Fluid Imbalance #1

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Fluid Imbalance Hypo/hyper Volemia and Natremia
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Fluid Imbalance #1
1 ISOTONIC IMBALANCE when WATER & ELECTROLYTES are - or + in = PROPORTIONS
1.1 OSMOLAR IMBALANCE is the - or + of ONLY WATER SUCH AS??????
1.1.1 osmolality of body is altered.
1.1.2 osmolar means measure of SOLUTE Concentration
1.1.2.1 solutes include particles like ELECTROLYTES
1.2 osmolality of body remains constant
1.3 Hyper-VOLEMIA the + of H2O & ELECTROLYTES in the intravascular fluid or blood
1.3.1 this excess of fluid build up causes Edema & Third-spacing fluid (peripheral edema, ascites, & pulmonary edema)
1.3.2 caused by over ingestion of sodium & fluid (IV solution with high concentration of solutes like sodium chloride, potassium chloride & glucose
1.3.3 also caused by impaired fluid balance regulation by the body organs i.e. heart failure, renal failure, & liver failure
1.3.4 S & S: VITALS - tachycardia, bounding pulse, hypertension, tachypnea, increased venous pressure. NEUROMUSCULAR - confusion, muscle weakness, lethargy RESP -increased rate, shallow respirations, dyspnea, orthopnea, crackles, diminished breath sounds. GI - weight gain & ascites could also include dependent edema & distended neck vein
1.3.5 LABS - decreased HCT, dec serum osmolarity, dec urine specific gravity & dec serum sodium
1.4 Hypo-VOLEMIA - low vascular vol, especially pertaining to the plasma
1.4.1 Caused by Abnormal GI losses - such as vomiting, nasogastric suctioning (NG tube, or gastric lavage), diarrhea. Abnormal skin fluid loss - such as diaphoresis. Abnormal Renal losses - such as diuretic therapy, BI, renal disease, adrenal insufficiency, or osmotic diuresis
1.4.1.1 NG tube: Nasogastric suction involves removing solids, liquids, or gasses from the stomach or small intestine by inserting a tube through the nose and suctioning the gastrointestinal material through the tube.
1.4.2 Also caused by HEMORHAGE, movement of fluid into a third space, dehydration & Enteral Feeding without sufficient water intake
1.4.2.1 enteral feeding - directly into the stomach, duodenum or jejunum.
1.4.3 S & S: Vitals - Tachycardia, thready pulse, orthostatic hypotension, tachypnea, hypoxia. NEUROMUSCULAR- dizziness, syncope (fainting), confusion, weakness & fatigue. RESP - inc'd breathing rate (trying to get more o2), GI - thirst, dry furrowed tongue, N & V, anorexia, acute weight loss
1.4.3.1 S & S of renal impairment due to HypoV. incl OLIGURIA, diminished cap refill, dry, scaly skin, dry mucous membranes, poor skin turgor, sunken eyeballs, flattened neck and veins
1.4.3.1.1 Oliguria = low urine output
1.4.4 LABS - Inc'd HCT, inc'd serum osmolarity,, inc'd urine-specific gravity, inc'd serum sodium
2 "ISO" = the value is considered to have the same solute concentration as the blood
3 "HYPO" the value is considered to be lower than the normal values
4 "HYPER" the value is considered to be higher than normal values
5 Hypo-NATREMIA - low sodium imbalance
5.1 Caused by gain of water or loss of sodium rich foods. this causes water to move from the ECF (which is where we take our measurements from) where the Na+ is low into the ICF where it is higher, in an attempt to dilute the Na+ of the ICF to reach equilibrium
5.1.1 this movement of fluid causes cells to swell = cellular edema
5.2 Causes GI - abnormal losses such as vomiting, NG suctioning, diarrhea, tap water enemas & gastrointestinal obstructions. RENAL losses - diuretics, kidney disease, adrenal insufficiency. SKIN losses - diuresis, burns, wounds. Excessive oral water intake
5.3 Also caused by oedematous states such as heart failure, cirrhosis of the liver, nephrotic syndrome
5.4 Excessive HYPOTONIC IV fluids & inadequate sodium intake
5.5 S & S lethargy, confusion, apprehension, muscle twitching, anorexia, N & V, headache, seizure, & coma
5.6 Labs - dec serum sodium
6 Hyper-NATREMIA - high sodium - fluid moves out of the cells and into the ECF. as a result the cells become dehydrated.
6.1 Causes - water deprivation (NPO), excessive sodium retention due to renal failure, cushion's, syndrome, aldosteronism, some medications such as glucocovrticosteroids
6.2 Causes - Fluid losses - due to fever, diaphoresis, burns, respiratory infection, diabetes insidious, hyperglycaemia, and watery diarrhea
6.3 AGE-Related Changes - older adults have decreased total body water content and inadequate fluid intake
6.4 S & S thirst, dry, st icky mucous membranes; tongue is red, dry, swollen; weak, fatigue, restlessness, decreasing LOC, disorientation, convulsions
6.5 LABS - inc serum sodium
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