Summary
RNSG 1533 Fluid Balance Summary
- Course
- RNSG 1533
- Institution
- San Antonio College
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RNSG 1533 Module 1 – In Class Assignment Fluid Volume WorksheetFluid Volume Deficit
Description & Pathophysiology Clinical Manifestations Diagnostic Findings
FVD, or hypovolemia, occurs when loss of ECF Acute weight loss, ↓ skin turgor, oliguria, Laboratory data useful in evaluating fluid volume
volume exceeds the intake of fluid. It occurs concentrated urine, capillary filling time status include BUN and its relation to serum
when water and electrolytes are lost in the same prolonged, low CVP, ↓ BP, flattened neck creatinine concentration. Normal BUN to serum
proportion as they exist in normal body fluids; veins, dizziness, weakness, thirst and creatinine concentration ratio is 10:1. A volume-
thus, the ratio of serum electrolytes to water confusion, ↑ pulse, muscle cramps, sunken depleted patient has a BUN elevated out of
remains the same. FVD should not be confused eyes, nausea, increased temperature; cool, proportion to the serum creatinine (ratio greater
clammy, pale skin than 20:1) (Sterns, 2014a).
with dehydration, which refers to loss of water
alone, with increased serum sodium levels. FVD The presence and cause of hypovolemia may
may occur alone or in combination with other be determined through the health history and
imbalances. Unless other imbalances are present physical examination. In addition, the
concurrently, serum electrolyte concentrations hematocrit level is greater than normal because
remain essentially unchanged. there is a decreased plasma volume.
Serum electrolyte changes may also exist.
Pathophysiology Potassium and sodium levels can be reduced
(hypokalemia, hyponatremia) or elevated
FVD results from loss of body fluids and occurs
(hyperkalemia, hypernatremia).
more rapidly when coupled with decreased fluid
Hypokalemia occurs with GI and renal
intake. FVD can also develop with a prolonged
losses.
period of inadequate intake. Causes of FVD
Hyperkalemia occurs with adrenal
include abnormal fluid losses, such as those
insufficiency.
resulting from vomiting, diarrhea, GI suctioning, Hyponatremia occurs with increased
and sweating; decreased intake, as in nausea or thirst and ADH release.
lack of access to fluids; and third-space fluid Hypernatremia results from increased
shifts, or the movement of fluid from the insensible losses and diabetes insipidus.
vascular system to other body spaces (e.g., with There may or may not be a decrease in urine
,edema formation in burns, ascites with liver (oliguria) in hypovalemia. Urine specific gravity
dysfunction). Additional causes include diabetes is increased in relation to the kidneys’ attempt to
insipidus (a decreased ability to concentrate
, urine owing to a defect in the kidney tubules that conserve water and is decreased with diabetes
interferes with water reabsorption), adrenal insipidus. Aldosterone is secreted when fluid
insufficiency, osmotic diuresis, hemorrhage, and volume is low causing reabsorption of sodium
coma. and chloride, resulting in decreased urinary
sodium and chloride. Urine osmolality can be
greater than 450 mOsm/kg because the kidneys
try to compensate by conserving water.
Labs indicate: ↑ hemoglobin and hematocrit, ↑
serum and urine osmolality and specific
gravity, ↓ urine sodium, ↑ BUN and
creatinine, ↑ urine specific gravity and
osmolality
Drug Treatments (with rationales) Other Therapies (with rationales) Nursing Interventions & Pt. Teaching
When planning the correction of fluid loss for the patient with FVD, the primary provider considers To assess for FVD, the nurse monitors and
the patient’s maintenance requirements and other factors (e.g., fever) that can influence fluid needs. measures fluid I&O at least every 8 hours, and
If the deficit is not severe, the oral route is preferred, provided the patient can drink. However, if sometimes hourly. Researchers have reported
fluid losses are acute or severe, the IV route is required. Isotonic electrolyte solutions (e.g., lactated that maintaining an accurate I&O is a particular
Ringer solution, 0.9% sodium chloride) are frequently the first-line choice to treat the hypotensive challenge with patients in critical care settings
patient with FVD because they expand plasma volume ( Sterns, 2014e). As soon as the patient (Diacon & Bell, 2014) (see Chart 13-1). As FVD
becomes normotensive, a hypotonic electrolyte solution (e.g., 0.45% sodium chloride) is often used develops, body fluid losses exceed fluid intake
to provide both electrolytes and water for renal excretion of metabolic wastes. These and additional through excessive urination (polyuria), diarrhea,
fluids are listed in Table 13-5. vomiting, or other mechanisms. Once FVD has
Accurate and frequent assessments of I&O, weight, vital signs, central venous pressure, level of developed, the kidneys attempt to conserve body
consciousness, breath sounds, and skin color are monitored to determine when therapy should be fluids, leading to a urine output of less than 1
slowed to avoid volume overload. The rate of fluid administration is based on the severity of loss and mL/kg/h in an adult. Urine in this instance is
the patient’s hemodynamic response to volume replacement (Sterns, 2014e). concentrated and represents a healthy renal
If the patient with severe FVD is not excreting enough urine and is therefore oliguric, the primary response. Daily body weights are monitored; an
provider needs to determine whether the depressed renal function is caused by reduced renal blood acute loss of 0.5 kg (1.1 lb) represents a fluid loss
of approximately 500 mL (1 L of fluid weighs
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