FLUID

IMBALANCES
RHEAJANE A. ROSALES, D.M, R.N
Click icon to add picture FLUID
VOLUME
DEFICIT

Dehydration in which
the body’s fluid intake
is not sufficient to meet
the body’s fluid needs
TYPES OF FLUID DEFICITS
1. Isotonic Fluid Volume Deficit (FVD)
◦ occurs when the body loses both water and electrolytes from the ECF in
similar proportions
◦ Fluid is initially lost from the intravascular compartment, so it is often called
HYPOVOLEMIA
◦ Results in decreased circulating blood volume and inadequate tissue perfusion.
◦ 2. Hypertonic dehydration
◦ Water loss exceeds electrolyte loss
◦ The clinical problems that occur result from alterations in the concentrations of specific plasma
electrolytes
◦ Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces,
causing cellular dehydration and shrinkage
3. Hypotonic dehydration
◦ Electrolyte loss exceeds water loss
◦ The clinical problems that occur result from fluid shifts between
compartments, causing a decrease in plasma volume
◦ Fluid moves from the plasma and interstitial fluid space into the cells, causing
a plasma volume deficit and causing the cell to swell
 Causes
• Inadequate intake of fluids • Conditions that increase fluid • Chronic illness
and solutes loss, such as excessive • Excessive fluid
• Fluid shifts between perspiration, hyperventilation, replacement(hypotonic)
compartments ketoacidosis, prolonged fever, • Renal failure
• excessive loss of isotonic diarrhea, early stage renal • Chronic malnutrition
body fluids failure and diabetes insipidus

HYPERTONI
ISOTONIC HYPOTONIC
C
Third space syndrome
◦ Large quantities of fluid from the intravascular compartment shift into
the interstitial space; is inaccessible to the body
◦ May be caused by lowered plasma proteins, increased capillary permeability &
lymphatic blockage
◦ Can be seen with trauma, inflammation, disease
◦ This fluid remains in the body but is essentially unavailable for use
◦ The client with third space syndrome has an isotonic fluid deficit but may not
manifest apparent fluid loss or weight loss.
◦ Hypotonic Dehydration- Skeletal muscle weakness
◦ Hypertonic dehydration-
◦ Hyperactive deep tendon reflexes
◦ Increased sensation of thirst

◦ Pitting edema
TO RESTORE FLUID VOLUME,
REPLACE ELECTROLYTES AS
NEEDED, AND ELIMINATE THE
CAUSE OF THE FVD
GOAL OF TREATMENT
NURSING INTERVENTIONS IN FVD
◦ Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary,
and GI status
◦ Prevent further fluid losses and increase fluid compartment volumes to
normal ranges
◦ Provide oral rehydration therapy if possible; IV fluid replacement if the
dehydration is severe
◦ Generally, isotonic dehydration is treated with isotonic fluid solutions;
hypertonic dehydration is treated with hypotonic solutions; and hypotonic
dehydration is treated with hypertonic fluid solutions
◦ Administer medications as prescribed to correct the cause, such as
antidiarrheal, antimicrobial, antiemetic, or antipyretic
◦ Administer oxygen as prescribed
◦ Monitor electrolyte values, and prepare to administer medications
to treat an imbalance if present
 FVE
Fluid intake or fluid
retention exceeds the
body’s fluid needs.

Also called
OVERHYDRATION or
FLUID OVERLOAD.
TYPES OF FVE
◦ 1 . ISOTONIC OVERHYDRATION
◦ Known as hypervolemia and results from excessive fluid in the extracellular
fluid compartment
◦ Only the ECF compartment is expanded, and fluid does not shift between
the ECF and IC compartments
◦ Causes circulatory overload and interstitial edema; when severe or when it
occurs in a client with poor cardiac function, CHF and pulmonary edema
can result
◦ 2. HYPERTONIC OVERHYDRATION
◦ Occurrence is rare and is caused by an excessive sodium intake
◦ Fluid is drawn from the ICF compartment; the ECF volume
expands, and the intracellular fluid volume contracts
◦ 3. HYPOTONIC OVERHYDRATION
◦ Known as WATER INTOXICATION
◦ The excessive fluid moves into the intracellular space,
and all body fluid compartments expand
◦ Electrolyte imbalances occur as a result of dilution
 ISOTONIC
OVERHYDRATIO
N
POORLY CONTROLLED
IV THERAPY

LONG TERM
CORTICOSTEROID
THERAPY
 HYPERTONIC
OVERHYDRATIO
N
EXCESSIVE SODIUM
INGESTION

RAPID INFUSION OF
HYPERTONIC SALINE

EXCESSIVE SODIUM
BICARBONATE
THERAPY
 HYPOTONIC
OVERHYDRATIO
N

EARLY RENAL FAILURE

REPLACEMENT OF ISOTONIC FLUID LOSS WITH

HYPOTONIC FLUIDS

IRRIGATION OF WOUNDS AND BODY CAVITIES WITH

POORLY CONTROLLED IV HYPOTONIC SOLUTION
THERAPY
 NURSING
ASSESSMENT
CARDIOVASCULAR
◦ Bounding, increased pulse rate
◦ Peripheral pulses full
◦ Elevated BP; decreased pulse pressure
◦ Elevated central venous pressure
◦ Distended neck veins
◦ Engorged venous and varicosities
RESPIRATORY
◦ Increased RR
◦ Shallow respirations
◦ Dyspnea
◦ Moist crackles on auscultation
NEUROMUSCULAR
◦ Altered LOC
◦ Headache
◦ Visual disturbances
◦ Skeletal muscle weakness
◦ Paresthesias
INTEGUMENTARY
◦ PITTING EDEMA IN DEPENDENT AREAS
◦ SKIN PALE AND COOL TO TOUCH
GI

◦ INCREASED MOTILITY
ISOTONIC OVERHYDRATION

◦ LIVER ENLARGEMENT
◦ ASCITES
Hypotonic overhydration

◦ Polyuria
◦ Diarrhea
◦ Nonpitting edema
◦ Dysrrythmias
◦ Projectile vomiting
NURSING CARE
◦ MONITOR CARDIOVASCULAR, RESPIRATORY, NEUROMUSCULAR,
INTEGUMENTARY, GI STATUS
◦ PREVENT FURTHER FLUID OVERLOAD, AND RESTORE NORMAL FLUOD BALANCE
◦ ADMINISTER DIURETICS; OSMOTIC DIOURETICS ARE TYPICALLY PRESCRIBED
FIRST TO PREVENT SEVERE ELECTROLYTE IMBALNCES
◦ RESTRICT FLUID AND SODIUMINTAKE
◦ MONITOR I&O AND WEIGHT
◦ MONITOR ELECTROLYTE VALUES, AND PREPARE TO ADMINISTER MEDICATION TO
TREAT AN IMBALANCE IF PRESENT