NURSING 120 FINAL STUDY GUIDE
Solutions with the same osmolality that maintain equilibrium or balance. No shrinking or
swelling of cells occurs. Used to expand extracellular fluid volume and for intravascular
dehydration.
- Isotonic
Manifestations of fluid volume deficit
- Increased urine specific gravity, dark urine, decreased urine output, and orthostatic
hypotension
Examples of isotonic solutions
0.9% NaCl (normal saline), lactated ringers, D5W: 5% dextrose in water
_______ does not replenish electrolytes and is contraindicated in pts with head injury and
should be used with caution in children because of risk for increased ICP
- D5W
Solutions with a greater effective osmolality - cause shrinking as water is pulled out of the cell
(Ex. Gatorade) used to treat situations of hyponatremia and hypovolemia.
-Administered slowly to reduce risk for intravascular volume overload; carefully monitor serum
sodium, lung sounds and BP.
- Hypertonic
Examples of hypertonic solutions
-Dextrose 5% in 0.45% (half strength NaCl)
-Dextrose 5% in 0.9% NaCl
,Solutions with a lower osmolality, cause swelling as water moves into the cell. May be used to
replenish cellular fluid - monitor closely for intravascular fluid loss, hypotension, changes in LOC
and edema.
-Hypotonic
Example of a hypotonic solution
0.45% or half-strength NaCl
Decreased volume of water and electrolyte change
-Dehydration
Distributional shift of body fluids into potential body spaces
-Third spacing
Risk factors for fluid volume deficit:
-Abnormal GI losses (vomiting, diarrhea, suction)
-abnormal skin losses (diaphoresis)
-abnormal renal losses
-drainage of secretions (third spacing)
-hemorrhage
-anorexia
-inability to swallow
-confusion
-depression
-fever
-increased respirations
-increased insensible losses
-hyperglycemia
Defining characteristics of fluid volume deficit (hypovolemia):
-Poor skin turgor
-dry mucous membranes
,-dry furrowed tongue
-tachycardia
-narrowing pulse pressure
-decreased central venous pressure
-postural hypotension
-flat neck veins
-decreased urinary output
-increased specific gravity
-hemoconcentration (increased hematocrit and BUN)
Assessments for fluid volume deficit:
-vitals
-neuromusculoskeletal
-GI
-renal
-thirst
-weight loss
-dry mucous membranes
-inelastic skin turgor
-sunken eyes
-flat neck veins
-Lab findings: Hct, serum osmolarity, urine specific gravity and osmolarity, serum sodium.
Excessive retention of water and sodium in ECF
-Hypervolemia
Above normal amounts of water in extracellular spaces
-Overhydration
Excessive ECF accumulates in tissue spaces
Edema
Movement of fluid from space surrounding cells to blood
, Interstitial to plasma shift
Risk factors for fluid volume excess (hypervolemia)
-Compromised regulatory mechanisms (renal, cardiac, endocrine)
-Excess IV fluids
-corticosteroid therapy
-interstitial to plasma fluid shifts
Assessments for fluid volume excess
-Weight gain
-Peripheral edema
-vital signs
-neuromusculoskeletal
-full bounding pulse
-crackle in lungs
-neck vein distention
-Lab findings: BUN, Hct, sodium, urine specific gravity
Nursing & collaborative care for fluid volume excess
-assess vital signs
-monitor for SOB and dyspnea
-check urinalysis
-O2 saturation
-monitor electrolytes
-administer O2 prn
-measure pts weight daily
-observe for N/V/D
-assess neurological status
-initiate and maintain IV access
-fluid replacement (isotonic solutions)
-monitor I&Os
-assess capillary refill
Nursing and collaborative care for edema
Solutions with the same osmolality that maintain equilibrium or balance. No shrinking or
swelling of cells occurs. Used to expand extracellular fluid volume and for intravascular
dehydration.
- Isotonic
Manifestations of fluid volume deficit
- Increased urine specific gravity, dark urine, decreased urine output, and orthostatic
hypotension
Examples of isotonic solutions
0.9% NaCl (normal saline), lactated ringers, D5W: 5% dextrose in water
_______ does not replenish electrolytes and is contraindicated in pts with head injury and
should be used with caution in children because of risk for increased ICP
- D5W
Solutions with a greater effective osmolality - cause shrinking as water is pulled out of the cell
(Ex. Gatorade) used to treat situations of hyponatremia and hypovolemia.
-Administered slowly to reduce risk for intravascular volume overload; carefully monitor serum
sodium, lung sounds and BP.
- Hypertonic
Examples of hypertonic solutions
-Dextrose 5% in 0.45% (half strength NaCl)
-Dextrose 5% in 0.9% NaCl
,Solutions with a lower osmolality, cause swelling as water moves into the cell. May be used to
replenish cellular fluid - monitor closely for intravascular fluid loss, hypotension, changes in LOC
and edema.
-Hypotonic
Example of a hypotonic solution
0.45% or half-strength NaCl
Decreased volume of water and electrolyte change
-Dehydration
Distributional shift of body fluids into potential body spaces
-Third spacing
Risk factors for fluid volume deficit:
-Abnormal GI losses (vomiting, diarrhea, suction)
-abnormal skin losses (diaphoresis)
-abnormal renal losses
-drainage of secretions (third spacing)
-hemorrhage
-anorexia
-inability to swallow
-confusion
-depression
-fever
-increased respirations
-increased insensible losses
-hyperglycemia
Defining characteristics of fluid volume deficit (hypovolemia):
-Poor skin turgor
-dry mucous membranes
,-dry furrowed tongue
-tachycardia
-narrowing pulse pressure
-decreased central venous pressure
-postural hypotension
-flat neck veins
-decreased urinary output
-increased specific gravity
-hemoconcentration (increased hematocrit and BUN)
Assessments for fluid volume deficit:
-vitals
-neuromusculoskeletal
-GI
-renal
-thirst
-weight loss
-dry mucous membranes
-inelastic skin turgor
-sunken eyes
-flat neck veins
-Lab findings: Hct, serum osmolarity, urine specific gravity and osmolarity, serum sodium.
Excessive retention of water and sodium in ECF
-Hypervolemia
Above normal amounts of water in extracellular spaces
-Overhydration
Excessive ECF accumulates in tissue spaces
Edema
Movement of fluid from space surrounding cells to blood
, Interstitial to plasma shift
Risk factors for fluid volume excess (hypervolemia)
-Compromised regulatory mechanisms (renal, cardiac, endocrine)
-Excess IV fluids
-corticosteroid therapy
-interstitial to plasma fluid shifts
Assessments for fluid volume excess
-Weight gain
-Peripheral edema
-vital signs
-neuromusculoskeletal
-full bounding pulse
-crackle in lungs
-neck vein distention
-Lab findings: BUN, Hct, sodium, urine specific gravity
Nursing & collaborative care for fluid volume excess
-assess vital signs
-monitor for SOB and dyspnea
-check urinalysis
-O2 saturation
-monitor electrolytes
-administer O2 prn
-measure pts weight daily
-observe for N/V/D
-assess neurological status
-initiate and maintain IV access
-fluid replacement (isotonic solutions)
-monitor I&Os
-assess capillary refill
Nursing and collaborative care for edema
