Fluid Imbalances

1. Decreased Fluid intake
2. Failure to absorb or reabsorb water -- i.e., diarrhea
3. Loss of fluid through GI tract -- i.e., vomiting, NG suctioning
4. Excessive renal excretion due to renal disease and inapropriate ADH secretion

1. Overuse of diuretics or inadequate fluid replacement of fluid loss
2. Excess fluid loss through skin & lungs due to febrile state
3. Impaired skin integrity -- i.e., burns, wounds, hemorrhage

1. Rapid, acute weight loss
2. Extreme thrist
3. Decreased urine output
4. Weakness, confusion, dizziness

Most accurate measure of fluid status

1. Tongue furrows
2. Dry skin & mucous membranes
3. Poor skin turgor - Tented
4. Flat jugular veins
5. Cap refill > 5 seconds

1. Decrease BP
2. Increased, weak pulse
3. Postural hypotension
4. Decreased CVP
5. Elevated temp

Major electrolyte that affects fluid balance. "Where it goes, so goes the water."

1. Specific gravity > 1.030
2. BUN > 25
3. Hematocrit > 55%
4. Sodium > 145

1. Excessive fluid intake
2. Failure to excrete fluids - i.e., renal or cardiac failure
3. Fluid increase due to excessive infusion of hypotonic fluids
4. Excess sodium intake

1. Weight gain
2. Dependent pitting edema
3. Pulmonary edema
4. Coughing, dyspnea, & crackles
5. Lethargy, changes in mental status

1. Jugular vein distention
2. Increased BP
3. Decreased, bounding pulse
4. Increased CVP

1. Sodium < 135
2. Hematocrit < 45%
3. Specific Gravity < 1.010
4. BUN < 8