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FLUID AND ELECTROLYTE IMBALANCES Body fluid is composed primarily of water and electrolytes. The body is equipped with homeostatic mechanisms to keep the composition and volume of body fluids within narrow limits. Organs involved in this mechanism include the kidneys, lungs, heart, blood vessels, adrenal glands, parathyroid glands, and pituitary gland. Body fluid is divided into two types: intracellular (within the cells) and extracellular (interstitial or tissue fluid, intravascular or plasma, and transcellular, such as cerebrospinal or synovial fluids). RELATED CONCERNS All plans of care specific to underlying health condition causing imbalance, e.g., DM, HF, upper GI bleeding, renal failure/dialysis. Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis NURSING PRIORITIES 1. Restore homeostasis. 2. Prevent/minimize complications. 3. Provide information about condition/prognosis and treatment needs as appropriate. DISCHARGE GOALS 1. Homeostasis restored. 2. Free of complications. 3. Condition/prognosis and treatment needs understood. 4. Plan in place to meet needs after discharge. Note: Because fluid and electrolyte imbalances usually occur in conjunction with other medical conditions, the following information is offered as a reference. The interventions are presented in a general format for inclusion in the primary plan of care. FLUID BALANCE Total body water, essential for metabolism, declines with age and also varies with body fat content and gender. It constitutes about 80% of an infant’s body weight, 60% of an adult’s, and as little as 40% of an older person’s weight. Hypervolemia (Extracellular Fluid Volume Excess) PREDISPOSING/CONTRIBUTING FACTORS Excess sodium intake including sodium-containing foods, medications, or fluids (PO/IV) Excessive, rapid administration of hypertonic (or possibly isotonic) parenteral fluids Increased release of antidiuretic hormone (ADH); excessive adrenocorticotropic hormone (ACTH) production, hyperaldosteronism Decreased plasma proteins as may occur with chronic liver disease with ascites, major abdominal surgery, malnutrition/protein depletion Chronic kidney disease/acute renal failure (ARF) Heart failure (HF)
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Patient Assessment Database ACTIVITY/REST May report: Fatigue, generalized weakness CIRCULATION May exhibit: Hypertension, elevated central venous pressure (CVP) Pulse full/bounding; tachycardia usually present; bradycardia (late sign of cardiac decompensation) Extra heart sounds (S 3 ) Edema variable from dependent to generalized Neck and peripheral vein distension ELIMINATION May report: Decreased urinary output, polyuria if renal function is normal Diarrhea FOOD/FLUID May report: Anorexia, nausea/vomiting Thirst (may be absent, especially in elderly) May exhibit: Abdominal girth increased with visible fluid wave on palpation (ascites) Sudden weight gain, often in excess of 5% of total body weight Edema initially dependent, pitting may progress to facial/periorbital, general/anasarca NEUROSENSORY May exhibit:
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