Fluid Volume Disorders PDF

9/18/2024 Fluid Volume Disorders Compiled and recorded by Ben McLain MSN, RN 1 Terms to remember Oncotic Pressure (Colloidal Pressure) - The pull exerted by things with a hig...

9/18/2024 Fluid Volume Disorders Compiled and recorded by Ben McLain MSN, RN 1 Terms to remember Oncotic Pressure (Colloidal Pressure) - The pull exerted by things with a high molecular weight (e.g. colloids, albumin) helps keep fluid in intravascular space. Osmotic Pressure - The pull exerted by electrolytes that can draw fluid through a semipermeable membrane. Hydrostatic Pressure - pressure that forces fluid out of the vessel Osmolality - A measure of the osmotic pull ○ Plasma - 275-290 mOsm/kg. ○ Determined mainly by serum Na+ 2 1  9/18/2024 Fluid Spaces Intracellular Fluid ○ ICF - Fluid inside the cell ○ Accounts for about two-thirds of total fluid ○ Extracellular Fluid ○ ECF – Fluid outside the cell ○ Two different places: ○ Interstitial – between tissue and cells ○ Intravascular – in the blood vessels 3 Intake and Output Overall, intake and output should be close to equal Output can be broken down into: ○ Sensible Fluid loss - measurable (e.g., Urine, gastric fluids, emesis, diarrhea, etc) ○ Insensible Fluid loss - unmeasureable (e.g., perspiration, respiration, solid feces, etc) As RN’s what is the normal urine output we look for in our patients? 4 2  9/18/2024 5 Fluid Volume Disorders 6 3  9/18/2024 Fluid Volume Deficit - Hypovolemia Low fluid volume can be extracellular, intravascular, or both. Risk Factors can be summarized by: Fluid loss > Fluid Intake ○ Inability to drink fluid ○ Trauma ○ NPO ○ Diarrhea/Vomiting ○ Disoriented patient ○ Elderly patients ○ The list could go on and on. 7 Identifying hypovolemia Assessment:: Diagnostics: Skin turgor CBC Mucous Membranes BMP Hypotension/Tachycardia Urine Specific Gravity Weak pulses Serum osmolarity Weight loss Changes in LOC and mentation 8 4  9/18/2024 Management of Hypovolemia Management Complications Short term: restore fluid volume Shock Longer term: Treat the cause Acute Tubular Necrosis Clotting/DVT Nephrolithiasis/Kidney Stones Nursing Interventions Angina Strict I&O Assess and Monitor Alleviate symptoms Encourage PO intake if able 9 Fluid Volume Deficit - Third Spacing Low intravascular fluid volume - moving to an interstitial space where it becomes useless to the body (peritoneal, pericardial, pleural, synovial) Associated with low albumin, increased capillary permeability, inflammation Risk Factors can be: ○ Abdominal Surgery ○ Liver disease ○ Burns ○ Sepsis 10 5  9/18/2024 Identifying Third Spacing Assessment: Diagnostics: Skin turgor CBC Mucous Membranes CMP Hypotension/Tachycardia Urine Specific Gravity Weak pulses Weight gain Changes in LOC and mentation Ascites Anasarca Brawny edema (non-pitting edema hard to touch) 11 Management of Third Spacing Management Complications IV Colloids Shock Management of underlying Acute Tubular Necrosis cause DVTs Nephrolithiasis/Kidney Stones Angina Nursing Interventions Possible hypervolemia Strict I&O Assess and Monitor Alleviate symptoms Encourage PO intake if able 12 6  9/18/2024 Patient Education A lot of education will depend on the underlying cause. Drink when thirsty, drink enough especially when weather is hot. Safety concerns (fall risk) 13 Fluid Volume Excess - Hypervolemia High volume of fluid in intravascular space Risk Factors can be summarized by: Fluid output < Fluid Intake ○ Rapid infusion of IV Fluid ○ Heart Failure, Renal Dysfunction, Adrenal Dysfunction ○ Excessive Salt intake ○ Medications (e.g. Steroids) 14 7  9/18/2024 Identifying hypervolemia Assessment: Diagnostics: Weight gain CBC Dilute urine BMP Lung sounds Urine Specific Gravity Edema (slight to pitting) Serum Osmolarity JVD Activity Intolerance Bounding pulse Vitals 15 Management of Hypervolemia Management Complications Short term: restrict fluids and Cardiac issues sodium, diuretics Pitting edema Long term: treat underlying cause Respiratory issues Nursing Interventions Compression stockings Monitor dietary restrictions Daily weights Repositioning 16 8  9/18/2024 Patient Education Education can depend on underlying cause Dietary changes Measuring fluid intake S/S of complications ○ Weight gain, increasing edema, SOB, etc. 17 IV Fluids 18 9  9/18/2024 Types of IV fluids Colloids Crystalloids IV fluid that has large molecules to help IV fluids that are used to increase fluid draw fluid from interstitial spaces into the volume (will be additional categories) vascular space Albumin Lactated Ringer’s Hetastarch (not used often anymore) 0.9% Normal Saline Blood Products Dextrose 5% in Water 19 Types of IV Fluids Isotonic Hypotonic Hypertonic Have the same osmolality as Have a lower osmolality than Have a higher osmolality than body fluids. Used to increase body fluids. Helps increase ICF. body fluids. Helps move fluid ECF from ECF to vascular space. 0.9% Normal Saline (NS) 5% dextrose in Water (D5W) 5% dextrose in 0.9% NS (D5NS) Lactated Ringers (LR) *Starts as isotonic then becomes 5% dextrose in 0.45% NS (D5 ½ hypotonic* NS) 0.45% Normal Saline (½ NS) 3% Normal Saline 20 10