Fluid and Electrolyte Imbalances: Hypovolemia and Hypervolemia

Hypovolemia (Fluid Volume Deficit)

• Causes:
  • Insufficient Fluid Intake: Inability to consume enough fluids due to various reasons.
  • Excessive Fluid Loss:
    • Hemorrhage (blood loss from trauma).
    • Vomiting.
    • Diarrhea.
    • Excessive sweating.
    • Wound drainage, especially from burns (leading to plasma loss).
    • Excessive wound drainage.
• Dehydration:
  • Too little water in the plasma.
  • Body draws water from cells, causing them to shrivel and potentially die.
  • Affects all types of cells, including those in organs and skin.
• Treatment:
  • Fluid administration (oral or IV).
  • Avoid rapid fluid administration in severe dehydration to prevent shock and electrolyte imbalances.
  • Electrolyte imbalances are common in dehydrated individuals; rapid fluid infusion can further disrupt electrolyte balance, leading to cardiac issues.
• Popsicles:
  • Can be a good way to hydrate, especially those with electrolytes.
  • Consider sugar content, which may not be suitable for all individuals.
• Signs and Symptoms:
  • Thirst.
  • Poor skin turgor (skin doesn't bounce back).
  • Fatigue.
  • Dizziness.
  • Concentrated, dark urine (orangey or brownish) with a strong odor.
  • Low blood pressure, especially orthostatic hypotension.
  • Decreased urine production.
  • Dry skin.
  • Cracked lips.
  • Dry mucous membranes.
  • Thick saliva.
  • Flat neck veins.
  • Increased, weak, and thready pulse.
  • Possible elevated temperature.
  • Headache.
• Physiological Response:
  • Decreased plasma volume.
  • Increased ADH (antidiuretic hormone) production, leading to decreased urine production as the body tries to retain fluid.

Hypervolemia (Fluid Volume Excess)

• Causes:
  • Circulatory issues.
  • Rapid IV fluid administration (bolus).
  • Excessive tap water enemas or high-volume enemas.
  • Drinking too much water.
  • Overproduction of antidiuretic hormone (ADH), causing fluid retention.
• Neurological Changes:
  • Headaches.
  • Confusion.
  • Altered level of consciousness.
• Cardiovascular Changes:
  • Bounding pulse.
  • Distended jugular vein.
  • Increased blood pressure (due to increased fluid volume).
  • Possible presence of extra heart sounds.
  • Tachycardia (increased heart rate) as the heart works harder to circulate the excess fluid.
• Gastrointestinal Issues:
  • Anorexia (loss of appetite).
  • Nausea.
  • Pulmonary congestion (fluid in the lungs).
• Edema:
  • May be pitting or non-pitting.
  • Can be painful and stretch the skin.
• Electrolyte Imbalance:
  • Sodium concentrations and osmolality may decrease due to dilution from excess water.
• Other Signs:
  • Weight gain.
  • Crackles in the lungs (wet lungs).
  • Slow, bounding pulse.
  • Elevated blood pressure.
  • Edema.

Assessing Fluid Balance

• Observations:
  • Check ankles for edema.
  • Assess moisture in the mouth.
  • Intake and Output (I&O) monitoring.
  • Vital signs.
  • Urinalysis (color, clarity, and odor).
• Laboratory Values:
  • Complete Metabolic Panel (CMP) to assess electrolyte levels.
• Physical Assessment:
  • Overall physical examination to identify signs of fluid imbalance.
• Nursing Diagnoses:
  • Fluid volume deficit.
  • Fluid volume excess.

Interventions for Fluid Volume Imbalance

• Assessment:
  • Monitor Intake and Output (I&O).
• Fluid Management:
  • For fluid volume excess: Limit fluids (fluid restriction), especially for patients with congestive heart failure (CHF).
  • For fluid volume deficit: Administer fluids.
• Electrolyte Monitoring:
  • Monitor electrolyte values via daily CMP.
• Daily Weights:
  • Essential for monitoring fluid retention, especially in CHF patients.
• Diuretics:
  • Administer diuretics to promote fluid excretion.
  • Monitor for potential sodium loss.
  • Consider potassium-sparing diuretics to avoid potassium loss.
  • Adjust diet or increase salt intake as needed.