Fluid Electrolyte SP pt 2

What is fluid volume deficit?

A decrease in fluid volume in the body

What term describes loss of fluid and electrolytes?

Hypovolemia

What are common causes of hypovolemia?

Vomiting, diarrhea, excessive sweating, NG suction, diuretics, third spacing

What is dehydration?

Loss of water only

How is dehydration different from hypovolemia?

Dehydration is water loss only; hypovolemia is fluid and electrolyte loss

What is hemorrhage?

Loss of blood

How does hemorrhage cause fluid volume deficit?

Decreases circulating blood volume

What is third spacing?

Fluid shifts into spaces where it is not usable

How does insufficient fluid intake cause fluid volume deficit?

Intake is less than output

What conditions can cause insufficient fluid intake?

Nausea, anorexia, inability to swallow, altered thirst, altered mental status

Which patients are at highest risk for fluid volume deficit?

Older adults, patients with vomiting or diarrhea, patients on diuretics

How are electrolytes affected in fluid volume deficit?

Sodium (Na⁺) and potassium (K⁺) may be abnormal

What happens to hemoglobin and hematocrit in severe dehydration?

Hemoglobin and hematocrit increases
- Dehydration = concentrated blood = ↑ Hgb & ↑ Hct

Why does hematocrit increase in dehydration?

Blood becomes more concentrated

What happens to hemoglobin and hematocrit in hemorrhage?

Both decrease

What happens to serum osmolality in fluid volume deficit?

Elevated

Why is serum osmolality elevated in fluid volume deficit?

Less water → more concentrated blood

What happens to urine osmolality in fluid volume deficit?

Elevated

Why is urine osmolality elevated in fluid volume deficit?

Kidneys conserve water

What happens to BUN and creatinine in fluid volume deficit?

Both are elevated

Why are BUN and creatinine elevated in fluid volume deficit?

Decreased kidney perfusion

What happens to urine specific gravity in fluid volume deficit?

Elevated

What does elevated urine specific gravity indicate?

Concentrated urine

What happens to blood pressure in fluid volume deficit?

Decreases

How does heart rate change in fluid volume deficit?

Increases

How does respiratory rate change in fluid volume deficit?

Increases

What pulse finding may be present in severe fluid volume deficit?

Weak, thready pulse

What happens to neck veins in severe fluid volume deficit?

Flat neck veins

What respiratory symptom may occur with fluid volume deficit?

Dyspnea

What neurological symptoms may be seen in fluid volume deficit?

Confusion and fatigue

How is urine output affected in fluid volume deficit?

Decreased urine output (oliguria)

What does urine look like in fluid volume deficit?

Dark and concentrated

How does fluid volume deficit affect the skin?

Decreased skin turgor

What happens to mucous membranes in fluid volume deficit?

Become dry

How does body weight change in fluid volume deficit?

Weight loss

What common sensation is reported with fluid volume deficit?

Thirst

What is the first step in medical management of fluid volume deficit?

Identify and treat the cause

What is the preferred fluid route if the patient can drink?

Oral fluids

What type of IV fluids are used for fluid volume deficit?

Isotonic crystalloids

Which IV solutions are commonly used to treat fluid volume deficit?

0.9% Normal Saline or Lactated Ringer’s

Why are isotonic fluids used in fluid volume deficit?

They expand intravascular volume

Why are vital signs closely monitored in fluid volume deficit?

Risk for orthostatic hypotension

What vital sign changes suggest worsening fluid volume deficit?

Decreased BP and increased HR

What physical assessments are important in fluid volume deficit?

Mucous membranes, skin turgor, mental status

What urine findings should be monitored in fluid volume deficit?

Specific gravity, color, and volume

Why is urine specific gravity important in fluid volume deficit?

Indicates urine concentration

What intake and output measures are essential in fluid volume deficit?

Strict I&O and daily weight

Why is daily weight important in fluid volume deficit?

Best indicator of fluid changes

Why is a fall risk assessment necessary in fluid volume deficit?

Risk for dizziness and orthostatic hypotension

What is fluid volume excess?

Increased water and sodium retention

What is another term for fluid volume excess?

Hypervolemia

What disease conditions commonly cause fluid volume excess?

Cirrhosis, renal failure, and heart failure

How can stress conditions affect fluid volume?

Increase fluid retention

How does surgery contribute to fluid volume excess?

Causes increased ADH and aldosterone release

Which hormones increase in fluid volume excess?

ADH and aldosterone

What is the effect of increased ADH?

Water retention

What is the effect of increased aldosterone?

Sodium and water retention

How do corticosteroids affect fluid volume?

Cause sodium and water retention

How can sodium intake lead to fluid volume excess?

Sodium pulls water into the bloodstream

How can rapid IV fluid infusion cause fluid volume excess?

Increases intravascular volume too quickly

How does fluid volume deficit differ from fluid volume excess?

Deficit = fluid loss; Excess = fluid retention

What happens to blood pressure in fluid volume deficit vs excess?

Deficit ↓ BP; Excess ↑ BP

How does urine output differ between deficit and excess?

Deficit ↓ UOP; Excess ↑ UOP (early)

How does body weight change in deficit vs excess?

Deficit = weight loss; Excess = weight gain

How does edema relate to fluid volume status?

Present in excess, absent in deficit

How are serum electrolytes affected in fluid volume excess?

Sodium (Na⁺) and potassium (K⁺) may be abnormal

What happens to hemoglobin and hematocrit in fluid volume excess?

Decreased due to dilution

Why do hemoglobin and hematocrit decrease in fluid volume excess?

Blood is diluted by excess fluid

What happens to BUN in fluid volume excess?

May be decreased due to dilution

When might BUN be elevated in fluid volume excess?

When caused by renal failure

What happens to serum osmolality in fluid volume excess?

Decreased

Why is serum osmolality decreased in fluid volume excess?

Excess water dilutes solutes

What happens to urine osmolality in fluid volume excess?

Decreased

Why is urine osmolality decreased in fluid volume excess?

Dilute urine from excess fluid

What happens to urine specific gravity in fluid volume excess?

Decreased

What does decreased urine specific gravity indicate?

Dilute urine

How is albumin affected in cirrhosis-related fluid volume excess?

Decreased

Why is albumin low in cirrhosis patients?

Decreased liver protein production