Chapter 13 And 15 Fluid Imbalances

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Chapter 13 And 15 Fluid Imbalances

  1. 1. Fluid Imbalances Peggy D. Johndrow 2009
  2. 2. Fluid Movement Between ECF & ICF <ul><li>Water deficit (increased ECF) is associated with symptoms that result from cell shrinkage as water is pulled into vascular system </li></ul><ul><li>Water excess (decreased ECF) develops from gain or retention of excess water </li></ul>
  3. 3. Fluid Spacing <ul><li>First spacing </li></ul><ul><ul><li>Normal distribution of fluid in ICF and ECF </li></ul></ul><ul><li>Second spacing </li></ul><ul><ul><li>Abnormal accumulation of interstitial fluid </li></ul></ul><ul><li>Third spacing </li></ul><ul><ul><li>Fluid accumulation in part of body where it is not easily exchanged with ECF </li></ul></ul>
  4. 4. Differential Assessment ECF Volume
  5. 5. Imbalances in ECF Volume
  6. 6. Extracellular Fluid Volume Imbalances <ul><li>Hypovolemia can occur with loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), decreased intake, or plasma-to-interstitial fluid shift </li></ul><ul><li>Hypervolemia may result from excessive intake of fluids, abnormal retention of fluids (CHF), or interstitial-to-plasma fluid shift </li></ul>
  7. 7. ECF Imbalances Management <ul><li>Treatment hypovolemia is balanced IV solutions, isotonic chloride, or blood </li></ul><ul><li>Treatment hypervolemia is use of diuretics, fluid restriction, and sodium restriction </li></ul>
  8. 8. Nursing Management <ul><li>Hypervolemia: </li></ul><ul><ul><li>Excess fluid volume </li></ul></ul><ul><ul><li>Ineffective airway clearance </li></ul></ul><ul><ul><li>Risk for impaired skin integrity </li></ul></ul><ul><ul><li>Disturbed body image </li></ul></ul><ul><ul><li>Potential complications: pulmonary edema, ascites </li></ul></ul>
  9. 9. Nursing Management <ul><li>Hypovolemia </li></ul><ul><ul><li>Deficient fluid volume </li></ul></ul><ul><ul><li>Decreased cardiac output </li></ul></ul><ul><ul><li>Potential complication: hypovolemic shock </li></ul></ul>
  10. 10. Nursing Implementation <ul><li>I&O </li></ul><ul><li>Monitor cardiovascular changes </li></ul><ul><li>Assess respiratory status and monitor changes </li></ul><ul><li>Daily weights </li></ul><ul><li>Skin assessment </li></ul><ul><li>Neurologic function </li></ul><ul><ul><li>LOC </li></ul></ul><ul><ul><li>PERLA </li></ul></ul><ul><ul><li>Voluntary movement of extremities </li></ul></ul><ul><ul><li>Muscle strength </li></ul></ul><ul><ul><li>Reflexes </li></ul></ul>
  11. 11. Protein Imbalances <ul><li>Plasma proteins, particularly albumin, are significant determinants of plasma volume </li></ul><ul><li>Hyperproteinemia is rare, but occurs with dehydration-induced hemoconcentration </li></ul>
  12. 12. Hypoproteinemia <ul><li>Caused by </li></ul><ul><ul><li>Anorexia </li></ul></ul><ul><ul><li>Malnutrition </li></ul></ul><ul><ul><li>Starvation </li></ul></ul><ul><ul><li>Fad dieting </li></ul></ul><ul><ul><li>Poorly balanced vegetarian diets </li></ul></ul><ul><ul><li>Poor absorption in certain GI malabsorptive diseases </li></ul></ul><ul><ul><li>Protein can shift out of intravascular space with inflammation </li></ul></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Nephrotic syndrome </li></ul></ul>
  13. 13. Hypoproteinemia Clinical Manifestations <ul><li>Edema </li></ul><ul><li>Slow healing </li></ul><ul><li>Anorexia </li></ul><ul><li>Fatigue </li></ul><ul><li>Anemia </li></ul><ul><li>Muscle loss </li></ul><ul><li>Ascites </li></ul>
  14. 14. Hypoproteinemia Management <ul><li>High-carbohydrate, high-protein diet </li></ul><ul><li>Dietary protein supplements </li></ul><ul><li>Enteral nutrition or total parenteral nutrition </li></ul>
  15. 15. IV Fluids <ul><li>Purposes </li></ul><ul><ul><li>Maintenance- when oral intake not adequate </li></ul></ul><ul><ul><li>Replacement- when losses have occurred </li></ul></ul><ul><li>IV fluids will cause electrolyte imbalances if not corrected </li></ul><ul><li>Imbalances classified as deficits or excesses </li></ul><ul><li>Sodium plays major role in homeostasis of ECF </li></ul>
  16. 16. D5W <ul><li>Isotonic </li></ul><ul><li>Provides 170 kcal/L </li></ul><ul><li>Free water </li></ul><ul><ul><li>Moves into ICF </li></ul></ul><ul><ul><li>Increases renal solute excretion </li></ul></ul><ul><li>Prevents ketosis </li></ul><ul><li>Supports edema formation </li></ul><ul><li>Decreased chance of IV fluid overload </li></ul><ul><li>Usually compatible with medications </li></ul>
  17. 17. Normal Saline (NS) <ul><li>Isotonic </li></ul><ul><li>No calories </li></ul><ul><li>More NaCl than ECF </li></ul><ul><li>30% stays in intravascular (IV) (most) </li></ul><ul><ul><li>70% moves out of IV </li></ul></ul><ul><li>Expands IV volume </li></ul><ul><ul><li>Preferred fluid for immediate response </li></ul></ul><ul><ul><li>Risk for fluid overload higher </li></ul></ul><ul><li>Does not change ICF Volume </li></ul><ul><li>Blood products </li></ul><ul><li>Compatible with most medications </li></ul>
  18. 18. Lactated Ringer’s <ul><li>Isotonic </li></ul><ul><li>More similar to plasma than NS </li></ul><ul><ul><li>Has less Na Cl </li></ul></ul><ul><ul><li>Has K, Ca, PO4, lactate (metabolized to HCO3) </li></ul></ul><ul><li>Expands ECF, IV </li></ul><ul><li>Common replacement fluid </li></ul>
  19. 19. D5 ½ NS <ul><li>Hypertonic </li></ul><ul><li>Common maintenance fluid </li></ul><ul><li>KCl added for maintenance or replacement </li></ul><ul><li>Provides calories </li></ul><ul><ul><li>Prevents ketosis </li></ul></ul><ul><li>Moves into ICF </li></ul><ul><li>Usually compatible with medications </li></ul>
  20. 20. D10W <ul><li>Hypertonic </li></ul><ul><li>Provides 340 kcal/L </li></ul><ul><li>Free water </li></ul><ul><li>Limit of dextrose concentration may be infused peripherally </li></ul>
  21. 21. Plasma Expanders <ul><li>Pull fluid into IV from interstitium </li></ul><ul><li>Colloids </li></ul><ul><ul><li>Packed RBCs </li></ul></ul><ul><ul><li>Albumin </li></ul></ul><ul><ul><li>Plasma </li></ul></ul>

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