Unit 2: Fluids & Electrolytes Flashcards
How do the kidneys regulate fluid balance?
*Aldosterone- acts on kidneys, tells them to hold on to sodium, therefore water will follow which will bring up pressure and volume
*ADH – tells the kidneys not to release volume, reabsorb it, therefore no urine output
*ANP – turns off all the other regulators so you can release volume through kidneys – ANP makes you pee
*Kidneys main regulator of fluid balance, controls blood pressure and perfusion to organs
What situations/conditions put patients at risk for dehydration?
Elderly, hemorrhage, diarrhea, vomiting, burns, NPO, meds (diuretics), suction, wounds
How are the following systems affected by hypovolemia?
-neuro _decreased LOC, no perfusion to brain. Elderly confused
-heart _ BP low, HR high, weak pulse. Watch for falls related to orthostatic hypotension
-lungs _ clear, RR higher due to lack of perfusion and lungs trying to increase perfusion
-GI _depends on underlying cause, could see constipation or diarrhea. Dry MM
-GU _decreased output, dark concentrated urine, risk of stone formation
-skin _ dry, flakey, risk of breakdown, tenting present, poor turgor
-weight _ decreased. 2.2 lb = 1 liter of fluid, wt most accurate assessment of fluid status
Lab values can reflect dehydration. Circle the value that would represent dehydration.
BUN: 10 or 30 high levels due to concentration
Urine specific gravity: 1.009 or 1.075
BUN: 30
USG: 1.075
List treatment options for hypovolemia
IV fluids – isotonic solution for dehydration: 0.9%NS, D5W, LR
Encourage PO intake, tell people how many glasses to drink
Give meds to treat underlying cause – antiemetic, antidiarrheal,
Monitor BP and pulse, urine output for return to normal values
Daily weights
List 3 nursing diagnoses for hypovolemia (prioritize them)
Fluid volume deficit, risk for impaired tissue perfusion, risk for impaired tissue integrity, risk for falls
What would a nurse teach their patient on how to prevent dehydration?
Drink plenty of water, replace fluids after exercise or illness, watch urine output and color of urine, should be pale yellow, take diuretics as directed
HYPERVOLEMIA – FLUID VOLUME OVERLOAD:
What conditions put patients at risk for hypervolemia?
Kidney failure, CHF, high sodium level, excessive intake
HYPERVOLEMIA – FLUID VOLUME OVERLOAD:
How are the following systems affected by hypervolemia?
-neuro _agitation, headache, altered LOC
-heart _high BP, increased pulse, bounding, JVD
-lungs _ increased rate, shallow or SOA, crackles
-GI: increased motility possibly
-GU: depends on cause- kidney failure will produce no output, but could have increased output
-skin _tight, edema, weeping skin
-weight _gain overnight
List treatment options for hypervolemia
Restrict fluids, restrict salt intake, diuretics, daily wt, I/Os, assess respiratory status for crackles and keep HOB elevated, elevate legs for edema and watch for skin breakdown, monitor VS
List 3 nursing diagnoses for hypervolemia (prioritize them)
Fluid volume overload, Risk for ineffective airway clearance (or something about airway), impaired tissue integrity, etc
What will you teach patients about when trying to prevent hypervolemia?
Take diuretics as prescribed for CHF, dialysis if necessary for kidney failure, low sodium diet- no processed or canned foods, daily weights and call if gain a few pounds overnight
hyponatremia
Decreased LOC, seizures, stomach cramping
hypercalcemia
kidney stones, arrhythmias, muscle weakness
hyperkalemia
EKG changes, muscle cramps, diarrhea, death
