Fluid Volume Balance
how many liters of plasma?
5L
Approximately __________% of adult body weight is water
60%
hypotonic IV fluids
0.45% NaCl (½ Normal Saline) 0.33% NaCl promotes fluid into cells
what is the normal creatinine?
0.6-1.2
what is a normal specific gravity?
1.005-1.030
what is the normal BUN?
10-20 mg/dL
How many liters of interstitial fluid?
10L
What is the total volume of ECF?
16L
How many liters of transcellular fluid?
1L
what percent of body water is intracellular?
2/3
Hypertonic IV fluids
3% NaCl 5% NaCl D5/0.45% NaCl D5/0.9% NaCl promotes fluid out of cells
What is the total volume of ICF?
32L
what is the normal hematocrit?
40-45%
how many liters of total body water is there?
48 L
Transceullar fluid
5% EFC; fluids like cerebrospinal, pericardial, pancreatic...; SPECIFIC SPACES
endocrine regulatory mechanism
Includes the RAAS, baroreceptors and natuiretic peptide hormones
cardiovascular manifestations of fluid volume overload (hypervolemia)
HTN, tachycardia, JVD
Hypertonic
Having a higher concentration of solute than another solution.
Hypotonic
Having a lower concentration of solute than another solution
Insensible fluid loss
Occurs daily through lungs and skin--cannot be measured for accurate output
RAAS (renin-angiotensin-aldosterone system)
Renin is released by kidneys in response to decreased blood volume; causes angiotensinogen to split & produce angiotensin I; lungs convert angiotensin I to angiotensin II; angiotensin II stimulates adrenal gland to release aldosterone & causes an increase in peripheral vasoconstriction
assessment for fluid volume overload (hypervolemia)?
Review labs, daily wt., I&O Lung sounds Peripheral edema Mental status
output
Sensible losses vs Insensible Loss of 1mg/kg/hr urine
intake
Solid food, fluid, cellular anaerobic respiration
what need to be monitored in fluid volume deficit (hypovolemia)?
Strict I&O Urine output Pulmonary status Neurologic Status Vital signs monitoring
general manifestations of fluid volume overload (hypervolemia)
acute weight gain
What influences the amount of body weight that consists of fluids?
age, sex and body fat
BUN
blood urea nitrogen... measurement of urea levels in the blood
Sensible fluid loss
can be measured (includes fluid lost from defecation, urination, and wounds)
what are hypertonic IV fluids used for?
cerebral edema
CRE
completely filtered by kidneys
Natiuretic peptides (ANP and BNP)
decrease water and sodium retention when high levels of fluids are detected
In fluid volume overload serum/urine osmolarity are _______________________
decreased
In fluid volume overload, HGB and HCT are ___________________________
decreased
Low hematocrit indicates _________________ while low Hemaglobin and hematocrit indicates ____________________
decreased circulating volume, hemorrhage
Integumentary/Circulatory manifestations of fluid volume deficit (hypovolemia)
decreased skin turgor, cool, clammy skin, pale ashen skin, dry/pale mucous membranes
Body water content __________ as we age
decreases
what are isotonic IV fluids used for?
dehydration
What does a high HGB and HCT indicate?
dehydration, hypovolemia
What does a high specific gravity indicate?
dehydration, very concentrated urine
comfort for fluid volume overload (hypervolemia)?
elevate HOB/legs
Hypovolemia
fluid volume deficit in which fluid loss is greater than fluid intake that can be caused by vomitting, diarrhea, NG suction, excess perspiration, hemorrhage, diabetes insipidus, diuretics, and third spacing
intravascular fluid
fluid within blood vessels
intracellular fluid
fluid within cells; 2/3 of fluid is within cells
neurological manifestations of fluid volume overload (hypervolemia)
headache, confusion
what does a low BUN/CRE indicate?
hydration
What does a low specific gravity indicate?
hydration, not concentrated urine
What are colloids typically used for?
hypovolemia
what does a low HGB and HCT indicate?
hypovolemia, bleeding out
genitourinary manifestations of fluid volume deficit (hypovolemia)
increased urine specific gravity, oliguria
What does a high BUN/CRE indicate?
kidney damage/dehydration
why is a chest X-ray needed for hypervolemia?
possible pulmonary congestion
specific gravity
ratio of a mineral's weight compared with the weight of an equal volume of water
Baroreceptors
stimulates sympathetic nervous system when there is low blood pressure; adrenal cortex stimulated to relase aldosterone
hypotonic solutions cause cell ____________
swelling
Tonicity
the ability of a surrounding solution to cause a cell to gain or lose water
third spacing
the accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury (eg.ascites)
monitor, reverse, prevent
the three things to guide fluid volume balance
what is the normal Hemoglobin (Hgb) ?
• Females 12-16 g/dL • Males 14-18 g/dL
isotonic IV fluids
• Normal Saline (0.9% NaCl) • Lactated Ringer (LR) • D5W fluids that maintain fluid balance
genitourinary manifestations of fluid volume overload (hypervolemia)
•Decreased specific gravity •Increased urine output
what is the nursing management for fluid volume overload (hypervolemia)?
