Fluid Imbalances Labs: BUN, creatinine, hematocrit, sodium, specific gravity Hypovolemia Signs and Symptoms Weight Loss (acute) Decreased Skin Turgor Oliguria Decreased BP/Increased Pulse and Temp Flattened Neck Veins . Muscle Cramps . Cool, clammy skin Diagnosis Hemodilution BUN & Creatinine Serum osmolality . Specific gravity . Health History and Physical Assessment Medical Management Isotonic IV Replacement, then to hypotonic solutions Correct Cause Prevent Shock Nursing Management . Monitor I&O Daily weight Monitor urine specific gravity Vital signs closely monitored Monitor Orthostatic blood pressure Monitor for hypothermia Assess skin turgor Identify risk factors Hypervolemia Signs and Symptoms Acute weight gain Edema, distended neck veins Crackles, Increased CVP, Increased blood pressure Increased urine output Increased respiratory rate Diagnosis Hemoconcentration BUN and creatinine Serum osmolality Sodium Health History and Assessment
Medical Management Pharmacologic Therapy: Loop Diuretics: Furosemide (Lasix), Thiazide Diuretics( Hydrochlorothiazide) Dialysis Nutrition Therapy: Sodium Restriction Treat Cause Nursing Management . I&0 Weights daily Breath sounds Identify risk Assess edema Nutrition education Position HOB elevated
Geriatric Considerations for Fluid Imbalances o Skin turgor and functional assessment o Sensitivity to Fluid Status changes
Management of Electrolyte Imbalances Sodium o Hyponatremia Signs and Symptoms Anorexia, N/V Headache Lethargy Muscle Cramps Dizziness Confusion (oxygen) Seizures . Increased Pulse, Decreased BP Diagnosis . Serum Sodium . Health History and Assessment Medical Management Sodium Replacement . Water Restriction . Treat Cause . Isotonic solutions Nursing Management Monitor for Risk (falls) Assessment and Health History Monitor Dietary Intake o Hypernatremia
Signs and Symptoms Thirst Elevated temperature Swollen, Dry mucous membranes Confusion (oxygen) Hallucinations Restlessness and Irritability Tonic Clonic Seizures Increased BP and Pulse Diagnosis Serum Sodium Urine Sodium Urine Specific Gravity and Osmolality . Assessment and Health History Medical Management IV Fluid Replacement . Treat Cause Nursing Management . Follow and monitor Prescribed Treatments
Potassium o Hypokalemia Signs and Symptoms Fatigue Anorexia/N/V Muscle Weakness/Leg Cramps Polyuria Decreased Bowel Function Ventricular Fibrillation up to Asystole Decreased BP Diagnosis . Serum Potassium ECG Medical Management . Increase Potassium Intake in Diet (foods rich in potassium) . Potassium Supplementation (parenteral administration) Nursing Management . Physical Assessment . Cardiac Monitoring . Follow prescribed treatments and monitor for effectiveness Hyperkalemia Signs and Symptoms Dysrhythmias Flaccid Paralysis Paresthesia Intestinal Colic, abdominal distention, abdomina