FUTURE READY FUTURE SMART PROGRAM

STUDY GUIDE

WEEK 5

Subject Fluids and Electrolytes

Topics Dehydration & Edema
Yr./Section
Date/Week Week 5
Time Allotment
School Year SY 2021

I. Objectives

- To be able to distinguish the Predisposing & Precipitating factors causing DHN &
Edema
- To be able to assess degree of DHN & Edema
- Identify management & treatment appropriate for DHN & edema
- Enumerate some examples of drugs being used in Fluid & electrolytes
disturbances

II. Discussion

Dehydration: (DHN)
- Occurs when H20 & electrolytes are lost in the same proportions;
- One of the most commonly blood fluid disturbances in infancy/childhood

Etiology:
- Lack of oral intake
- Abnormal loss of fluids (ox suffer fr vomiting, diarrhea or NPO)

Category:
Mild Dehydration 3-5
body weight loss
Moderate Dehydration
6-9
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 Severe Dehydration
10-15

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 Predisposing Factor:
1. Decrease H20 intake
2. Increase H20 loss
3. Excess solute intake

Manifestation: (Sign & Symptoms)

 Thirst
 Weight loss
 Increase body temperature (lack of fluid - perfuration)
 Dry or cracked mucous membrane & tongue
 Poor skin turgor (no to below 12 mos)
 Decrease urine output
 Depressed fontanel (only after 18 mos)
 Sunken eyeball (note the nationality of the px)
 Decrease or absence of tears
 Alteration in CNS (adjetation, confused to coma)
 Manifestation of decrease circulating blood volume; (postural hypotension, rapid, decrease
vein reveal)

Complication:
- Fever
- Dilutional Hypernathremia (excess fluid)
- Renal Failure
- Shock
- Coma

Implementation/ Intervention (Management)

1. Assess for S/S of DHn
2. Monitor V/S & I & O
3. Check Peripheral circulation
4. Check specific urine gravity
5. Administered IV therapy as ordered

* Monitor sign of H20 intoxication during IV replacement such as:

-Polyuria
-Decrease Na & osmolarity
-CNS alteration
(twitching, disoriented to coma bc of cerebral edema)
Edema
Excess fluids in the interstitial space which maybe localized or generalized,
It forms in;
- Peritoneal Cavity (ascites)
- Pleural Space (pleural iffusion)
- Pericardial Cavity (cardiomegaly w/ failure)
- Subcutaneous (chceck degree of edema)

Predisposing Factors:
1. Increased capillary hydrostatic pressure
Precipitating Factors:
 Conditions causing venous obstruction(venous clot, right heart failure, varicosity, pressure
of vein from cast and bandage)
 Conditions causing arteriolar dilation (allergic reaction/ local or systemic allergic reaction -
inflammation)
 Increase Extracellular fluid volume (renal failure, excessive fluid administration, endocrine
disorder resulting to aldosterone increasing level - cushing disease)

2. Increased capillary permeability( inflammation, allergic reaction, burn, mechanical injury)

3. Decreased Plasma Colloid Osmotic Pressure

Precipitating Factors:
 Conditions causing loss of albumin (burn, hemorrhage, diarrhea, nephrosis)
 Conditions causing decreased albumin prapiroduction such as; liver disease, dietary w
dietary protein deficiency

4. Lymphatic Obstruction
 Malignant invasion of lymph nodes
 Surgical removal of lymph nodes
 Infection & inflammation (philiariasis, or elephantiasis)

Manifestation: (Sign & Symptoms)

 Elevated BP
 Skin alterations (due to skin tension - stretch, pale, and shiny)

Alteration in Body Contours:

1. Pitting Edema
- Indentation PIT that forms over edematous area under pressure from examiner
fingers.
2. Dependent Edema
-Gravitational flow of edema fluid to most dependent portion of the body (happen
 when prolong standing and sitting - who takes amlodipine) (pregnant)
3. Brawny Edema
- Caused by trapping of fluid by coagulated proteins in tissue spaces, skin
become thick & hardened with an orange peel appearance due to severe stretching.
(mukang puputok)
4. Weeping Edema
- A very severe form of edema, fluid leaks out of skin pores when pressure
exerted over the area. (fluid leaks in skin pores when assessing)

