Fluid
What percentage of the Adult body is composed of fluid?
2 minutes
Approximately 60% of the Adult body.
What are the electrolytes we need to monitor in Fluid Volume Deficit?
2 minutes
Na, K, Mg, Phosphate, Ca,
What are the common signs of Fluid Volume Deficit?
A. Hypertension, Tachycardia, fatigue, muscle weakness, fever, fatigue
B. Weight loss, skin tenting, hypotension, tachycardia, weakness, fatigue, fever, dry mucus membranes, weak pulses,
C. Fever, hypotention, bradycardia, chest pain, nausea, diarrhea, weight loss
D. Tachycardia, fatigue, strong pulses, hypertension, skin tenting, tinnitis (ringing in ears), fever
5minutes
B-Weight loss, skin tenting, hypotension, tachycardia, weakness, fatigue, fever, dry mucus membranes, weak pulses
Which of the following are interventions for Fluid Volume Deficit?
A. Increase oral intake
B. Oral hygiene
C. Intravenous fluid replacement
D. Administering anti-emetics or antipyretics
E. All of the above
2minutes
E. All of the above
What fraction of the bodies water is intracellular (in the cells)? and extracellular (outside of the cells)?
2 minutes
2/3 intracellular and 1/3 Extracellular
What are signs of Hypokalemia? Select all that apply.
A. Muscle weakness, spasms, or cramps
B. Nausea
C. Seizures
D. Finger and lips numbness/tingling
E. Heart palpitations
F. Stroke
5minutes
A E
What are LATE signs of Fluid Volume Deficit? Select all that apply:
A. Hallucinations
B. Chest Pain
C. confusion
D. Maniacal behavior
E. Coma
F. Restlessness
5minutes
Early signs: Apprehension, headache, restlessness
Late signs: hallucinations, maniacal behavior, confusion, followed by coma.
Your 56 yo male patient is newly admitted for Dehydration. You are completing your 10 am rounds. As you enter his room you notice he is sleeping and had refused his breakfast. He appears to be breathing through his mouth and you can see his dry cracked lips and tongue. His respiration's are 22 per minute and heart rate is 110 bpm on his cardiac monitor. His eyes appear slightly sunken in.
You notice his cell phone, nurse call bell, and an empty water cup that states 6 am on his bedside table. You do not notice a bedside urinal in his room or bathroom. His room is fairly clean and safety measures are in place.
Critically think about your assessment of your patient and his surroundings.
What did you notice that is important?
What nursing interventions should you perform?
5minutes
Your assessment findings are normal for dehydration but should be evaluated for improvement.
He probably has not had a water refill since 6 am. We need to promote oral intake by providing fresh water and encouraging intake every one to two hours.
We need to ensure adequate intake and output. Accurate measurement with a urinal is an easy nursing intervention.
Define fluid volume deficit.
2 minutes
A state which a person has vascular, interstitial, or intracellular dehydration.
When a person has Fluid Volume Deficit do the serum Na levels increase or decrease? Why?
5minutes
Na becomes more concentrated in the blood stream because there is not enough fluid being consumed to lower the concentration.
The body will pull fluid from interstitial space and even cells in severe fluid volume deficit to attempt to compensate.
What type of fluid volume deficit may your patient be experiencing if your assessment findings include; fever, diarrhea, vomiting?
a. Hypertonic dehydration
b. Isotonic dehydration
C. Hypotonic dehydration
d. All of the above
5minutes
C-Hypotonic dehydration
A client is directly admitted to the hospital from their PCPs office due to high ileostomy output resulting in dehydration. Their Lab results are in and their Serum Potassium level is 2.7mEq/L place the following interventions in order.
A. Administer 10mEq Potassium Chloride IVPB x5.
B. Call the physician
C. Place patient on the cardiac monitor
D. Assess for signs and symptoms of hypokalemia
5 minutes
C, D, B, A
You should be placing your patient on the Monitor while assessing for other Signs and Symptoms of hypokalemia such as fatigue, weakness, constipation, muscle cramps, palpitations,
Which of the following could cause Fluid Volume Deficit? Select all that apply.
