Day-2-FE.docx - Day 2 Osmolarity and Isotonic Volume...

Day 2 (Osmolarity and Isotonic Volume Imbalances)
2 Types of Fluid Imbalances
 Osmolarity Imbalance
o Hyperosmolar Imblance
o Hypoosmolar Imbalance
 ECF Volume Imbalances
o Hypervolemia
o Hypovolemia
Hyperosmolarity Imbalance
 ECF water deficit (exceed to 300
mOsml/L
 Results from either a water deficit or an
extracellular solute overload
 Causes:
o Decrease water intakedue to
 Difficulty swallowing
 Unavailability of water
 Severe debility
 Coma or confusion
o Increase loss of water due to
 Diarrhea, diaphoresis
o Injudicious use of hypertonic
solution
o Near drowning in salt water
Assessment of Hyperosmolar State
 Signs and Symptoms
o Thirst
o Poor skin turgor
o Dry tongue
o Sunken fontanels
o Increase tmeperature
o CV symptoms
o Decreased urine
o Decreased weight
o Increased BUN, Creatinin, Uric
Acid, HCT
o Decreased LOC
o Muscle Weakness
Goal Of Care
 Maintain adequate fluid volume
 Assess: tissue dehydration,
hypovolemia, hypoxia, shrinkage of
brain cells
 Eliminate cause
 Replace water
 Maintain skin integrity
Nursing Diagnosis
 Fluid volume deficit
 Risk for injury
 Risk for impaired skin integrity
 Activity intolerance
Nursing Intervention
 Eliminate the cause of imbalance
 Check VS upon admission & q2-4 hours
 Replace water
 Prevent complication of DHN
 Monitor serum Na & Hgb values
 Preserve skin and mucous integrity
 Assess capillary refill, skin turgor and
the status of the mucsous membrane
 Uncouraged increase of oral fluids
especially water intake
 Measure and record intake and output
and urine specific gravity

Day 2 (Osmolarity and Isotonic Volume Imbalances)
 Administer IV fluids as indicated
Hypoosmolarity Imbalance
 ECF water excess or solute deficit
 Over hydration of FVE
 Causes:
o Increase water intake due to
 Excessive water intake
 Inability to excrete
water excess
 Administration of
hypotonic solutions
 Administrations of
multiple tap enemas
 Near drowning
 Surgery or trauma,
burns
o Solute deficit due to
 Low sodium intake
o Use of diuretics, low salt diet
o Replacement of sodium and
water with water only
Assessment of Hypoosmolar State
 S/Sx:
o Swelling of cerebral cells
o Pulmonary edema, flushed skin
o Oliguria
o Anorexia
o Nausea and vomiting
o Bounding pulse
o Lethargy, confusion, convulsion
o Decrease Na and hematocrit
o Increase urine output
o Sudden weight gain
o Skin turgor
 Old – Use sternum,
forehead, inner thigh,
top of hip bone
 Infant – abdomen, inner
thighs
Nursing Management
 Water restriction
 Eliminate the cause
Pinch the capillary in the finger, notice the
change of color which should be 2-3 seconds
only. Pag nakakainom naman encourage the
fluid. Pero if the patienthas problem in taking
in fluid, the doctor will order NGT which is a
tube that will enter the nose down to the
throat to the stomach. However, if the patient
cannot tolerate this, there is other way which
is the Total parenteral Feeding which is done in
a minor or. There will be a tube inserted
directly to your stomach, and the food is