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Laboratory Data in nutrition assessment

Intake of results fluid or sodium or shift in fluid

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Unformatted text preview: Elderly and those with renal and cardiac Elderly failure are at risk failure Causes of Hypervolemia • • • Results from retention or excessive intake of Results fluid or sodium or shift in fluid from interstitial space into the intravascular space interstitial Fluid retention: renal failure, CHF, cirrhosis of Fluid the liver, corticosteroid therapy, hyperaldosteronism hyperaldosteronism Excessive intake: IV replacement tx using Excessive normal saline or Lactated Ringer’s, blood or plasma replacement, excessive salt intake plasma Causes of Hypervolemia • Fluid shifts into vasculature caused by Fluid remobilization of fluids after burn tx, administration of hypertonic fluids, use of colloid oncotic fluids such as albumin colloid Symptoms of Hypervolemia • • • • • • No single diagnostic test, so signs and symptoms No are key are Cardiac output increases Cardiac Pulse rapid and bounding BP, CVP, PAP and pulmonary artery wedge BP, pressure rise pressure As the heart fails, BP and cardiac output drop Distended veins in hands and neck Symptoms of Hypervolemia • • • • • • Anasarca: severe, generalized edema Pitting edema: leaves depression in skin when Pitting touched touched Pulmonary edema: crackles on auscultation Patient SOB and tachypneic Labs: low hematocrit, normal serum sodium, Labs: lower K+ and BUN (or if high, may mean renal failure) failure) ABG: low O2 level, PaCO2 may be low, ABG: causing drop in pH and respiratory alkalosis causing Treatment of Hypervolemia • • • Restriction of sodium and fluid intake Restriction Diuretics to promote fluid loss; morphine Diuretics and nitroglycerine to relieve air hunger and dilate blood vessels; digoxin to strengthen heart Hemodialysis or CAVH Dehydration • • • • Excessive loss of free water Loss of fluids causes an increase in the Loss concentration of solutes in the blood (increased osmolality) osmolality) Water shifts out of the cells into the blood Causes: prolonged fever, watery diarrhea, failure Causes: to respond to thirst, highly concentrated feedings, including TF including Symptoms of Dehydration • • • • • • Thirst Fever Dry skin and mucus membranes, poor skin turgor, Dry sunken eyeballs sunken Decreased urine output Increased heart rate with falling blood pressure Elevated serum osmolality; elevated serum...
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