Fluid Imbalances

Question 1

FVD

Answer 1

Fluid Volume Deficit
Hypovolemia

Question 2

FVD Pathophysiology - Dehydration

Answer 2

Loss of water
↑ Serum Na+ and tonicity

Activates osmoreceptors:
↑ Thirst
↑ Water Intake
↑ ADH (antidiuretic hormone)

Question 3

FVD Pathophysiology - ECF Volume Depletion

Answer 3

Loss of water and salt
↓ BP and renal perfusion
↓ ANP
↑ ADH
↑ RAAS (renin angiotensin aldosterone system) and Aldosterone
↑ Norepinephrine (fight or flight)

Question 4

Why Fluid Volume Deficit?

Answer 4

Excessive Fluid Loss (e.g., diarrhea, vomiting, hemorrhage, polyuria)

Inadequate Fluid Intake (e.g., NPO patients, NG tube)

Fluid Shift (e.g., 3rd spacing, burns, trauma, malnutrition, loss of protein)

Question 5

Fluid Shift: 3rd Spacing

Answer 5

Fluid shifts from vascular space to spaces unavailable for physiologic processes

Fluid is trapped where it is difficult/impossible for it to move back into cells or blood vessels

May be trapped in abdomen (ascites), bowel, soft tissue, pleural space

Question 6

FVD: Recognize Cues

Answer 6

Assess for daily weight (most accurate measure to assess FVD)

Accurate I&Os

1L = 1kg = 1000mL

Urine Specific Gravity: 1.005-1.030 (<1.005 clear and diluted; >1.030 amber and concentrated)

Question 7

System Effects of FVD

Answer 7

Mucous Membrane (dry, sticky, lack of saliva)

Urinary (dark urine, decreased output)

Integumentary (skin tenting, cold clammy skin)

Neurologic (confusion, restlessness, drowsiness, lethargy)

Cardiovascular (1+ pulse, postural hypotension, tachycardia, decreased BP)

Musculoskeletal (weight loss, weakness, dizziness)