1. FLUIDS AND ELECTROLYTES

2. PYRAMID POINTS Maintaining fluid and electrolyte balance
Description of the common fluid and electrolyte imbalances
Causes of common fluid and electrolyte imbalances
Assessment of common fluid and electrolyte imbalances
Treatment and evaluation of response to treatment for common fluid and electrolyte imbalances

3. MAINTAINING FLUID AND ELECTROLYTE BALANCE
DESCRIPTION
Homeostasis is a term that indicates the relative stability of the internal environment
Concentration and composition of body fluids must be nearly constant

4. MAINTAINING FLUID AND ELECTROLYTE BALANCE
DESCRIPTION
In the client, when one of the substances—fluids or electrolytes—is deficient, it must be replaced either normally by the intake of food and water or by therapy such as IVs and/or medications
When the client has an excess of fluid or electrolytes, therapy is directed towards assisting the body to eliminate the excess

5. MAINTAINING FLUID AND ELECTROLYTE BALANCE
Kidneys
Play a major role in controlling all types of balance in fluid and electrolytes
Adrenal glands
Through the secretion of aldosterone, the adrenal glands also aid in controlling extracellular fluid volume by regulating the amount of sodium reabsorbed by the kidneys
Antidiuretic hormone (ADH)
ADH from the pituitary gland regulates the osmotic pressure of extracellular fluid by regulating the amount of water reabsorbed by the kidney

6. FLUID VOLUME DEFICIT DESCRIPTION
Dehydration in which the body’s fluid intake is not sufficient to meet the body’s fluid needs
The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit

7. FLUID VOLUME DEFICIT CAUSES Isotonic dehydration
Inadequate intake of fluids and solutes
Fluid shifts between compartments
Excessive losses of isotonic body fluids
Hypertonic dehydration
Conditions that increase fluid loss such as excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage renal failure, and diabetes insipidus

8. FLUID VOLUME DEFICIT CAUSES Hypotonic dehydration Chronic illness
Excessive fluid replacement (hypotonic)
Renal failure
Chronic malnutrition

9. FLUID VOLUME DEFICIT ASSESSMENT Cardiovascular
Thready, increased pulse rate
Decreased blood pressure and postural hypotension
Flat neck and hand veins in dependent positions
Diminished peripheral pulses

10. FLUID VOLUME DEFICIT ASSESSMENT Respiratory
Increased rate and depth of respirations
Neuromuscular
Decreased central nervous system activity from lethargy to coma
Fever
Renal
Decreased urinary output
Increased specific gravity

11. FLUID VOLUME DEFICIT ASSESSMENT Integumentary Dry and scaly skin
Poor turgor, tenting present
Dry and fissured mouth, paste-like coating present

12. FLUID VOLUME DEFICIT ASSESSMENT Gastrointestinal (GI)
Decreased motility and diminished bowel sounds
Constipation
Thirst

13. FLUID VOLUME DEFICIT ASSESSMENT Hypotonic dehydration
Skeletal muscle weakness
Hypertonic dehydration
Hyperactive deep tendon reflexes
Increased sensation of thirst
Pitting edema

14. FLUID VOLUME DEFICIT IMPLEMENTATION
Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and GI status
Prevent further fluid losses and increase fluid compartment volumes to normal ranges
Provide oral rehydration therapy if possible; IV fluid replacement if the dehydration is severe

15. FLUID VOLUME DEFICIT IMPLEMENTATION
Generally, isotonic dehydration is treated with isotonic fluid solutions; hypertonic dehydration with hypotonic fluid solutions; and hypotonic dehydration with hypertonic fluid solutions
Administer medications as prescribed to correct the cause
Administer oxygen as prescribed
Monitor electrolyte values and prepare to administer medication to treat an imbalance if present

16. FLUID VOLUME EXCESS DESCRIPTION
Fluid intake or fluid retention exceeds the body’s fluid needs
Also called overhydration or fluid overload
The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload

17. FLUID VOLUME EXCESS CAUSES Isotonic overhydration
Poorly controlled IV therapy
Renal failure
Long-term corticosteroid therapy
Hypertonic overhydration
Excessive sodium ingestion
Rapid infusion of hypertonic saline
Excessive sodium bicarbonate therapy

18. FLUID VOLUME EXCESS CAUSES Hypotonic overhydration Early renal failure
Congestive heart failure
Syndrome of inappropriate antidiuretic hormone
Poorly controlled IV therapy
Replacement of isotonic fluid loss with hypotonic fluids
Irrigation of wounds and body cavities with hypotonic fluids

19. FLUID VOLUME EXCESS ASSESSMENT Cardiovascular
Bounding, increased pulse rate
Peripheral pulses full
Elevated blood pressure; decreased pulse pressure
Elevated central venous pressure
Distended neck and hand veins
Engorged venous varicosities

20. FLUID VOLUME EXCESS ASSESSMENT Respiratory Increased respiratory rate
Shallow respirations
Dyspnea
Moist crackles on auscultation

21. FLUID VOLUME EXCESS ASSESSMENT Neuromuscular
Altered level of consciousness
Headache
Visual disturbances
Skeletal muscle weakness
Paresthesias

22. FLUID VOLUME EXCESS ASSESSMENT Integumentary
Pitting edema in dependent areas
Skin pale and cool to touch GI
Increased motility

23. FLUID VOLUME EXCESS ASSESSMENT Isotonic overhydration
Liver enlargement
Ascites
Hypotonic overhydration
Polyuria
Diarrhea
Nonpitting edema
Dysrhythmias
Projectile vomiting

24. FLUID VOLUME EXCESS IMPLEMENTATION
Monitor cardiovascular, respiratory, neuromuscular, integumentary, and GI status
Administer diuretics; osmotic diuretics are typically prescribed first to prevent severe electrolyte imbalances
Restrict fluid and sodium intake
Monitor I&O and weight
Monitor electrolyte values and prepare to administer medication to treat an imbalance if present