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FINAL REVIEWby LELIA DURAN-MORA1Isotonic fluid- stays where I put it Close to ECF

Cells dont shrink or swell

Crystalloid

NS, LR

D5W infuses as isotonic but disperses into a hypotonic solutionUsed primarily to correct hypernatremia

Isotonic fluids2Hypotonic fluids- moves OUT of the vessel

Used to replace cellular fluid

Overuse can lead to intravascular depletion, hypotension, cellular edema, cell damage

NS

Hypotonic fluids3Hypertonic-Enters the vesselShifts from the intracellular to the extracellular

Causes cells to shrink

If administered too quickly or in large volumes can cause circulatory overload & dehydration

Administer slowly & cautiously

3% NS

Hypertonic fluids4Hypovolemia-abnormal fluid loss-water & electrolyte loss proportionalVomitingDiarrheaGI suctioningSweatingDecrease PO intakeFluid ShiftsAcitesBurnsDIAdrenal insufficiencyOsmotic diuresisHemorrhageComa

Fluid Volume Deficit-Hypovolemia5Fluid Volume Deficit Signs & Symptomsrapid weight loss

decreased skin turgor

oliguria

concentrated urine

postural hypotension

rapid weak pulse

decreased temperature, cool clammy skin due to vasoconstriction

thirst

confusion

muscle weakness

cramps

6Provide oral fluids Oral care, non-irritating fluids

IV solutions-isotonic fluids

I&O, weight, VS, CVP, LOC,

Assess breath sounds

Monitor urine output 30ml/hr

Assess skin turgor & color

Assess urine concentration

Identify at risk patients

Assess nausea, diarrhea, or other cause & treatAntiemeticAntidiarrheal

Provide skin care/repositionManagement of Fluid Volume Deficit7Hypervolemia

Fluid overload or diminished homeostatic mechanismsheart failurerenal failurecirrhosis of liverexcessive dietary sodium or sodium-containing IV solutions

Diagnostic FindingsDecreased BUN & HCT (dilution)CXR- pulmonary congestionFluid Volume Excess-Hypervolemia8Signs & SymptomsEdema

JVD

Adventitious breath sounds

Elevated HR & BP

Increased pulse pressure

Increased CVP

Increased weight

Increased UOP

SOBFluid Volume Excess - Nursing Management I&O and daily weight

Assess lung sounds, edema

monitor responses to medications- diuretics

Promote adherence to fluid restrictions

patient teaching related to sodium and fluid restrictionsMonitor, avoid sources of excessive sodium, including medications

Promote rest

Semi-Fowlers position for orthopnea

Skin care, positioning/turning

10Sodium: hyponatremia, hypernatremia

Potassium: hypokalemia, hyperkalemia

Calcium: hypocalcemia, hypercalcemia

Magnesium: hypomagnesemia, hypermagnesemia

Phosphorus: hypophosphatemia, hyperphosphatemia

Chloride: hypochloremia, hyperchloremia

Electrolyte Imbalances11Hyponatremia Serum sodium less than 135 mEq/L

Causes: adrenal insufficiencywater intoxicationSIADHlosses by vomiting, diarrhea, sweating, diuretics

Signs & Symptoms: poor skin turgordry mucosaheadachedecreased salivationdecreased BPNauseaabdominal crampingSigns & Symptoms (Cont)Neurological changesCerebral edemaSeizures, muscle twitchingConfusion

Medical management: water restriction sodium replacement

Nursing management:assessment and preventiondietary sodium and fluid intake identify and monitor at-risk patientseffects of medications (diuretics, lithium)

12HypernatremiaSerum sodium greater than 145mEq/L

Causes:Excess water lossExcess sodium administrationDiabetes InsipidusHeat stroke

Signs & Symptoms: ThirstElevated temp, HR, & BPDry, swollen tongueSticky mucosaConfusion/restlessness/irritabilitySeizure activityNote: thirst may be impaired in elderly or the ill

Medical management: hypotonic electrolyte solution or D5W

Nursing management: assessment and preventionassess for OTC sources of sodiumoffer and encourage fluids to meet patient needsprovide sufficient water with tube feedings

13HypokalemiaBelow-normal serum potassium (