Nursing 1 - 20110310 - Hyper Hypovolemia

Front 1

Defined as loss of water & electrolytes

Back 1

Hypovolemia:

Front 2

Results from: Inadequate intake

Back 2

Hypovolemia:

Front 3

Results from: Abnormal fluid losses

Back 3

Hypovolemia:

Front 4

Results from: Underlying medical conditions

Back 4

Hypovolemia:

Front 5

Results from: 3rd space fluid shifts

Back 5

Hypovolemia:

Front 6

Clinical Manifestations: Weight loss

Back 6

Hypovolemia:

Front 7

Clinical Manifestations: Dizziness

Back 7

Hypovolemia:

Front 8

Clinical Manifestations: Decreased skin turgor

Back 8

Hypovolemia:

Front 9

Clinical Manifestations: Weak, rapid pulse

Back 9

Hypovolemia:

Front 10

Clinical Manifestations: Increased temperature

Back 10

Hypovolemia:

Front 11

Clinical Manifestations: Cool clammy skin

Back 11

Hypovolemia:

Front 12

Clinical Manifestations: Thirst

Back 12

Hypovolemia:

Front 13

Clinical Manifestations: Muscle weakness & cramping

Back 13

Hypovolemia:

Front 14

Laboratory Findings: BUN elevated

Back 14

Hypovolemia:

Front 15

Laboratory Findings: HCT elevated

Back 15

Hypovolemia:

Front 16

Laboratory Findings: Urine specific gravity increased

Back 16

Hypovolemia:

Front 17

Laboratory Findings: Serum electrolytes increased:

Back 17

Hypovolemia:

Front 18

Laboratory Findings: Increased K+ (Hyperkalemia)

Back 18

Hypovolemia:

Front 19

Laboratory Findings: Increased Na+ (Hypernatremia)

Back 19

Hypovolemia:

Front 20

Nursing Diagnoses: Fluid volume deficit related to (R/T)….

Back 20

Hypovolemia:

Front 21

Treatment: Volume Replacement

Back 21

Hypovolemia:

Front 22

Treatment: Oral Fluids

Back 22

Hypovolemia:

Front 23

Treatment: Parenteral (IV)

Back 23

Hypovolemia:

Front 24

Treatment: Enteral (GI)

Back 24

Hypovolemia:

Front 25

Nursing Management: Identify causative factors

Back 25

Hypovolemia:

Front 26

Nursing Management: Monitor intake & output (I & O)

Back 26

Hypovolemia:

Front 27

Nursing Management: Fluid challenge to assess renal function

Back 27

Hypovolemia:

Front 28

Nursing Management: Monitor vital signs

Back 28

Hypovolemia:

Front 29

Nursing Management: Assess skin signs (cap refill, turgor)

Back 29

Hypovolemia:

Front 30

Nursing Management: Assess skin & tongue turgor

Back 30

Hypovolemia:

Front 31

Fluid Volume deficeit

Back 31

Hypovolemia:

Front 32

FVD

Back 32

Hypovolemia:

Front 33

Fluid Volume Excess

Back 33

Hypervolemia

Front 34

FVE

Back 34

Hypervolemia

Front 35

Defined as abnormal retention of water & sodium

Back 35

Hypervolemia

Front 36

Results from: Fluid overload

Back 36

Hypervolemia

Front 37

Results from: Excessive salt intake

Back 37

Hypervolemia

Front 38

Results from: Diminished function of homeostatic mechanisms responsible for maintaining fluid balance

Back 38

Hypervolemia

Front 39

Results from: Underlying chronic illness

Back 39

Hypervolemia

Front 40

Clinical Manifestations: Edema

Back 40

Hypervolemia

Front 41

Clinical Manifestations: Distended neck veins

Back 41

Hypervolemia

Front 42

Clinical Manifestations: Abnormal lung sounds

Back 42

Hypervolemia

Front 43

Clinical Manifestations: Increased weight

Back 43

Hypervolemia

Front 44

Clinical Manifestations: Increased blood pressure

Back 44

Hypervolemia

Front 45

Clinical Manifestations: Increased urine output

Back 45

Hypervolemia

Front 46

Clinical Manifestations: Shortness of breath

Back 46

Hypervolemia

Front 47

Clinical Manifestations: Increased central venous pressure (CVP)

Back 47

Hypervolemia

Front 48

Clinical Manifestations: Laboratory Findings:

Back 48

Hypervolemia

Front 49

Clinical Manifestations: Decreased BUN

Back 49

Hypervolemia

Front 50

Clinical Manifestations: Decreased Hct

Back 50

Hypervolemia

Front 51

Clinical Manifestations: Decreased serum osmolality

Back 51

Hypervolemia

Front 52

Clinical Manifestations: Decreased Na+

Back 52

Hypervolemia

Front 53

Nursing Diagnosis: Fluid volume excess related to (R/T)….

Back 53

Hypervolemia

Front 54

Treatment: Directed at causative factor

Back 54

Hypervolemia

Front 55

Treatment: Fluid restriction

Back 55

Hypervolemia

Front 56

Treatment: Diuretic administration

Back 56

Hypervolemia

Front 57

Treatment: Dialysis

Back 57

Hypervolemia

Front 58

Treatment: Nutritional restrictions

Back 58

Hypervolemia

Front 59

Nursing Management: Monitoring intake & output (I & O)

Back 59

Hypervolemia

Front 60

Nursing Management: Daily weights

Back 60

Hypervolemia

Front 61

Nursing Management: Evaluation of breath sounds

Back 61

Hypervolemia

Front 62

Nursing Management: Monitoring edema

Back 62

Hypervolemia

Front 63

Nursing Management: Anasarca: severe generalized edema

Back 63

Hypervolemia

Front 64

Nursing Management: Ascites: fluid in peritoneal cavity

Back 64

Hypervolemia

Front 65

Nursing Management: Pitting edema: fluid in tissues, pits when pressed

Back 65

Hypervolemia

Front 66

Nursing Management: Pulmonary edema: fluid in pulmonary interstitium & alveoli

Back 66

Hypervolemia

Front 67

Nursing Management: Administration of diuretics

Back 67

Hypervolemia