4 Point Scale of Edema Assessment

Scale Assessment
1+ Edema barely detected with slight pitting
2+ Deeper pit but fairly normal contours
3+ Deep pit & puffy apparance
4+ Excessive fluid accumulation with deep pit & frankly swollen appearance

Scenario:
Pressure from examiners finger:

0 - no pitting - No Edema
1+ - 2mm depressor that disappear rapidly - Mild Pitting Edema
2+ -4mm depression that disappear in 10-15 second - Moderate Edema
3+ - 6mm depression that last more than 1 minute - Moderately Severe
after releasing examiner’s finger Edema
4+ - 8mm depression that can last more than 2 minute - Severe Pitting Edema
after releasing examiner’s finger
Treatment:
- Specific depends on the cause of Edema (combination of phartmacology and nutrition - or
administer niv to increase releasing of fluids)
- Combination of Pharmcology & Nutrition

Management:
1. Monitor I & O
2. Administer prescribed drugs
3. Restrict fluid & Na intake
4. Instruct clients to read food labels for Na content
5. Elevate body parts prone to edema, avoid pressure/sharp bends
6. Use elastic support stockings & sleeves
7. Keep skin over edematous tissue clean & lubricated
8. Change client position frequently
9. Monitor electrolytes for sign of hypokalemia or hyponatremia & administer prescribed
electrolytes supplements if needed.
 Examples of Essential Drugs for Treatment of Fluid & Electrolytes Disturbances:
1. Aluminum Hydroxide (neutralize gastric acid and may cause constipation - stool may
appear white in color)
2. Ca Gluconate (to prevent hypokalcemia with meals to enhance absorption, meals bc it
cause GI irritation (nausea, anorexia, abdo pain, vomit
3. Kalium Durules (electrolytes supp to hypokalemia - with food with 1/2 glass of liquid,
no crash no chew, 120 ml of h20 when drinking - ass for s/s of hypokalemia confuse,
lethargic)
4. MgSO4 (must be taken w 80z of h20 - can take with juices) (do not adm during
bedtime, it may cause laxative effect
5. NaHCO3 (neutralize gastric acid - taken with empty stomach, dissolve, with meals
when its granules - avoid milk cause alkaline syndrome)

References:
- Medical-Surgical Nursing 12th Edition
Brunner & Suddarth’s

III. Learning Rubric

Instruction: Please read carefully and check the

corresponding box for your answer. (Basahin ng
mabutiangbawattanong at i-tsekangkahon ng iyongsagot).

Note: Your honest answers will help us gather accurate data in order for the Teachers
to understand and provide appropriate interventions for the topic discussed.
(Angmatapatnapagsagot ay makapagbibigay ng tumpaknadatosupang mas higitnamaunawaan
at makapagbigay ng nararapatinterbensiyonpatungkolsapaksangito.)

YES MAYBE NO
Content
(3) (2) (1)
1. I have background knowledge about the topic.
(Mayroonnaakongkontingkaalamantungkolsapaksa.)
2. I can analyze the content to deepen my understanding.
(Kaya kongsuriingmabutiangpaksaupangmapalawak pa
angakingkaalaman.)
3. I can give my own examples.
(Kaya kongmagbigay ng sarilikonghalimbawa.)
4. I can summarize the content and information that I have
learned.
(Kaya konglaguminangpaksa at angkaalamangakingnatutunan.)
5. I clearly understood the topic.
(Luboskongnaunawaanangpaksa ng aralin.)
6. I understand the direction of each activity and answered it
correctly.
(Nauunawankoangpanuto ng bawatgawain at nasagutanito ng tama.)
7. I can enumerate the necessary steps and procedures related
to the lesson.
(Kaya konghanayinangmgahakbang at prosesona may
kaugnayansapaksangtinalakay.)
8. I can independently perform the skill, strategy or process.
(Kaya kongi-apply angakingnatutunanupangmagsagawa ng
isangkasanayan, pamamaraan, o proseso.)
9. I can relate the topic in real-life situations.
(Kaya kongiugnayangpaksasatotoongbuhay.)
10. I accomplished the task on time.
(Nataposkoangmgagawainsaitinakdangoras.)