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Adult Health study guide #1OxygenationFluid Balance-Fluids are different between age and gender-Watch for fluid status to overlook electrolytes and blood count-Regulation of Fluids- 2x sodium + blood sugar divided by 18oLots of fluids can be lost through stressoKidneys30 mL/hour normal urine output1 ml/kg/houroSkinLoss variesAverage 500 mL/dayWhat would increase water loss through skin?oLungs- osmolarity can have an affectAverage 300 mL/dayWhat would increase water loss through lungs?oGI100-200 mL/dailyWhat would increase water loss through GI tract?Where is the majority of water absorbed in GI tract?oKidneyRAASoHeart and Blood VesselsWhat condition may affect fluid regulation?oLungsoPituitaryADHoAdrenalAldosterone- causes the movement between membranesCortisoloBaroreceptors- can cause a drop in blood pressure patient stood up to quicklyoOsmoreceptorsoNatriuretic PeptidesName 2
Fluid Balance Problems: Assessment-Fluid Volume Deficit: Hypovolemia- patient needs more volumeIV fluidsoThirstoTemperature increasesoRapid/weak pulseoTachypneaoPoor skin turgoroHypotensionoWeight lossoDry mucous membranesoHeadache, confusion, lethargyoOliguria (less than 24 hrs.)/anuria (no urine)If patient can not excrete then they will be on dialysis-Fluid Volume Excess: HypervolemiaoPulse increase/boundingoSOB/dyspnea/cough/cracklesoWeight gainoPeripheral edemaoJVDMuffled heart soundsoIncreased venous pressure/CVP-Edema versus AscitesoAscites
Fluid accumulation in the peritoneal cavity related to certain conditions such as cirrhosis, nephrotic syndrome, certain malignanciesRenal failure- nephrotic syndromeoEdemaCount 1-1000 2-1000 3-1000An indent should remain if present-Fluid volume DeficitoBlood lossoBody fatoVomiting/ diarrhea oBurn victims-Fluid volume ExcessoHeart failureoOverload- too much IV fluidoRenal failure-Fluid Balance Problems: Lab TestsoFVD: HypovolemiaUrine specific gravity > 1.030Increased Hgb and HCTIncreased sodiumIncreased serum osmolalityIncreased BUNoFVE: HypervolemiaUrine specific gravity < 1.010Decreased Hgb and HCTDecreased sodium (CRF)Decreased serum osmolality (CFR)Decreased BUNCXR- pulmonary congestion-Fluid Balance Problems: Plan/ImplementationoFVD: HypovolemiaForce fluidsPO versus IVIVFsIsotonicMonitor I & ODaily weightsMonitor vital signsAssess trendsAssess skin & tongue turgorEvaluate daily labs valuesAssess trendsoFVE: Hypervolemia
Restrict fluids DiureticsSodium-restricted dietDaily weightsAssess breath sounds/O2 saturationO2 if neededAssess edemaPeripheral, sacralPositioningDialysis-IV FluidsoDextrose water= sugar and has caloriesEquals the amount of plasmaAdd it to saline then the solution becomes hypertonicgreater than plasmao