Fluid & Electrolyte Imbalance
N132
Fluid Imbalance
Fluid Volume Deficit
(Hypovolemia, Isotonic Dehydration)
Common Causes
– Hemorrhage
– Vomiting
– Diarrhea
– Burns
– Diuretic therapy
– Fever
– Impaired thirst
Clinical Manifestations
Signs/Symptoms
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Weight loss
Thirst
Orthostatic changes in pulse rate and bp
Weak, rapid pulse
Decreased urine output
Dry mucous membranes
Poor skin turgor
Treatment/Interventions (FVD)
Fluid Management
– Diet therapy – Mild to moderate dehydration.
Correct with oral fluid replacement.
– Oral rehydration therapy – Solutions containing
glucose and electrolytes. E.g., Pedialyte,
Rehydralyte.
– IV therapy – Type of fluid ordered depends on
the type of dehydration and the clients
cardiovascular status.
Nursing Implications
Monitor
postural heart rate and bp
when getting patients out of bed
Fluid Volume Excess
Common Causes:
– Congestive Heart Failure
– Early renal failure
– IV therapy
– Excessive sodium ingestion
– SIADH
– Corticosteroid
Clinical Manifestations
Signs/Symptoms
– Increased BP
– Bounding pulse
– Venous distention
– Pulmonary edema
Dyspnea
Orthopnea (diff. breathing when supine)
crackles
Treatment/Interventions (FVE)
Drug therapy
– Diuretics may be ordered if renal failure is not
the cause.
Restriction of sodium and saline intake
I/O
Weight
More to consider?
Age
– Infants
– Older adults
Prior medical history
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Acute illness
Chronic illness
Environmental factors
Diet
Lifestyle
Medications
Physical Assessment
– Body systems
– I/O
– Weight
– Labs
Electrolyte Imbalance
Hypokalemia (5.0mEq/L)
Interventions
– Need to restore normal K+ balance:
– Eliminate K+ administration
– Inc. K+ excretion
Lasix
Kayexalate (Polystyrene sulfonate)
– Infuse glucose and insulin
– Cardiac...