GOOD

MORNING!
 FLUID
IMBALANCES
 OBJECTIVES
At the end of the discussion, the student will be able to:

Discuss the risk factors that contribute to the development of fluid

imbalances
Discuss the principles of management and essential nursing
intervention for patient suffering from fluid volume deficit and
excess
 Pathophysiologic
Mechanism
A. FLUID IMBALANCES

1. Fluid Volume Deficit

2. Fluid Volume Excess
 REGULATION OF BODY FLUID VOLUME

HYPERVOLEMIA HYPOVOLEMIA

Excess fluid Decreased fluid

volume volume

INHIBITS
STIMULATES

Aldosterone Aldosterone
ADH Released THIRST THIRST ADH Released
Released Released
(inhibited) (Inhibited) (Stimulated) (Stimulated)
(inhibited) (Stimulated)

Contribute to Contribute to

DECREASED URINATION
INCREASED URINATION
Of
Of dilute urine
Concentrated urine

NORMAL FLUID VOLUME RESTORED

A. FLUID VOLUME DEFICIT:

• Hypovolemia occurs when loss of ECF volume

exceeds the intake of water. It occurs when water
and electrolytes are lost in the same proportion as
they exist in normal body fluids.

Etiology

1. Inadequate fluid intake

2. Increased output

3. Massive third-space fluid shift

 CATEGORIES OF ECFVD

 Mild ECFVD - 1 to 2 L of water or 2% of

body weight is lost

 Moderate ECFVD – 3 to 5 L of water or 5%

body weight is lost

 Severe ECFVD – 5 to 10 L of water or 8%

body weight is lost
C. Types of Fluid Deficit

1.Hypertonic Imbalance/ Extracellular Water Deficit and

Solute Excess
• Increase solute, loss water

2.Hypotonic Water Deficits/Depletion

• water is lost in excess of sodium

3. Isotonic Volume Deficit/ Extracellular fluid Deficit

•most common form of depletion or DHN
•occur when fluids and electrolytes are loss in equal
amount
Clinical manifestations:

a. Tented skin turgor and dry mucous

membranes
b. Postural hypotension
c. Increased heart rate
d. Extreme thirst
e. Dizziness, weakness, and change in
mental status
f. Renal shutdown and coma
g. Acute weight loss
B. FLUID VOLUME EXCESS:
hypervolemia, expansion of ECF caused by
abnormal retention of water and sodiumin the same
proportion; increased local or total body fluid volume.

Etiology

1. Excessive fluid intake

2. renal disease
3. Abnormal fluid retention
4. Excessive sodium intake
(intravenous or oral)
Types of Fluid Excess

1.Hypotonic Water Excess Or

Water Intoxication

2. Volume Excess/
Extracellular fluid Excess/
Edema
Fluid Volume Overload (EDEMA)

 Increased hydrostatic pressure –

(pulmonary edema)

 Decreased plasma & albumin

 Altered lymphatic function

 Tissue Injury
Clinical manifestations:
•acute weight gain
•Peripheral edema and ascites
•Jugular venous distention
•Crackles, cough
•increased CVP
•Shortness of breath
•Increase BP
•Bounding pulse
•Increase RR
•Increase UO
 THIRD SPACE FLUID SHIFTING
 Third-spacing occurs when too much fluid moves from the
intravascular space (blood vessels) into the interstitial or
"third" space-the nonfunctional area between cells.

Causes of third space fluid shift:

Any condition that destroys tissue or reduces protein
intake can lead to protein losses and third-spacing. Some
examples are severe liver diseases, alcoholism,
malabsorption, malnutrition, renal disease, diarrhea,
immobility, burns, and cancer.
 FLUID LOCATION FLUID
SPACE
Intrapleural Between lungs and Pleural effusion
chest

Pericardial Between heart and Pericardial

pericardial sac effusion

Peritoneal Between intestines and Ascites

abdominal wall
Nursing Diagnoses and
Management
(Fluid Imbalances)
 Nursing Diagnoses

 Deficient fluid volume

 Impaired Oral Mucous Membrane

 Risk for injury

 Fluid volume excess

 Medical Management

 FLUID VOLUME DEFICIT

 
 IVF – Isotonic solutions (lactated ringer’s solution,
0.9% sodium chloride)

 Fluid Challenge Test – administering 100 to 200 ml

of normal saline solution over 15 minutes.
The goal is to provide fluids rapidly enough to
attain adequate tissue perfusion without
compromising the cardiovascular system.
 Nursing Management

FLUID VOLUME DEFICIT

Maintain normal fluid balance.
Monitor intake and output accurately. (urine output greater
than 0.5 ml/kg/hr.)
Monitor urine specific gravity
Weigh the client daily.
Maintain adequate hydration through oral or intravenous
fluid supplementation by oral intake between 1500 to 2500
ml or more in 24 hours.
Provide ongoing assessment. (absence of crackles, fluid
in alveoli)

Maintain skin integrity. Assess skin turgor, tongue

turgor, and mucous membranes.

Provide frequent oral care to client.

Teach the client to change positions slowly to minimize

postural hypotension.
 Medical Management

FLUID VOLUME EXCESS

Diuretics – (Thiazides, Loop diuretics)

Hemodialysis

Nutritional therapy – dietary restriction of

sodium.
< 6 – 15 gms of salt.
Be cautious with salt substitute.
Instruct to drink distilled water and 1L/day.
 Nursing Management

Maintain normal fluid balance.

Monitor intake and output accurately.

Use an urometer if necessary.
Weigh the client daily
Assess vital signs. Assess for peripheral
and sacral edema.
Closely monitor the rate of intravenous
fluids.
Prevent or minimize edema.
If pulmonary edema occurs,
elevate the head of the bed and have the client turn, cough,
and deep breath every two hours.
Turn the client every 2 hours
Administer diuretics as prescribed.

Provide client and family teaching.

Teach the client the fundamentals of a sodium=restricted diet as
ordered.
Instruct the client to avoid over-the-counter medications.
 REFERENCES

 Smeltzer S. Bare, B ( 2010) Brunner and Suddarth’s

Textbook of Medical- Surgical Nursing, 12th edition
Lippincott, William and Wilkins Philadelphia
 Hinkle,J. Cheever,K. (2018). Brunner and Suddarth’s
Textbook of Medical- Surgical Nursing, 14th edition
Wolters Kluwer