Fluid and Electrolyte Problems

  1. Hypotonic
    Water is pulled out of vessels and into cells
  2. Hypotonic IV fluids are used to _____
    Prevent and treat cellular dehydration
  3. Hypotonic Solutions
    • D5W, 0.45 NS, 0.225 NS
    • Glucose solutions are hypertonic in the bag, but have a hypotonic effect on the cells due to rapid metabolization of dextrose
  4. Nursing Considerations of pt receiving hypotonic solutions
    Frequent monitoring of VS, LOC, and cirulation to detect depletion of vascular volume and cerebral cellular edema
  5. Hypertonic
    • Very Rare
    • Cause water to be pulled from cells and into the vessels
  6. Hypertonic IV Solutions
    • Saline solutions greater than 0.9%
    • Dextrose solutions (10 or 50%) used on a limited basis to treat pt with hypoglycemia
  7. Hypertonic Solutions should be given to pt when _____
    Serum Sodium is dangerously low (115 or less)
  8. Nursing Considerations of pt receiving hypertonic solutions
    Monitor VS, neurological status, lung sounds, urine output, serum sodium levels to avoid hypernatremia and vasular volume overload
  9. Antidiuretic Hormone
    Synthesized by the hypothalmus and secreted by the pituitary gland
  10. ADH release is triggered by:
    • Drop in BP or blood volume OR
    • Rise in osmolality causing the kidneys to reabsorb more water
  11. ADH release is inhibited by:
    • A rise in BP or blood volume OR
    • A drop in blood osmolality
  12. Aldosterone
    Adrenal gland hormone that conserves sodium in the body by causing the kidneys to retain sodium and extrete potassium in its place
  13. Aldosterone release is triggered by:
    Drop in BP, blood volume, serum sodium, or a rise in serum potassium
  14. Aldosterone release causes the kidneys to ____
    Reabsorb more sodium into the blood increasing serum sodium levels, and water follows sodium to raise vascular
  15. Aldosterone release is inhibited by:
    Rise in BP, blood volume, or sodium or a drop in potassium level
  16. Glucocorticoids (Cortisol)
    • Hormone produced and released by the adrenal gland when the body is stressed
    • Promotes renal retention of sodium and water
  17. Atrial Natriuretic Peptide (ANP)
    • Cardiac hormone found in the atria
    • Lowers blood volume and BP
  18. ANP is released when ____
    Atria are stretched by high blood volume or high BP
  19. Brain Natriuretic Peptide (BNP)
    • Cardiac hormone found within ventricles
    • Decreases blood volume and pressure
  20. BNP is released when ____
    Blood volume and pressure withing the ventricles are increased
  21. Isotonic Fluid Loss
    • Fluid and solute are lost in proportional amounts so osmolality remains normal and no osmotic force is created
    • Can lead quickly to shock
  22. Causes of Isotonic Fluid Loss
    • Hemmorrhage (hypovolemia)
    • GI losses
    • Wound drainage or wound suctioning
    • Fever
    • Burns (#1 problem)
    • Diuretics
    • Third space fluid shifts
  23. Treatment of Isotonic Fluid loss
    • Isotonic Solutions
    • Blood Products
    • Colloid volume expanders
  24. Hypertonic Dehydration
    • More water is lost than solute (primarily sodium)
    • Serum osmolality is elevated, so fluid is pulled into vessels from cells causing cellular dehydration
  25. Causes of Hypertonic Dehydration
    • Inadequate fluid intake
    • Prolonged isotonic fluid losses when body is no longer able to compensate
    • Prolonged watery diarrhea
    • Diabetes Insipidus
    • Increased solute intake
  26. Causes of Third Spacing
    • Injury or inflammation
    • Malnutrition
    • Liver dysfuntion
    • High vascular hydrostatic pressure as seen in heart failure
    • Renal failure
  27. Assessment findings in pt with Fluid volume Defecit
    • Thirst
    • Urine output less than 30 cc/hour
    • Concentrated, dark urine with high specific gravity
    • Dry skin with decreased turgor and elasticity; dry mucous membranes
    • Dry tongue with longitudinal furrows
    • Decreased tearing and dry conjunctiva
    • Sunken eyeballs
    • Flat neck veins and poor peripheral vein filling
  28. Lab Findings of Fluid Volume Deficit
    • Normal or high HCT
    • High urine specific gravity
    • Serum osmolality elevated >300
    • Hypernatremia
  29. Therapeutic Management of Fluid volume deficit
    • Oral fluid volume replacement
    • Avoid drinks with high sugar and salt content (hypertonic)
    • Avoid caffeine (mild diuretic)
    • Administer isotonic fluids
    • Administer blood transfusions for hemorrhage
  30. Evaluation of adequate Fluid Volume
    • Urine output and concentration >30 cc/hr
    • Stable heart rate and blood pressure lying and standing
    • Skin and mucous membranes moist with normal turgor and elasticity
    • Normal mental status and behavior
    • HCT, BUN, Serum osmolality, serum electrolytes return WNL within 48-72 hours
  31. Lab values of Fluid Volume Excess
    • Hematocrit and BUN decreased due to hemodilution
    • Serum osmolality is low <275
    • Serum sodium is low <125
    • Chest x-ray may show plerual effusions
Card Set
Fluid and Electrolyte Problems
Test 2