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