Adult Health study guide #1
Oxygenation
Fluid Balance
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Fluids are different between age and gender
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Watch for fluid status to overlook electrolytes and blood count
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Regulation of Fluids- 2x sodium + blood sugar divided by 18
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Lots of fluids can be lost through stress
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Kidneys
30 mL/hour normal urine output
1 ml/kg/hour
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Skin
Loss varies
Average 500 mL/day
What would increase water loss through skin?
o
Lungs- osmolarity can have an affect
Average 300 mL/day
What would increase water loss through lungs?
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GI
100-200 mL/daily
What would increase water loss through GI tract?
Where is the majority of water absorbed in GI tract?
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Kidney
RAAS
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Heart and Blood Vessels
What condition may affect fluid regulation?
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Lungs
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Pituitary
ADH
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Adrenal
Aldosterone- causes the movement between membranes
Cortisol
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Baroreceptors- can cause a drop in blood pressure
patient stood up to quickly
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Osmoreceptors
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Natriuretic Peptides
Name 2
Fluid Balance Problems: Assessment
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Fluid Volume Deficit: Hypovolemia- patient needs more volume
IV fluids
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Thirst
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Temperature increases
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Rapid/weak pulse
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Tachypnea
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Poor skin turgor
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Hypotension
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Weight loss
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Dry mucous membranes
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Headache, confusion, lethargy
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Oliguria (less than 24 hrs.)/anuria (no urine)
If patient can not excrete then they will be on dialysis
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Fluid Volume Excess: Hypervolemia
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Pulse increase/bounding
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SOB/dyspnea/cough/crackles
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Weight gain
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Peripheral edema
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JVD
Muffled heart sounds
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Increased venous pressure/CVP
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Edema versus Ascites
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Ascites
Fluid accumulation in the peritoneal cavity related to certain conditions
such as cirrhosis, nephrotic syndrome, certain malignancies
Renal failure- nephrotic syndrome
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Edema
Count 1-1000 2-1000 3-1000
An indent should remain if present
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Fluid volume Deficit
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Blood loss
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Body fat
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Vomiting/ diarrhea
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Burn victims
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Fluid volume Excess
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Heart failure
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Overload- too much IV fluid
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Renal failure
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Fluid Balance Problems: Lab Tests
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FVD: Hypovolemia
Urine specific gravity > 1.030
Increased Hgb and HCT
Increased sodium
Increased serum osmolality
Increased BUN
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FVE: Hypervolemia
Urine specific gravity < 1.010
Decreased Hgb and HCT
Decreased sodium (CRF)
Decreased serum osmolality (CFR)
Decreased BUN
CXR- pulmonary congestion
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Fluid Balance Problems: Plan/Implementation
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FVD: Hypovolemia
Force fluids
PO versus IV
IVFs
Isotonic
Monitor I & O
Daily weights
Monitor vital signs
Assess trends
Assess skin & tongue turgor
Evaluate daily labs values
Assess trends
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FVE: Hypervolemia
Restrict fluids
Diuretics
Sodium-restricted diet
Daily weights
Assess breath sounds/O2 saturation
O2 if needed
Assess edema
Peripheral, sacral
Positioning
Dialysis
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IV Fluids
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Dextrose water= sugar and has calories
Equals the amount of plasma
Add it to saline then the solution becomes hypertonic
greater than plasma
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