"caused by failure of the body's homeostatic mechanisms to regulate the retention & excretion of body fluids. The condition is characterized by decreased output of urine, high specific gravity of urine, output of urine that is greater than the intake of fluid in the body, hemoconcentration, and increased serum levels of sodium.Three types: dehydration, isotonic fluid, third spacing"
fluid volume excess (FVE)
"Increased capillary hydrostatic pressure forces more fluid out of arterial end and draws less fluid back into venous end; Hypertension and vascular fluid volume excess are causes of edema; Decreased oncotic pressure results in weaker pulling power drawing fluid back; Trauma, burns, sepsis, bacterial infections, allergic reactions, cancer, intestinal obstruction, malnutrition and liver dysfunction; Lymphatic obstruction or surgical removal of lymph nodes impairs lymph drainage resulting in localized edema; Sodium excess causes water retention leading to elevated blood pressure, hydrostatic pressure and edema; Renal failure, decreased renal perfusion and excess aldosterone or corticosteroids"
third spacing FVD
Shift of fluid from vascular space to area where not available for normal physiologic processes; Trapped fluid represents fluid volume loss
Both water & electrolytes are lost; Na+ level normal; Decrease body temperature; Fluid drawn into vascular compartment bodys attempt to maintain tissue perfusion; Eventually depletes fluid in intracellular compartment as well
"Rapid fluid loss symptoms develop rapidly; Gradual loss very low fluid status before symptomology; Rapid weight loss 1 liter =1 kg = 2.2 lbs.; Decreased skin turgor examine tongue turgor (size, dryness & longitudinal furrow) dry sticky mucous membranes; Postural / Orthostatic hypotension drop more then 15 mmHg systolic - changing from lying to standing position; Venous pressure falls as well; Increase hematocrit; Tachycardia, vasoconstriction (pale, cool skin), v urine output, ^ specific gravity; Altered mental state, anxiety, restlessness, v alertness & cognition; Flat neck veins, v venous filling, v amplitude pulse, v capillary refill"
"Serum electrolytes Na normal or high depending water loss, K decreases common; Serum osmolarity High with water loss, norm with isotonic fluid loss; Hg & Hct Hct often elevated, hemoconcentration; Urine specific gravity & osmolarity - increased; Central venous pressure - decreased"
"Monitor I/O, vitals signs, CVP, peripheral pulse volume; Wt daily; Ensure adequate po fluids; Control nausea & vomiting; Monitor renal, cerebral & peripheral tissues for signs decreased perfusion; Turn & reposition every 2 hours; Provide comfort measures oral hygiene, brushing & rinsing (Avoid lemon-glycerin & hard candy); Apply lip moisturizer & lotion to dry skin; Administer IVF as prescribed, monitor for overload (dyspnea, tachypnea, tachycardia, jugular vein distention, edema); Monitor laboratory values electrolytes, serum osmolarity, BUN, Hct; Safety precautions"
"Avoid exercise in extreme weather, replace fluid with sports drinks; Maintain fluid intake when ill, replace with fruit juice, broth (vomiting, diarrhea); Discuss decreased thirst with aging / decreased level of consciousness - monitor & ensure adequate intake; Discuss early signs impending fluid volume deficit; Reduce intake coffee, tea, alcohol - stimulate increased urine output"
Hypotonic FVE causes
repeated plain water enemas; NG irrigation / bladder irrigation; continuous use hypotonic IV infusion - too much &/or too quick; excessive intake of plain water; SIADH; lack of protein & electrolyte intake; kidney impairment
Isotonic FVE causes
renal failure; heart failure; cirrhosis liver; excess fluid intake (isotonic IV solution too quickly); high corticosteroid levels; Stress - ADH release & high aldosterone levels
"Full / bounding peripheral pulses, brisk capillary refill; Warm extremities; Rapid weight gain (>5%); High central venous pressure, venous engorgement; Gallop heart rhythm"
"Serum electrolytes & osmolarity usually remain in normal range; Hg & Hct - decrease due to dilution; Renal & liver function - help determine cause of overload (creatinine, BUN, liver enzymes)"
"Restrict fluid intake (1000-1500 per 24hrs), I/O, daily weights; Na restricted diet; Position of comfort high fowlers; Diuretics: loop (lasix), K-sparing (spironolactone), or hiazide diuretics; Increase protein intake; Monitor cardiac status, treat CHF, listen to heart sounds; Monitor vitals, respiratory status and lung sounds, venous engorgement, neurologic status, labs; Irrigate NG with NS instead of plain water; Avoid tap water enemas"
FVE Nursing Interventions
"Oral hygiene at least every 2 hours; Monitor skin integrity, turn & reposition every 2 hours; Egg crate mattress; Fowlers positon for dyspnea / orthopnea; Oxygen as indicated; Avoid restrictive clothing; Support stocking, SCDs; Elevate legs; Avoid crossing legs when sitting"
"same osmolarity blood plasma, 0.9% sodium chloride, expands bodys fluid volume without shifts, can be administered more rapidly, RBC maintain shape and size"
"higher osmotic pressure - 3% sodium chloride pulls fluid from intercellular & interstitial compartments into blood vessels, can cause overload, RBCs irritated & shrink"
"lower osmotic pressure, 0.45% sodium chloride, moves fluid out of blood & into cells & interstitial spaces, RBCs swell & can burst"