A. Nausea, vomiting, or Diarrhea
B. Overeating
C. Diuresis
D. Decreased oral intake
E. Fluid shifts such as ascites and effusions
F. Large amount of drainage from a surgical site
5minutes
A. Nausea, vomiting, or Diarrhea
C. Diuresis
D. Decreased oral intake
E. Fluid shifts such as ascites and effusions
F. Large amount of drainage from a surgical site
Interpret these labs:
Serum K 3.5mEq/L
Na 148 mEq/L
Mg 1.5 mEq/L
BUN 26 mg/dl
Osmolality 300 mOsm/kg
Is this normal for Fluid Volume Deficit?
What other electrolytes/labs could we check for fluid volume deficit?
6minutes
Serum Potassium 3.5mEq/L Normal
Na 148 mEq/L High
Mg 1.5 mEq/L Normal
BUN 26 mg/dl High
Osmolality 300 mOsm/kg High
These are normal for fluid volume deficit. Mg and K could be low also but in this case they continue to remain normal for now.
Other electrolytes/labs: Phosphate, Cl, Cr, Co2, urinalysis,
J.P a 42 yo woman who presents to the emergency department complaining of abdominal pain, hallucinations, and severe weakness by her friend. Her friend states she has been taking laxatives for weight loss and days ago J.P reported to her friend that she lost 10lbs in a week, last known weight of 115lbs 1 week ago.
Upon assessment her vital signs are;
T 100.8, P 126, R24, BP 89/40, SpO2 95% Room air. Bed scale:102lbs.
What are the signs of Fluid Volume Deficit presented in this case?
What is the probable cause of the Fluid Volume Deficit?
5minutes
Hallucinations, weakness, weightloss, fever, tachycardia, tachypnia, hypotension
Laxative use resulting in diarrhea.
Scenario: Your new patient is a 32 yo female who complains of vomiting and diarrhea for the past 2 days. She states she is unable to keep any liquid or solid food down. Your assessment is as follows;
Pallor, slightly sunken eyes, complaint of headache and severe nausea, currently dry heaving.
Vital signs:
T 99.6, P 122, R 24, BP 98/42, SpO2 98% Room Air
Place the interventions in the correct order:
A. Administer anti-emetic medication
B. Fluid replacement-intravenously
C. Obtain intravenous access
D. Give oral fluids
E. Assess for additional nausea and vomiting
6 minutes
C. obtain IV access
B. Fluid replacement-intravenously
A. Administer anti-emetic medication
E. Assess for additional nausea and vomiting
D. Give oral fluids
What type of fluid volume deficit are the water and electrolytes lost in the same proportion and does not cause a fluid shift in a patient?
a. Hypotonic dehydration
b. Isotonic dehydration
c. Hypertonic dehydration
d. All of the above
2 minutes
B- Isotonic dehydration
What type of Fluid volume deficit does your patient have when they experience more water loss than solute loss (ex. Perspiration or diarrhea)?
a. Hypertonic dehydration
b. hypotonic dehydration
c. isotonic dehydration
d. none of the above
2 minutes
A- Hypertonic dehydration
What type of fluid volume deficit may your patient be experiencing if your assessment findings include; poor oral intake due to dysphagia?
a. Hypertonic dehydration
b. Isotonic dehydration
C. Hypotonic dehydration
d. All of the above
2minutes
A-Isotonic dehydration because the patient is not consuming enough liquids for hydration.
What is the first intervention you would perform on a patient experiencing fluid volume deficit symptoms including tachycardia, hypotension, tachypnea, weak thready pulse, weakness, and fatigue?
a. Call the physician
b. Place your patient on a cardiac monitor
c. Obtain Arterial Blood Gases
d. None of the above
B-Place your patient on a cardiac monitor
Then call the physician and carry out order to obtain ABGs.