively participate in patient education and ensure understanding of procedures, medications, and the significance of ongoing monitoring. By staying aware of fluid balance and the clinical signs of imbalance, nurses play a vital role in preventing complications and improving outcomes in critically ill patients