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Isotonic
Dehydration
- Most common
- Loss of isotonic fluids from
the ECF, plasma and
interstitial spaces.
- Loss of F/E at the same
proportion
- Results to inadequate tissue
perfusion
Etiology
Poor intake of fluids and solutes, heavy losses of
isotonic body fluids.
Hemorrhage
Vomiting
Diarrhea
Profuse salivation,
Fistulas, abscesses
Ileostomy, Cecostomy
Frequent enemas Burns,
Prolonged NPO
Diuretic therapy
GIT suction.
HYPERTONIC
DEHYDRATION
Water loss from the ECT>
electrolyte loss osmolarity
of plasma.
Water move from ECT and
interstitial fluid spaces to the
plasma cellular dehydration
and CELL shrinkage.
Etiology
Excessive sweating
Hyperventilation,
Ketoacidosis
Prolonged fevers
Diarrhea,
Early stage renal
failure
DI, RF
Watery diarrhea,
Excessive
Hypertonic
fluid replacement
Excessive NaHCO3 ,
tube feeding
Dysphagia
Impaired thirst
Unconsciousness
Fever
Impaired motor
Function
Systemic infection
Addisons dse
3. HYPOTONIC DEHYDRATION
least common type
results from fluid shifts between spaces, causing decrease
in plasma volume.
loss of Na & K from ECF
neurologic problems.
Etiology
Chronic illness: CRF w/ Na+ wasting, excessive
ingestion/administration of hypotonic fluids,
chronic/severe malnutrition
- Thirst
- Dry mucous membranes of mouth and eyes
- Cracked lips and tongue furrows, difficult swallowing
- Tenting of the skin (decreased turgor)
- Soft sunken eyes
- Decrease in systolic BP, weak pulse, HR & PR
- Flat jugular veins in supine position
- Prolonged peripheral venous filling time of more than 5
seconds.
- temperature (vessel constriction)
- Muscle weakness (Na K imbalance)
- Changes in I & O.
- Weight loss
- Hard stool (compensatory reabsorption of fluid from the
colon)
Cerebral signs (intracellular compartmental shifting)
Early signs: apprehension, restlessness, headache
Severe: hallucinations, confusion, coma.
ASSESSMENT
History
Ask about:
Abnormal or excessive fluid losses: sweating, diarrhea,
bleeding, vomiting, urination, salivation, and wound
drainage.
Chronic illness, recent acute illness, recent surgery,
drug regimens.
Urine output, frequency and amount of voiding, usual
fluid intake
Intake during the previous 24 hours
Strenuous physical activity
Diagnostic
Findings
Serum osmolarity
Plasma sodium
BUN
Plasma glucose
Hct
Hgb (hemoconcentration,
hypotonic dehydration w/ plasma
volume deficits)
USG >
CVP
Nursing Dx
Deficient fluid volume r/t excessive fluid loss
(vomiting, diarrhea, hemorrhage, or third-space
fluid loss such as ascites or burns) or
insufficient fluid intake.
Impaired oral mucous membrane R/T lack of
oral intake/ inadequate oral secretions.
Decreased cardiac output r/t decreased plasma
volume.
Risk for injury related to orthostatic
hypotension.
Expected Outcomes:
BP and PR WNL
24-hour fluid intake & fluid output balance.
USG < 1.030
Good skin turgor (-)tenting
MANAGEMENT
Goal: restore normal fluid volume, replace
ongoing losses, correct underlying problem
(vomiting
or diarrhea)
a. Medical
Oral rehydration
OFI, ORS
Avoid chocolate, coffee cola drinks, sugar
1. IV REHYDRATION
2. Drug therapy
Antiemetics
Antidiarrheal drugs
Antibiotics infectious diarrhea
Antipyretic
3. Monitoring for Complications of FVD
Restoration
IVF adm. is based on the clients overall
condition
Severe ECFVD with heart, pulmonary, liver or
kidney disease = at risk of heart failure
Accurate and frequent assessment of I &
O ,WT, V/S, CVP, LOC, Breath sounds
Nursing Management
Restore oral fluid intake
Monitor USG
- Monitor skin & tongue turgor
- The skin turgor is not a valid test in elderly
people due to loss of skin elasticity
-
FLUID VOLUME
EXCESS
a. Isotonic overhydration
b. Hypotonic overhydration
c. Hypertonic overhydration
Third Space Fluid Shift
a. Isotonic overhydration:
ETIOLOGY (FVE)
Compromised regulatory mechanism
a. Kidneys malfunction = inability to excrete
excesses
b. Cardiac failure = accumulation of fluid : lungs
& dependent parts
c. Liver cirrhosis = failure to metabolize 3 basic food
groups (CHO, Fats, CHON)
Excessive administration of Na containing fluids in a pt.
w/ impaired regulatory mechanism
Corticosteroid therapy
Excessive ingestion of table or other Na salts
Hypothyroidism
Lymphatic or venous obstruction
Hyperaldosteronism= Na reabsorption by the kidneys &
GIT
SIADH: dilutional hyponatremia
fluid
in visceral
tissues
Rapid wt gain (2 lbs/day or 1L/day of fluid).
Anasarca
D. Integumentary
dermatitis, ulcers
Weeping edema
Skin pale and cool to touch
E. Cerebral dysfunction d/t intracellular fluid shifting
DIAGNOSTIC FINDINGS
Plasma < 275mOsm/kg
S. Na< 135mEq/L
BUN < 8mg/dl
Hct < 45%
Azotemia - nitrogen levels in the blood
- urea & creatinine not excreted
USG <1.010
CXR= pulmonary congestion
Mg = d/t adm thiazide diuretics
NURSING DIAGNOSIS
Excess fluid volume r/t : heart, renal,
liver failure
Decreased cardiac output r/t heart
failure
Risk for altered skin integrity, injury
Altered comfort
Impaired gas exchange
MANAGEMENT (FVE)
Medical
Restrict Na & fluid intake
Promote urine output
NURSING INTERVENTION
Monitor I & O strictly.
fluid restrictions
Give cold fluids :thirst
Regulate IV accurately.
Use isotonic saline for bladder or NGT irrigations
Suggest alternatives for seasoning: lemon,
garlic, pepper
Avoid long periods of standing
Elevate legs when sitting/lying
Bed rest to promote diuresis ( pts w/ HF)
cerebral perfusion
Assignment
Electrolytes
Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia