Fluid Imbalance

[bsquared]

I will be presenting in our clinical post-conference about Fluid imabalance, specifically hypo/hypernatremia. Any ideas how I can make it interesting and easy to understand? hand-out?

Thank you in advance!

[Daytonite, BSN, RN]

i can save you a lot of research. here is all the information i have on sodium:

• major cation in the extracellular space - promotes neuromuscular function - reflects the balance between dietary sodium intake and renal excretion
  
• normal adult:
  
  • 135-145 meq/liter
    
  • (135-145 mmol/liter)
    

  [*]normal urine sodium:

  • 27-287 meq/24 hrs
    
  • (27-287 mmol/24 hrs)
    

  [*]panic (critical) values:

  • below120 meq/liter
    
  • above 160 meq/liter

  [*]hypernatremia

  • elevated blood pressure (hypertension)
    
  • elevated pulse (tachycardia)
    
  • elevated temperature
    
  • elevated respiratory rate, possible dyspnea
    
  • increased body weight
    
  • bounding peripheral pulses
    
  • moist mucous membranes
    
  • moist respiratory secretions
    
  • crackles in lungs on auscultation
    
  • fever
    
  • edema (may be pitting)
    
  • dry skin
    
  • thirst
    
  • weakness
    
  • restlessness/agitation
    
  • disorientation
    
  • delusions
    
  • hallucinations
    
  • lethargic when undisturbed
    
  • irritable when stimulated
    
  • muscle irritability
    
  • diminished or absent dtrs
    
  • high pitched cry in infants
    
  • seizures
    
  • coma (due to swelling of brain cells)
    
  • respiratory arrest due to increased osmotic pressure

  [*]causes of hypernatremia

  • increased sodium intake:
    
    • excessive dietary intake of sodium or water
      
    • excessive saline in iv therapy
      
    • excessive infusion of isotonic iv solutions
      

    [*]decreased sodium loss:

    • cushing's syndrome
      
    • hyperaldosteronism
      
    • decreased water output due to renal disease
      

    [*]excessive body water loss:

    • excessive sweating
      
    • extensive burns
      
    • dehydration
      
    • diabetes insipidus
      
    • osmotic diuresis
      

    [*]other causes of increased water:

    • azotemia
      
    • heart failure
      
    • pulmonary edema
      
    • lactic acidosis
      
    • long term administration of adrenocortidal hormones

  [*]hyponatremia

  • increased pulse (tachycardia)
    
  • weak, thready peripheral pulses
    
  • flat neck veins
    
  • increased respiratory rate
    
  • decreased blood pressure (hypotension)
    
  • decreased body weight
    
  • thick, slurred speech
    
  • anorexia
    
  • nausea/vomiting/abdominal cramps
    
  • oliguria
    
  • anuria
    
  • lethargy/malaise
    
  • headache
    
  • confusion
    
  • muscular twitching
    
  • seizures
    
  • coma
    
  • respiratory arrest

  [*]causes of hyponatremia

  • decreased sodium intake:
    
    • insufficient dietary intake
      
    • deficient sodium in iv fluids
      
    • n/g feeding with inadequate fluid
      

    [*]increased sodium loss:

    • addison's disease
      
    • fever
      
    • diarrhea
      
    • vomiting
      
    • excessive use of diuretics
      
    • chronic renal insufficiency
      
    • nephrotic syndrome
      

    [*]excessive body water gains:

    • excessive oral intake
      
    • excessive iv water intake
      
    • chf
      
    • siadh (syndrome of inappropriate secretion of adh)
      
    • osmotic dilution
      

    [*]third-space losses of sodium:

    • ascites
      
    • peripheral edema
      
    • pleural effusion
      
    • ileus or mechanical bowel obstruction
      
    • hidden fluid in body cavities

references: fluid & electrolyte balance: nursing considerations, 4th edition, by norma m. metheny; davis's comprehensive handbook of laboratory and diagnostic tests with nursing implications, 2nd edition, by anne m. van leeuwen, todd r. kranpitz, and lynette smith; mosby's diagnostic and laboratory test reference, 4th edition, by kathleen deska pagana and timothy james pagana; nurse's 5-minute clinical consult: diagnostic tests, published by wolter kluwer/lippincott williams & wilkins health, 2008; saunder's comprehensive review for the nclex-rn examination, 3rd edition, by linda anne silvestri; pathophysiology: the biologic basis for disease in adults and children, third edition, by kathryn l. mccance and sue e. heuther; pathophysiology: a 2-in-1 reference for nurses by springhouse, springhouse publishing company staff; memory notebook of nursing, volume ii, 2nd edition, by joann zerwekh, jo carol claborn, and c.j. miller

[bsquared]

thank you so much! I will definitely use this.