Lecture 16 : Fluid volume disturbance

what is homeostasis ?

what does your body constantly adjust ?

Homeostasis = keeping the internal environment stable

Your body constantly adjusts:

• Fluid levels

• Electrolytes

• Blood pressure

• Temperature

How do the following organs help regulate

• Kidneys

• Adrenal glands

• Pituitary gland

• Heart & blood vessels

• Lungs

• Hormone systems

• Nervous system

• Kidneys (MOST important) - regulate electrolytes / filter urine 

• Adrenal glands - hormone production / regulate BP 

• Pituitary gland - regulates electrolytes - release diuretic to pull fluid out of kidney to make you urinate , and an anti-diuretic when dehydrated 

• Heart & blood vessels – pump blood and help control blood pressure

• Lungs – control oxygen and carbon dioxide levels, help with pH balance

• Hormone systems (pituitary, adrenal, parathyroid) – release hormones to balance fluids, electrolytes, and minerals

• Nervous system – senses changes and tells organs how to respond to keep everything stable

What amount of our weight is water for adults and children ?

• Adults: 50–60% of body weight is water

• Older adults: 45% (more risk for dehydration)

The follwoing are in the water in our body , describe where

 Intracellular Fluid (ICF)

Extracellular Fluid (ECF)

• what is Intravascular

• what is Interstitial

• what is Transcellular?

 Intracellular Fluid (ICF)

• Inside cells

• Majority of body water

Extracellular Fluid (ECF)

Outside cells:

• Intravascular → inside blood vessels (you want more fluid here)

• Interstitial → between cells (tissue cells and lymph)

• Transcellular → special fluids:

  • CSF

  • Pleural 

  • Synovial

  • GI fluids

  • Sweat

  • Synovial 

what kind of electrolytes and nonelectrolytes are in our body fluids ?

Cations (+)

• Sodium (Na⁺)

• Potassium (K⁺)

Nonelectrolytes

• Glucose

• Proteins

• Creatinine

• Fats

• Vitamins

where is sodium found

here is potassium found ?

what knid of relationship do sodium and potassium have ?

• Sodium (Na⁺) - extravascular space 

• Potassium (K⁺) have inverser relationship with sodium  - found in cells 

Define solute and solvent ?

what do electrolytes control ?

SOLVENT - water 

SOLUTE - all other things that dissolve in water 

Electrolytes control:

• Nerve signals

• Muscle contraction

• Fluid balance

Fluid balance

What is part of the intake ?

Intake:

• Drinks (most important) (largest)

• Food

• Metabolism

Fluid balance

what is part of the output

what is the difference between sensible and insensible measure ?

what do you orry about the loss of when your stool is liquid ?

list some examples

ho mnay ml of fluids per hour should you be urinating

Output:Sensible (measurable)

• Urine - at least 30 ml 

• Stool (liquid) - WORRY ABOUT LOSS OF POTASSIUM WHEN HAVING DIARRHEA

• Vomit

• Blood

• Wound (fluid from wound)

Insensible (can’t measure easily)

• Skin evaporation (sweat)

• Breathing (inhaling/exhaling)

how many ml should be in total for intake and output each 24 hours ?

• Average fluid intake and output in adults = 1,500-3,500 mL each 24 hours

• Output of urine should equal the ingestion of liquids AND, water from food and oxidation equals the water lost through feces, the skin, and the respiratory process

• Balance should occur within 2-3 days

What do fuild is and drain out tell us ?

what are some exampels of fluid s in and drains out ?

• All fluids in (PO, IV, tube feeds, bladder irrigation)

• All fluids out (urine, drains, diarrhea, wounds, emesis, blood, suction)

👉 This tells you if a patient is:

• Dehydrated

• Fluid overloaded

what does volume equal?

what is osmosis ?

what is diffusion?

VOLUME = PRESSURE (think about blood pressure) 

1. Osmosis

Water moves:
➡ From low → high concentration, to balance thing out 

“Water follows salt”

2. DiffusionSolutes move:
➡ From high → low concentration

Define the following terms

Hemoconcentration
Hemodilution
Osmolality
Osmolarity
Hypernatremia
Hypernatremia

Hemoconcentration—too much solute in blood, not enough water
Hemodilution—too much water and not enough solute
Osmolality - concentration of solute
Osmolarity - concentration of fluids
Hypernatremia - increase in sodium
Hypernatremia - low potassium

Describe active transport

describe Filtration

Active Transport

• Requires energy

• Moves against gradient

Filtration

• Movement due to pressure

• Think: blood pressure pushing fluid out

what is the difference between

Hypovolemia (FVD)

Hypervolemia (FVE)

• Too little → Hypovolemia (FVD)

• Too much → Hypervolemia (FVE)

When assessing FVD / FVE

When doing an assessment on a patient, describe what you?

• Nursing history

• Physical assessment

• Fluid intake / outtake

• Daily weight 

• Laboratory studies 

• Access to safe drinking water 

• Disease

• Medication

• Nursing history (how much do you drink) (what do you drink) (shortness of breath)

• Physical assessment—skin/tongue turgor, moisture, crying with no tears (children), temperature of skin, edema, swelling, pulse, and respiration. 

