Chapter 13 And 15 Fluid Imbalances
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Chapter 13 And 15 Fluid Imbalances

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Chapter 13 And 15 Fluid Imbalances Chapter 13 And 15 Fluid Imbalances Presentation Transcript

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