BSN Notes: Common Signs And Symptoms: Fluid and electrolyte Imbalance- introduction , Hypovolemia

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Fluid and electrolyte Imbalance
·         Body water is the main solvent in living cells.
·         It consists of intracellular and extra cellular fluid.
·         Extracellular fluid consists of plasma (inside the blood vessels) and interstitial fluid (outside the blood vessels).
·         Distribution of body water in between the compartments
·         Intracellular fluid 28 liters (40 %)
·         Interstitial fluid 11 liters (15 %)
·         Plasma 3 liters (5%)
Fluid and electrolyte imbalance
Extracellular Fluid volume imbalances
·         ECF volume deficit ( hypovolemia)
·         ECF volume excess (hypervolemia)
Hypovolemia
It is a state of decreased blood volume
Causes
·         Increased insensible water loss-  high fever, heat stroke.
·         GI losses - Diarrhea, vomiting, NG suction, fistula drainage.
·         Polyuria -  Diabetes insipidus, osmotic diuresis
·         Overuse of diuretics
·         Inadequate fluid intake
·         Bleeding
·         Third space fluid shift -  burns, intestinal obstruction

Pathophysiology
Due to etiological factors loss of fluid from intravascular spaces.
Interstitial fluid move in to restore vascular volume.
Other compensation systems are initiated to restore fluid volume.
ADH and aldosterone secretion increase to reabsorb water and sodium in the kidney
Fluid reabsorbed from intestine.
Stimulation of sympathetic nervous system causes vasoconstriction, and moves fluid from periphery into the circulation.
Increased sodium level in the blood is sensed by osmoreceptors in the hypothalamus, increases thirst.
If these compensation mechanism fails person becomes dehydrated.
If dehydration is not corrected, Fluid shifts from cells to vascular system causing cell injury.

Clinical features
·         Restlessness
·         Drowsiness
·         Confusion       
·         Thirst
·         Dry mouth
·         Decreased skin turgor
·         Decreased capillary refill
·         Postural hypotension
·         Increased pulse rate, decreased CVP
·         Decreased urine output, concentrated urine
·         Increased respiratory rate
·         Weakness & dizziness
·         Weight loss,
·         Seizures, coma
 Management
 Fluid restoration (Oral rehydration)
If fluid loss is mild, the thirst mechanism is intact and client can drink fluids replace oral fluids
Intravenous rehydration
·         When the fluid loss is severe and life threatening.
·         Volume of fluid replacement based on body weight and presence of comorbidities. 

·         Type of fluid replacement based on type of fluid lost.
Correction of underlying problems:
·         Antiemetic and antidiarrheal drugs to correct nausea, vomiting, diarrhea.
·         Antipyretics for fever.
·         Diuretics -  dose regulation
Nursing diagnosis
·         Fluid volume deficit related to insufficient fluid intake, Vomiting, diarrhea, hemorrhage.
·         Impaired oral mucous membrane related to lack of oral intake.
 Nursing management
·         Monitor vital signs
·         Treat the underlying cause
·         Record intake & output
·         Monitor I V fluids

·         Frequent mouth care

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notes.nursium.com: BSN Notes: Common Signs And Symptoms: Fluid and electrolyte Imbalance- introduction , Hypovolemia
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