• Fluid intake / outtake (how often do you urinate, sweat, or vomit?) (do you feel hydrated)

• Daily weight 

• Laboratory studies 

• Access to safe drinking water  / social determinants of health (SDoH)

• Disease - heart failure, fluid backup, diabetes, vomiting, diarrhoea, kidney failure, burns, cancer, fever 

• Medication - laxatives , Lasix  

FVD

What does it mean?

• Not enough fluid in bloodstream

• Mostly affects ECF

• Hemoconcentrated 

• BP drops when you sit up

FVD

what are some cause ?

Cause

• Vomiting, diarrhea

• Sweating, fever

• Burns

• Bleeding

• Diuretics - pull fluid out of kidney to make you urinate 

• Poor intake

• Trauma 

• Renal disease 

• Draining wounds 

• Third spacing/ascites/edema—fluid in the abdomen 

• Excess urine takes out potassium 

• Injuries / brain injuries / dementia - drinking is not the priority , brain is stressed , you forget

FVD

what are some signs and symptoms?

what is oliguria?

which age group loses thirst mechanisms?

• Dry skin & mouth

• Orthostatic - pressure drops when you sit up or stand 

• Low BP

• Fast heart rate

• Dizziness

• Weight loss

• High temperature—not enough volume to cool you down 

• Weak pulse—not enough fluid for pulse to bounce 

• Decreased urine (oliguria)

• Thirst

• Sunken eyes

• Oliguria—low urine output / dark and concentrated 

• Decreased skin turgor

• Cool extremities 

• Slow reaction time 

• OLDER PEOPLE LOSE THIRST MECHANISM 

FVD

what would lab results look like ?

what are the normal ranges for the following ?

• Sodium

• Potassium

• BUN

• Hemoglobin

• Hematocrit

• Color

• Appearance

• Specific gravity

• Osmolarity

• High urine concentration

• Serum osmolarity—concentration of blood high 

• NA is elevated because of low H₂O, then potassium decreases—inverse relationship

• Electrolyte changes

• BUN/Creatinine ↑

• Sodium - normal range 135-145

• Potassium - normal range 3.5-5

• BUN - normal range - 8-20

• Hemoglobin - normal level - 12-17.4

• Hematocrit - normal level - 36-52

• Color—pale yellow to amber 

• Appearance - clear - slightly havy 

• Specific gravity - 1.005 - 1.025

• Osmolarity - 50-1200

FVD

What are some treatments?

What is some nursing care and teaching?

• Oral fluids (best if mild); try not to overhydrate them 

• IV fluids (if severe) (isotonic, hypertonic, hypotonic, blood products—losing blood) 

• Treat cause (anti-diarrheal, antiemetics (vomiting), and antipyretics (fever))

Nursing care and teaching

• I&O tracking - 30 ml/hr

• Skin care - prevent skin breakdown 

• Education - fluid loss 

• Evaluate - Is everything back to normal? - Check Urine / BP / intake and output 

Fluid Volume Excess (FVE) = Hypervolemia

what does this mean ?

what are some poessible causes ?

Too much fluid/volume in bloodstream; Hemodiluted 

Causes:

• Kidney failure

• Heart failure

• Too much IV fluid

• High sodium intake

• Corticosteroids -  cause fluid retention 

• Blood product administration

• Antidiuretic 

Fluid Volume Excess (FVE) = Hypervolemia

what are some signs and symptoms ?

• Weight gain

• Edema (swelling)

• Crackles in lungs

• Shortness of breath (dyspnea)

• High BP

• Weak or fragile 

• Crackles (adventitious) 

👉 Think: “fluid overload → drowning inside”

Fluid Volume Excess (FVE) = Hypervolemia

what are some treatments ?

Treatment:

• Fluid restriction

• Low-sodium diet

• Diuretics (Lasix, etc.)

Fluid Volume Excess (FVE) = Hypervolemia

how will results of diagnostics test come back ?

what are some diagnostic tests to do ?

Diagnosis tests :

• Low test results 

• Serum osmolarity

• Cbc

• BUN / Creatine - 

• CXR - fluid in lungs (pleural effusion)

Fluid Volume Excess (FVE) = Hypervolemia

What are some nursing care plans

what about weights? what is too much?

• Daily weights (MOST important): 2 pounds in 24 hr not good , 3 hours in a week not good

• Adjust diet—renal diet: avoid solid, sweet foods 

• Lung sounds—no more crackles 

• I&O

• Fluid restriction strategies

• Meds - Furosemide (Lasix) - pull fluid off

how should a patient be positioned if they have pulomary edema?

Fluid fills lungs → LIFE-THREATENING - Hypoxia 

Congestive heart failure 

What to do:

• Sit patient upright

• Give oxygen

• Monitor closely

FVD (Deficit)	FVE (Excess)
Dry
Low BP
Weight loss
Tachycardia
Oliguria

FVD (Deficit)	FVE (Excess)
Dry	Wet/swollen
Low BP	High BP
Weight loss	Weight gain
Tachycardia	Crackles
Oliguria	Possible normal or high urine

potassium

describe its fuction

sources

regulation

food high

foods low

NOTES

Sodium

describe its fuction

sources

regulation

food high

foods low

NOTES