This document discusses fluid imbalances and extracellular fluid volume imbalances. It describes hypovolemia as a deficiency in fluid volume that can result from loss of fluids or decreased intake. Hypervolemia is an excess fluid volume that may occur from excessive fluid intake or abnormal fluid retention. Nursing management for hypervolemia focuses on excess fluid volume, while management for hypovolemia addresses deficient fluid volume and potential complications like hypovolemic shock. The document also covers protein imbalances like hypoproteinemia and treatments like high protein diets or IV fluids.

1. Fluid Imbalances Peggy D. Johndrow 2009

2. 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

3. 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

4. Differential Assessment ECF Volume

5. Imbalances in ECF Volume

6. 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

7. ECF Imbalances Management Treatment hypovolemia is balanced IV solutions, isotonic chloride, or blood Treatment hypervolemia is use of diuretics, fluid restriction, and sodium restriction

8. Nursing Management Hypervolemia: Excess fluid volume Ineffective airway clearance Risk for impaired skin integrity Disturbed body image Potential complications: pulmonary edema, ascites

9. Nursing Management Hypovolemia Deficient fluid volume Decreased cardiac output Potential complication: hypovolemic shock

10. 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

11. Protein Imbalances Plasma proteins, particularly albumin, are significant determinants of plasma volume Hyperproteinemia is rare, but occurs with dehydration-induced hemoconcentration

12. 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

13. Hypoproteinemia Clinical Manifestations Edema Slow healing Anorexia Fatigue Anemia Muscle loss Ascites

14. Hypoproteinemia Management High-carbohydrate, high-protein diet Dietary protein supplements Enteral nutrition or total parenteral nutrition

15. 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

16. 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

17. 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

18. 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

19. D5 ½ NS Hypertonic Common maintenance fluid KCl added for maintenance or replacement Provides calories Prevents ketosis Moves into ICF Usually compatible with medications

20. D10W Hypertonic Provides 340 kcal/L Free water Limit of dextrose concentration may be infused peripherally

21. Plasma Expanders Pull fluid into IV from interstitium Colloids Packed RBCs Albumin Plasma