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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