Intracellular fluid (ICF)

fluid inside the cells

Extracellular fluid (ECF)

Fluid outside of cells

2 types of extracellular fluid

-intravascular: fluid within blood vessels (plasma)-interstitial fluid: fluid between cells or tissues (lymph, CSF, intraocular fluid, GI secretions)

third spacing

-abnormal fluid accumulation in other areas than ICF and ECF-Ex: -- peritoneal cavity (ascites)--pleural cavity (pleural effusion)--swelling of tissues after trauma/burn- when too much fluid moves from the intravascular space into the interstitial and third spaces this can cause hypotension, decreased CO, and edema

I&O

-daily weights should be taken at the same time, with the same scale, same clothes, same equipment to determine water balance

fluid input

ingested food, fluids, IVF

fluid output

Occurs through kidneys, skin, lungs and GI tract.

sensible output

can be seen and measured (urine, diarrhea, wound drainage)

insensible output

cannot be measured (perspiration and respiration)

Osmosis

-Diffusion of water through a selectively permeable membrane-equilibrium

Isotonic

same strength/concentration of solutes as plasma

Hypertonic

greater strength/concentration of solutes than plasma

Hypotonic

lesser strength/concentration of solutes than plasma

isotonic solutions

-examples: 0.9% NaCI, lactated ringers (LR)-used to expland ecf, expand volume in the vessels-uses: hypovolemia, resuscitative efforts, shock-only fluid that can be given with blood products-watch for hypercolemia/fluid overload-s/s: bounding pulse, hypertension, edema, crackles

hypotonic solution

-fluid moving into cell-commonly used to help pt avoid dehydration-examples:--0.45% normal saline (half normal saline)--0.33% (normal saline)--0.225% (quarter normal saline)--2.5% dextrose-do not give for ICP-give slow to prevent cellular edema and possibly lysis-watch for hypovolemia as fluids shift from EC to IC-s/s hypovolemia: tachycardia, postural hypotension

hyper tonic solution

-fluid out of the cell-examples:--3% NS--5% NS--D10%W--D50W-used to shift fluids into bloodstream to dilute electrolytes-used for heat exhaustion, hypovolemia, to decrease cellular edema, and severe hyponatremiaNursing interventions: -infuse slowly-no bolus-monitor serum Na+-S/S: bounding pulses, hypertension, JVD, crackles, edema

Manifestations: FVD/hypovolemia

-weight loss-decreased skin turgor-oliguria-high urine specific gravity-elevated BUN-low u/o-postural hypotension-rapid, weak pulse-high H&H due to concentration

hemoglobin and hematocrit

-normal hb levels for males: 14-18 females: 12 to 16-normal hematocrit for men: 42-52% women: 35-47%

Low Hct indicates

volume excess (overhydration/anemia)

High Hct indicates

volume deficit (dehydration/polycythemia)

BUN and creatinine

kidney function test

BUN levels

10-20 mg/dL

High BUN indicates

-dehydration-kidney disfunction-volume deficit

Low BUN indicates

-over hydration-low protein-malnutrition

Creatinine level

0.7 to 1.3

High Creatinine

dehydration

Low Creatinine

overhhydration

Urine Specific Gravity

compares the density of urine to the density of waterdetermines how well your kidneys are diluting your urine

FVD/hypovolemia interventions

-treat underlying cause-monitor daily weight-monitor I&Os-oral care-admin of oral/parenteral fluids-use caution with elder pt-monitor for fluid overload when giving fluids

fluid volume excess/hypervolemia

-risk factors: HF, renal failure, cirrhosis-contributing factors: excessive dietary sodium or sodium containing IV solutions

manifestions of fve/hypervolemia

-edema, weight gaine-jvd-abnormal lung sounds (crackles)-tachycardia, increased b/p-polyuria-low specific gravity-low hct-low bun/creatinine

fve/hypervolemia interventions

-admin diuretics and monitor responses (output and labs)-fluid restriction-I&O and daily weights-assessing lung sounds, edema, other symptoms-promote pt adherence & teaching R/T sodium and fluid restriction-promote rest-semi-fowlers position for orthopnea (SOB when flat)-skin care, positoning/turning