Urgentna

Urgentna

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








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







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...