Fluid volume Deficit and Fluid volume Excess
Fluid volume Deficit
Dehydration occurs when the fluid intake in of the body is not sufficient to meet the fluid needs of the body.
The goal of the treatment is to replace the fluid volume replace electrolytes as needed and eliminate the cause of the fluid volume deficit.
Types of fluid volume deficit.
I. Isotonic Dehydration
Water and dissolved electrolytes are lost in equal proportions. this situation is also known as hypovolemia, isotonic dehydration is is the most common types of dehydration.
Isotonic dehydration result in decreased circulating blood volume and inadequate tissues perfusion.
II. hypertonic Dehydration
Water loss exceeds electrolytes loss. the clinical problems that occur result from alterations in the concentration of specific plasma electrolytes.
Fluid move from the intracellular compartment into the plasm and interstitial fluid space causing cellular dehydration and shrinkage.
III. Hypertonic Dehydration
Electrolyte loss exceeds water loss. the clinical problem that occur result from fluid shifts between compartments, causing a decrease in plasma volume.
fluid move from the plasma and interstitial fluid space into the cells, causing a plasma volume deficit and causing the cells to swell.
The cause of fluid volume deficits
Isotonic dehydration
1. inadequate of the fluid and solutes
2. fluid shifts between compartments
3. excessive losses of isotonic body fluids.
Hypertonic Dehydration: the condition that increase the fluid loss such as keto acidosis , prolonged fevers, diarrhea, early-stage kidney disease, and diabetes insipidus.
Hypotonic Dehydration
1. chronical illness.
2. excessive fluid replacement(hypotonic).
3. kidney disease.
4. chronical malnutrition.
Assessment and intervention of Fluid volume deficit and fluid volume excess.
Fluid volume deficit
Cardiovascular
- thread increased in the pulse rate
- decrease in the blood pressure and orthostatic hypotension
- flat neck and veins in the dependent positions
- diminished in the peripheral pulses
- decreased central venous pressure
- dysthymias
Respiratory system
- increased rate and depth of respiration
- dyspnea
Neuromuscular
- decrease in central nervous system activity from lethargy to coma
- fever , depending on the amount of fluid loss
- skeleton muscle weakness
Renal
- decrease in urine output
- integumentary
- dry skin
- poor turgor, tenting
- dry mouth
Gastrointestinal
- decrease motility and diminished bowel sounds
- constipation thirst
- decrease body weight
Laboratory findings
- increased serum osmolarity
- increased hematocrit
- increased blood urea nitrogen(BUN) level
- increased serum sodium level
- increased urinary specific gravity
Intervention
1. monitor cardiovascular, Respiratory, Neuromuscular, Renal, Integumentary and Gastrointestinal status
2. Prevent further Fluid losses and increase fluid compartment volume to the normal ranges.
3. Provide oral rehydration Therapy if possible and Iv fluid Replacement if the dehydration is severe; monitoring intake and output.
4. isotonic dehydration is treated with isotonic Fluid solution , hypertonic Dehydration with hypotonic fluids solution.
5. Administer medications, such as antidiarrheal, antimicrobial, antiemetic, and antipyretic medications, as prescribed to correct the cause and treat any symptoms.
6. Monitor electrolyte values and prepare to administer medication to treat an imbalance, if present.
Fluid Volume Excess
Fluid intake or fluid retention exceeds the fluid need of the body. fluid volume excess is also called overhydration or fluid overload.
the goal of treatment is to restore fluid balance, correct electrolytes imbalance if present, and eliminating or control the underlying caused f the overload.
Types of fluid volume excess
I. isotonic overhydration
1. This is also known as hypervolemia, isotonic overhydration results from excessive fluid in the extracellular fluid compartment.
only extracellular fluid is expended and fluid does not shift between the extracellular and intracellular compartment.
2. isotonic overhydration causes circulatory overload and interstitial edema. when severe or when it occur in a client with poor cardiac function, heart failure and pulmonary edema can result.
II. Hypertonic overhydration.
the occurrence of hypotonic overhydration is rare and is caused by the an excessive sodium intake . Fluid is drawn from the intracellular compartment, the extracellular fluid volume expends and the intracellular fluid volume contacts.
III. Hypotonic overhydration
1. hypertonic over hydration is also known as water intoxication. the excessive fluid moves into the fluid into the intracellular space, and all body fluid compartment expand.
2. electrolytes imbalances occur as a result of dilution.
causes
1. isotonic over hydration
- inadequate administration of uncontrolled IV fluid therapy
- kidney disease
- long term corticosteroid therapy
2. hypertonic overhydration
- excessive sodium ingestion
- rapid infusion of hypotonic saline
- excessive sodium bicarbonate therapy
3. hypotonic over hydration
- Early kidney disease
- heart failure
- syndrome of inappropriate antidiuretic hormone secretion
- inadequate controlled iv therapy
- replacement of isotonic fluid loss loss with hypotonic fluid.
Fluid volume excess
cardiovascular
- bounding increased pulse rate
- elevated blood pressure
- distended neck and and hand veins
- dysrhythmias
Respiratory
- increased respiratory rate (shallow respiration)
- dyspnea
- Moisture crackles on Auscultation
Neuromuscular
- Altered level of consciousness
- headache
- visual disturbances
- skeleton muscle weakness
- paresthesia's
Renal
increased urine output if kidneys can compensate: decreased urine output if the kidney damage is the cause.
Integumentary
- pitting edema in dependent areas
- pale, cool skin
Gastrointestinal
- increased motility in thee gastrointestinal tract
- diarrhea
- increased body weight
- live enlargement
- ascites
Laboratory findings
- decreased serum osmolality
- decreased BUN level
- Decreased serum sodium level
- Decrease urine specific gravity
Intervention
1. monitor cardiovascular, Respiratory, Neuromuscular, Renal, Integumentary and Gastrointestinal status
2. Prevention of further fluid overload and restore normal fluid balance.
3. administer diuretic, osmotic diuretics may be prescribed initially may be prescribed initially to prevent severe electrolytes imbalance
4. restrict fluid that and sodium intake as prescribed
5. Monitor intake and out; monitor weight.
6. monitor electrolyte values and prepare to administer medication to treat an imbalance if present.
A client with acute kidney injury or chronical kidney disease is at high risk for fluid volume excess.
Reference:
1. NCLEX-RN EXAMINATION LINDA ANNNE SILVESTRI 7th EDITION