Fluid Volume Imbalances

What are the geriatric considerations of fluid imbalances?

• clinical manifestations may be subtle

• fluid deficit may cause delirium

• decreased cardiac reserve

• reduced renal function

• dehydration is common

• age-related thinning of the skin and loss of strength and integrity

Is dehydration an example of fluid volume deficit (FVD)?

no

it is the loss of water alone, with increased serum Na levels

What is the definition of fluid volume deficit (FVD)?

may occur alone or in combination w/ other imbalances

loss of ECF exceeds intake ratio of water

• electrolytes lost in same proportion as they exist in normal body fluids

What are some causes of FVD?

abnormal fluid losses

• vomiting diarrhea, sweating, GI suctioning

decreased intake

• nausea, lack of access to fluids

third-space fluid shifts

• d/t burns, ascites

additional causes

• diabetes insipidus, adrenal insufficiency, hemorrhage

What are the signs and symptoms of FVD?

acute weight loss

decreased skin turgor

oliguria, concentrated urine

capillary filling time prolonged

low CVP (central venous pressure

decreased BP, increased pulses

flattened neck veins

dizziness, weakness, nausea

thirst and confusion

muscle cramps

sunken eyes

increased temp

cool, clammy, pale skin

What are the lab findings of FVD?

increased hemoglobin and hematocrit

increased serum and urine osmolality and specific gravity

decreased urine Na

increased BUN and creatinine

What are nursing interventions for FVD?

I&O at least 4 - 8 hrs, sometimes hourly

daily weight

VS closely monitored

skin and tongue turgor, mucosa, urine output, mental status

measures to minimize fluid loss

administration of oral fluids, if tolerated

administration of parental fluids, if severe or if orally not tolerated

What is the definition of fluid volume excess (FVE)?

isotonic expansion of ECF caused by the abnormal retention of water and Na in approximately the same proportions in which they normally exist in the ECF

secondary to an increase in the total body Na content

What are causes of FVE?

• HF, kidney injury, cirrhosis of liver

• excessive fluid intake

• contributing factors

  • excessive Na intake

  • over administration of saline containing fluids

  • meds: steroids

What are the signs and symptoms of FVE?

acute weight gain

peripheral edema and ascites

distended jugular veins

crackles

elevated CVP

SOB

increased BP

bounding pulse and cough

increased RR

increased urine output

What are the lab findings of FVE?

decreased hemoglobin and hematocrit

decreased serum and urine osmolality

decreased urine Na and specific gravity

What are nursing interventions of FVE?

I&O and daily weights; assess lung sounds, edema, other sx

monitor responses to medications — diuretics and parenteral fluids

promote adherence to fluid restrictions, pt teaching r/t Na and fluid restrictions

monitor, avoid sources of excessive Na, including medications

promote rest