Fluid imbalances
With dehydration specific gravity will be greater than
1.030
change position every?
2 hours
1 L of water = ____ lbs
2.2
1 kg= _____ lbs
2.2
1 ounces = ml
30
For every degree increase in a fever lose ____ ml of fluid
500
1 pounds weight change=
500 ml
With fluid overload specific gravity with be
<1.005
What is actual dehydration?
Actual decrease in total body water
What body systems are affected by dehydration?
All of them
What neuromuscular finding do we find with fluid overload?
Altered LOC, headahce, visual disturbance, weakness, paresthias
What is fluid overload?
An excess of body fluid (intake or retention is greater than the body's needs)
What body systems are MOST affected by dehydration?
CV and skin
What drugs can be used for fluid overload if diuretics should not be used?
Canivaptan, tolvaptan
The urine with dehydration will look?
Dark amber, strong odor
What is hypovolemia
Decreased circulating blood volume
What is actual dehydration caused by
Decreased intake, increased loss
What does hyvolemia lead to?
Decreased pressure which leads to decreased perfusion
What is fluid intake or retention is less than what is needed to meet the body's fluid needs
Dehydration
What drugs are usually prescribed for fluid overload?
Diurectics- if kidney failure is not the cause
What do we need to teach people to prevent mild dehydration
Drink more fluids
With dehydration where is the fluid loss from?
ECF
What is hypervolemia caused by?
Excessive intake, or inadequate excretion
With dehydration a patient is at risk for? and why
Falls b/c of orthostatic hypotension, muscle weakness, confusion
Teach a patient to ___ when dehydration
Get up slowly, and sit if dizzy
When overload is severe (or if it occurs in someone with poor cardiac/kidney health) it can lead to?
Heart failure and pulmonary edema
What is the most common type of fluid overload?
Hypervolemia (excessive fluid in ECF)
What are the CV changes with dehydration?
Increased HR (trying to maintain BP), peripheral pulses are weak and easily blocked, hypotension, orthostatic hypotension (light headed and dizzy), neck and hand veins are always flat
What resp findings do we find with fluid overload?
Increased RR, shallow, SOB, crackles
Increased contractility caueses?
Increased arterial pressure
Circulatory overload causes?
Increased arterial pressure, increased venous pressure
What CV finding do we find with fluid overload?
Increased pulse, bounding pulse, increased blood pressure, distended neck and hand wins, weight gain, edema
Decreased ADH and increased NP cause?
Increased renal excretion
What is the most common type of fluid loss?
Isotonic
Why does RR increase with dehydration?
Less volume= decreased perfusion
How is mild dehydration corrected?
Match fluid intake with output
What type of dehydration is very common in health adults?
Mild
When is oral fluid replacement used?
Mild to moderated dehydration and those would can tolerate fluids
What is key information to be collected with dehydration?
Nutrition, daily weight, medications, sense of thirst, mental status
How to prevent moderate dehydration?
Offer residents fluids every 1-2 hours and with all of their meds
Who is at a higher risk for dehydration and why?
Older adults, they have less total body water and have a decreased thirst mechanism, and less motor skills to get water.
IF possible do we want to replace fluids orally or IV?
Orally
What is fluid overload also called?
Overhydration
Who is moderate dehydration more like to occur in?
Patients that cannot obtain fluids without help.
What do we find in skin with fluid overload?
Pitting edema, skin is pale and cool
Intake includes all?
Po and IV fluids, meds, and flushes
What are the two most important areas to monitor during rehydration?
Pulse rate and quality, and urine output
What are the resp changes with dehydration?
RR increases
What are nutritional restrictions with fluid overload?
Restrictions of fluid and salt
Pt with edema is a risk for?
Skin breakdown
What are the skin changes with dehydration?
Skin turgor will be poor, lots of tenting, skin is dry and scaly, mucous membranes are thick, sticky with cracks
When is drug therapy/ fluid replacement used?
To restore fluid AND control the cause of dehydration
What is not a good sign of dehydration in older adults?
Turgor- it will already be bad b/c of decreased elasticity
What is isotonic dehydration?
Water and electrolytes are lost equally
What is relative dehydration?
Water shifts from the plasma to interstitial space
What are neuro changes with dehydration?
change in mental status with decreased blood flow to brain, confusion (common in older adults). WILL HAVE A LOW GRADE FEVER WHICH WILL WORSEN DEHYDRATION
Increased ECF causes?
circulatory overload
what is a classic symptom of dehydration in older adults
confusion
dehydration results in fluid volume _____
deficit
Hypervolemia will do what to electrolytes
dilute them
What drugs to older adults take that would put them at risk for dehydrations?
diuretics, antihypertensives, laxatives
Increased arterial pressure causes
edema, decreased ADH, and increased NP.
weight loss > 1/2 pound
fluid loss
What is the way to correct dehydration and prevent death d/t decreased perfusion
fluid replacement
Increased venous pressure causes
increased contractility
What is the GI like in fluid overload
increased motility, enlarged liver
Where does the fluid volume deficit in dehydration mostly occur
plasma
Intake and output should be acaluclate every?
shift
When dehydration is severe and oral cannot be tolerated-
use IV
A decrease in ECF will decrease _____ which will decrease _____ wich will decrease_______
volume, blood pressure, perfusion