NR 341
(EDAPT WEEK 4 NOTES)
COMPLEX FLUID BALANCE ALTERNATION
Complex Adult Health
,WEEK 4 COMPLEX EDAPT NOTES
COMPLEX FLUID BALANCE ALTERNATION:
Fluid and electrolyte imbalances are among the most common problems encountered in
critically ill patients and are associated with increased morbidity and mortality.
Disorders such as severe burns, trauma, sepsis, and heart failure lead to disturbances in
fluid and electrolyte balance. Supporting treatments, such as mechanical ventilation, may
also affect fluid balance.
Nurses must be able to recognize the signs of severe fluid and electrolyte imbalance and
act quickly to restore homeostasis.
The nurse is caring for a client experiencing a decrease in preload due to
hypovolemia. Which action will support an increase in preload and cardiac output?
Increased intravenous (IV) fluid administration will increase preload, which will
increase cardiac output.
Diuretics (furosemide) decrease preload.
Nitroglycerin decreases preload.
Calcium channel blockers (nifedipine) decrease preload.
The nurse is caring for a patient diagnosed with acute respiratory distress syndrome
(ARDS). Which factor contributes to fluid retention during mechanical ventilation?
Mechanical ventilation causes fluid retention. Because decreased cardiac output
is associated with positive pressure ventilation and positive end-expiratory pressure (PEEP)
results in decreased renal perfusion, release of renin, and increased aldosterone
secretion.
Antidiuretic hormone (ADH) may be released and is responsible for fluid retention.
Increased thoracic pressure will decrease the release of atrial natriuretic factor, causing
sodium retention. Sensible water loss is decreased via the airway during mechanical
ventilation.
,An elderly client with severe dehydration is admitted to the intensive care unit (ICU)
after being found unconscious on the floor of her home.
Laboratory results include:
sodium 122 mEq/L
hematocrit 56%
BUN 38 mg/dL
The provider orders intravenous administration of D5W at 200 ml/hour to treat
hypovolemia. Several hours after the infusion is started, the patient has a
generalized seizure. Which statement most accurately describes the cause of the
seizure? Administered of sodium free fluids causes cerebral cellular swelling.
Dextrose in water causes fluid to shift from the extracellular space into the cells, which
caused cerebral cellular swelling and led to the seizure activity.
All other answer options are not directly related to the administration of D5W to a client
with severe hyponatremia.
FLUID HOMEOSTASIS:
Fluid and electrolyte balance are essential to homeostasis. When either is in excess or
deficit within the body, unique challenges present for the patient.
Fluids must be stable in the intravascular, interstitial, and intracellular spaces. Intracellular
fluid volume is relatively stable, whereas intravascular fluid fluctuates in response to fluid
intake and loss. Interstitial fluid is the reserve fluid, replacing intravascular and intracellular
volume as needed.
Almost all acute and chronic conditions affect fluid balance within the body, especially in
critically ill patients.
FACTORS AFFECTING FLUID BALANCE:
Fluid movement between body spaces depends on osmosis and diffusion. Three main
hormones regulate fluid balance:
1. Aldosterone promotes sodium retention while increasing urinary losses of
potassium. Severe hypotension and hypovolemia trigger the release of aldosterone.
2. Antidiuretic hormone (ADH) triggers the renal tubules to reabsorb water and
return it to the intravascular space. Hypovolemia and increased blood osmolarity
cause ADH to be released. Conditions such as diabetes insipidus and syndrome of
inappropriate ADH secretion (SIADH) affect the release of this hormone.
3. Natriuretic peptides (atrial natriuretic peptide) are released from the heart in
response to chamber stretching and overfilling. Increased renal excretion of sodium
and water and increased glomerular filtration rate happen in response.
, The posterior pituitary gland releases antidiuretic hormone (ADH), causing renal cells to
reabsorb water which decreases urine output, concentrating the urine, and diluting the blood.
The normal urine specific gravity is 0.010–0.030. Decreased specific gravity indicates fluid
volume overload. Increased specific gravity indicates dehydration.
Desmopressin is a synthetic form of ADH administered intranasally, subcutaneously, or
intravenously.
RENAL FUNCTION: The kidneys are the main organ involved in fluid and electrolyte
homeostasis. Assessing renal function before attempting to correct the imbalance is
essential.
Important laboratory tests to analyze include:
albumin
calcium
creatinine
chloride
glucose
phosphorous
potassium
sodium
blood urea nitrogen (BUN)
Pause: What are the normal values for these tests? Take the time to review prior to
proceeding with the next learning activity.
ASSESSING FLUID VOLUME STATUS: Vital signs, Central venous pressure, Pulmonary
artery pressure, Breath sounds, Oxygen saturation, Skin turgor, Edema, Weight.
RISK FACTORS FOR FLUID BALANCE ALTERNATIONS:
During major illness or injury, normal homeostatic mechanisms are disrupted, often
causing fluid alterations.
Heart failure due to decreased cardiac output can cause fluid overload.
Renal dysfunction impedes the removal of unneeded fluids.
Gastrointestinal (GI) loss by vomiting, diarrhea, and gastric suctioning can cause
fluid deficit.
Severe blood loss leads to fluid deficit.
High fever can cause fluid deficit.
Lack of antidiuretic hormone (ADH) causes too much fluid excretion.
Some treatments lead to fluid alterations.
