Question

Case Studies, Chapter 40, Fluid, Electrolyte, and Acid--Base Balance

You are a nurse who frequently cares for postsurgical patients in your hospital unit. Most of the medical-surgical patients have IV fluids infusing during their admission. Due to the frequent use of IV fluids on your floor, understanding fluid balance and electrolyte function is primary to your nursing practice. (Learning Objectives 1, 6, and 7)

What conditions might lead to the development of hypovolemia?

How would the amount of patient fluid loss be determined?

Describe how hypovolemia and third-space fluid shift correlate.

Outline the major difference between hypovolemia and third-space fluid shift.

Which conditions can result in third-space fluid shift?

You are a nurse in a nonsurgical cardiac unit caring for a 92-year-old patient who has two sons, 15 grandchildren, and 49 great-grandchildren. She lives in assisted living and has a history of congestive heart failure (CHF). She consistently struggles with balancing her fluids and electrolytes and has an affinity for dill pickles and sauerkraut. While hospitalized, she remains on a fluid restriction---much to her chagrin, as she loves ice cream.

What within her history would indicate she was at risk for hypervolemia?

How would dill pickles and sauerkraut impact her fluid volume?

What body areas offer observational evidence of excessive interstitial extracellular fluid (ECF)?

Why would your patient be on a strict fluid restriction while hospitalized?

Outline nursing interventions used while a patient is on fluid restriction.

Answer 1

que1. Condition that can result in hypoglycemia hypovolemia results from increase in fluid amount loss than normal fluid loss .

Trauma bleeding

Low protein in blood

Vomiting

Diarrhea

Suction

Third space fluid shift

Burn draining wounds

Excessive laxative and diuretics

B) majorly the amount of weight loss is measured to assess the amount of fluid loss .

Decrease in Weight daily ,it Can indicate Indicate amount of the fluid loss in the Body .

It can measured with urine intake and output charting , decrease in urine output than 20mmmol/L ,indicate hypovolemia . Not amount of fluid loss .

Supine heart rate more than 100 and systolic bp less than 200mm HG , patient may be hypovolemia but not assess amount loss of fluids .

C) hypovolemia and Third space fluid shift are conditions caused by extracellular fluid volume .

As there is decrease albumin losses can occur in liver failure ,liver dysfunction ,and malnutrition . Albumin losses can lead to extracellular fluid shifting into the peritoneum , causing ascites , pericardial , pleural cavities ,soft tissue or joints . And reduced fluid volume in Vessels result in hypovolemic shock.

D) the major difference between hypovolemia and third space fluid shift is the Final location of the fluid .

In hypovolemia the final location of fluid is interstitial space or intracellular space from the intravascular space . But in third space fluid shift , fluid is found at non functional cavities as peritoneum , pleural space, pericardial , or soft tissue.

E) condition can result in third space fluid shift.

1)Decrease albumin

2) excessive IV fluids replacement

3) renal dysfunction

4) . Heart failure

5). Hyponatremia

6). Gross tissue trauma

7) sever burn

8) bowel obstruction

Que2. CHF is risk factor for hypervolemia. As in history patient has congestive heart failure than functioning of left ventricle is reduced , results in decrease in cardiac output . Cardiovascular disease also caused water and sodium retention . CHF also reduce the blood flow to the renal hence decrease in excretion of sodium and water.

B AS CHF causes water and Sodium retention because of decreased cardiac output and decrease in blood supply to the kidney hence low excretion . But .if she takes pickles and sauerkraut. Which has high content of salt or sodium. . high sodium in body. Causes more water retention and further increase in volume of fluid and decrease excretion .

C) lower limbs are observational evidence of increase in interstitial fluid .

High fluid accumulation occur in lower limbs , due to gravity. And result in the edema of the lower . Edema observations is also first observed at lower limbs .

D) .In hospital setting , fluid restrictions is strict a slight intake of water can result more accumulation of fluid in body And their would high risk of death because of the overloaded heart functioning. Due high volume fluid.

Hence its strictly restricted .

E) NURSING INTERVENTION

1. Monitor fluid intak and output

2. Monitor daily weight

3. Monitor cardiopulmonary status.

4.Ascultate breath sounds

5. Assess for complaint of dyspnea

6.6.Monit ABG values

7. Assess for peripheral edema

8. Inspection of . patient for sacral edema

9. Monitor infusion of IV Solution

10. Monitor the effect of .Prescribed medications

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