•Dietary •Oral Fluid/Sodium restriction •Limit IV fluids •Monitoring Daily Weight •Diuretics •Dialysis (severe)
Management of fluid volume deficit (hypovolemia)
•Promote intake of oral fluid •Isotonic IV Fluids • 0.9% NS or LR •Hypotonic IVF later •0.45% NaCl •Blood products •Hemorrhage
respiratory manifestations of fluid volume overload (hypervolemia)
•Pulmonary edema •Dyspnea •Tachypnea •Crackles
antidiuretic hormone (ADH)
•Released in response to changes in blood osmolality •Detected by osmoreceptors in the hypothalamus •Causes water reabsorption in the kidneys
renal regulatory mechanism
•Selectively reabsorb water and electrolytes •1-2 L urine output per/day
Colloid
•Solution with large insoluble molecules •Remains in vascular space longer had a higher risk for anaphylaxis includes albumin, dextran, & plasma
A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention? A. Daily weight B. Sodium level C. Tissue turgor D. Intake and output
A. Daily weight
A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.) A. Increased heart rate B. Increased blood pressure C. Increased respiratory rate D. Increased hematocrit E. Increased temperature
A. Increased heart rate B. Increased blood pressure C. Increased respiratory rate
A nurse in the neurologic ICU has received a prescription to infuse a hypertonic solution into a client with increased intracranial pressure. This solution will increase the number of dissolved particles in the client's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described with which of the following terms? A. Hydrostatic pressure B. Osmosis and osmolality C. Diffusion D. Active transport
B. Osmosis and osmolality
A nurse is assessing a client who has fluid volume deficit. The nurse should expect which of the following findings? A. Decreased urine specific gravity B. Decreased Hgb C. Increased BUN D. Increased urine ketones
B. Decreased Hgb C. Increased BUN
A nurse is assessing a client who received IV conscious sedation for a colonoscopy. Which of the following findings indicated that the client is ready for discharge? A. The client is restless B. The patient is cooperative and oriented C. The patient shows a brisk but brief response to stimulus D. The client shows a sluggish response to stimulus
B. The patient is cooperative and oriented
The community health nurse is performing a home visit to an 80-year-old client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused at times and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response? A."I will need to have your medications adjusted, so you will need to be readmitted to the hospital for a complete workup." B."Limiting your fluids can create imbalances that can result in confusion, so let's try adjusting the timing of your fluids." C."It is normal to be a little confused following surgery, and it is safe not to urinate at night." D."Confusion and bladder issues are a normal consequence of aging, so I am not too concerned."
B."Limiting your fluids can create imbalances that can result in confusion, so let's try adjusting the timing of your fluids."
A nurse is caring for a client who is scheduled to have a magnetic resonance imaging (MRI) scan. The client asks the nurse what to expect during the procedure. Which of the following statements should the nurse make? A. "An MRI scan is not distorted by movement, so you do not have to lie still." B. "An MRI scan is a short procedure and should take no longer than 30 minutes." C. "The MRI contrast dye contains iodine and can cause your skin to itch." D. "An MRI scan is very noisy, and you will be allowed to wear earplugs while in the scanner."
D. "An MRI scan is very noisy, and you will be allowed to wear earplugs while in the scanner."
A nurse is assessing four clients for fluid balance. The nurse should identify that which of the following clients is exhibiting manifestations of dehydration? A. A patient with a urine specific gravity of 1.010 B. The patient who has a weight gain of 2.2kg in 24 hours C. A client who has a hematocrit of 45% D. A client who has a temperature of 39C (102F)
D. A client who has a temperature of 39C (102F)
A nurse is preparing a client for a kidney biopsy. Which of the following client conditions should the nurse identify as a contraindication for this diagnostic test? A. Elevated creatinine B. Flank pain C. Urinary retention D. Bleeding disorder
D. Bleeding disorder
A nurse is caring for a client who is experiencing hypovolemia. Which of the following findings should the nurse identify as the priority to report to the provider? A. Dry mucous membranes B. Decreased urine output C. Report of thirst D. Decrease in level of consciousness
D. Decrease in level of consciousness
Osmosis
Diffusion of water through a selectively permeable membrane in which the goal is to equalize water and solute concentrations on both sides of the membrane through passive transport
neurological manifestations of fluid volume deficit (hypovolemia)
dizziness, anxiety & confusion
respiratory manifestations of fluid volume deficit (hypovolemia)
dyspnea, tachycardia
integumentary/circulatory manifestations of fluid volume overload (hypervolemia)
edema, localized vs generalized
interstitial fluid
fluid between cells
Fluid volume excess (hypervolemia)
fluid intake exceeds fluid output which is caused by retention of sodium and/or water, SIADH, HF, and high salt diet
extracellular fluid
fluid outside the cell that includes intravascular, interstitial, trans-cellular
Crystalloids
salts that dissolve readily into true solutions •Solution with electrolytes/molecules •Restores fluid volume
what are hypotonic IV fluids used for?
severe dehydration; DKA
hypertonic solutions cause cell _________________
shrinking
what are the considerations regarding fluid volume balance for older adults?
small events have a greater impact (dec oral intake fluids), multiple disease processes = greater threat to homeostasis, medications (diuretics), cognitive changes
cardiovascular manifestations of fluid volume deficit (hypovolemia)
weak, thready pulse, tachycardia, and hypotension
isotonic
when the concentration of two solutions is the same; matches ICF