(EDAPT WEEK 4 NOTES)
COMPLEX FLUID BALANCE ALTERNATION
Complex Adult Health
,WEEK 4 COMPLEX EDAPT NOTES
COMPLEX FLUID BALANCE ALTERNATION:
Fluid and electrolyte imbalances are among the most common problems encountered in
critically ill patients and are associated with increased morbidity and mortality.
Disorders such as severe burns, trauma, sepsis, and heart failure lead to disturbances in
fluid and electrolyte balance. Supporting treatments, such as mechanical ventilation, may
also affect fluid balance.
Nurses must be able to recognize the signs of severe fluid and electrolyte imbalance and
act quickly to restore homeostasis.
The nurse is caring for a client experiencing a decrease in preload due to
hypovolemia. Which action will support an increase in preload and cardiac output?
Increased intravenous (IV) fluid administration will increase preload, which will
increase cardiac output.
Diuretics (furosemide) decrease preload.
Nitroglycerin decreases preload.
Calcium channel blockers (nifedipine) decrease preload.
The nurse is caring for a patient diagnosed with acute respiratory distress syndrome
(ARDS). Which factor contributes to fluid retention during mechanical ventilation?
Mechanical ventilation causes fluid retention. Because decreased cardiac output
is associated with positive pressure ventilation and positive end-expiratory pressure (PEEP)
results in decreased renal perfusion, release of renin, and increased aldosterone
secretion.
Antidiuretic hormone (ADH) may be released and is responsible for fluid retention.
Increased thoracic pressure will decrease the release of atrial natriuretic factor, causing
sodium retention. Sensible water loss is decreased via the airway during mechanical
ventilation.
,An elderly client with severe dehydration is admitted to the intensive care unit (ICU)
after being found unconscious on the floor of her home.
Laboratory results include:
sodium 122 mEq/L
hematocrit 56%
BUN 38 mg/dL
The provider orders intravenous administration of D5W at 200 ml/hour to treat
hypovolemia. Several hours after the infusion is started, the patient has a
generalized seizure. Which statement most accurately describes the cause of the
seizure? Administered of sodium free fluids causes cerebral cellular swelling.
Dextrose in water causes fluid to shift from the extracellular space into the cells, which
caused cerebral cellular swelling and led to the seizure activity.
All other answer options are not directly related to the administration of D5W to a client
with severe hyponatremia.
FLUID HOMEOSTASIS:
Fluid and electrolyte balance are essential to homeostasis. When either is in excess or
deficit within the body, unique challenges present for the patient.
Fluids must be stable in the intravascular, interstitial, and intracellular spaces. Intracellular
fluid volume is relatively stable, whereas intravascular fluid fluctuates in response to fluid
intake and loss. Interstitial fluid is the reserve fluid, replacing intravascular and intracellular
volume as needed.
Almost all acute and chronic conditions affect fluid balance within the body, especially in
critically ill patients.
FACTORS AFFECTING FLUID BALANCE:
Fluid movement between body spaces depends on osmosis and diffusion. Three main
hormones regulate fluid balance:
1. Aldosterone promotes sodium retention while increasing urinary losses of
potassium. Severe hypotension and hypovolemia trigger the release of aldosterone.
2. Antidiuretic hormone (ADH) triggers the renal tubules to reabsorb water and
return it to the intravascular space. Hypovolemia and increased blood osmolarity
cause ADH to be released. Conditions such as diabetes insipidus and syndrome of
inappropriate ADH secretion (SIADH) affect the release of this hormone.
3. Natriuretic peptides (atrial natriuretic peptide) are released from the heart in
response to chamber stretching and overfilling. Increased renal excretion of sodium
and water and increased glomerular filtration rate happen in response.
, The posterior pituitary gland releases antidiuretic hormone (ADH), causing renal cells to
reabsorb water which decreases urine output, concentrating the urine, and diluting the blood.
The normal urine specific gravity is 0.010–0.030. Decreased specific gravity indicates fluid
volume overload. Increased specific gravity indicates dehydration.
Desmopressin is a synthetic form of ADH administered intranasally, subcutaneously, or
intravenously.
RENAL FUNCTION: The kidneys are the main organ involved in fluid and electrolyte
homeostasis. Assessing renal function before attempting to correct the imbalance is
essential.
Important laboratory tests to analyze include:
albumin
calcium
creatinine
chloride
glucose
phosphorous
potassium
sodium
blood urea nitrogen (BUN)
Pause: What are the normal values for these tests? Take the time to review prior to
proceeding with the next learning activity.
ASSESSING FLUID VOLUME STATUS: Vital signs, Central venous pressure, Pulmonary
artery pressure, Breath sounds, Oxygen saturation, Skin turgor, Edema, Weight.
RISK FACTORS FOR FLUID BALANCE ALTERNATIONS:
During major illness or injury, normal homeostatic mechanisms are disrupted, often
causing fluid alterations.
Heart failure due to decreased cardiac output can cause fluid overload.
Renal dysfunction impedes the removal of unneeded fluids.
Gastrointestinal (GI) loss by vomiting, diarrhea, and gastric suctioning can cause
fluid deficit.
Severe blood loss leads to fluid deficit.
High fever can cause fluid deficit.
Lack of antidiuretic hormone (ADH) causes too much fluid excretion.
Some treatments lead to fluid alterations.
