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TABLE 3-5 Fluid YVolume * Increased serum osmolarity * Elevated hemoglobin and hematocrit Variable Deficit Excess Description * Occurs when the body loses water and electro- * Occurs when the body retains water and lytes isotonically—that is, in the same proportion electrolytes isotonically as exists in the normal body fluid » Water intoxication: state in which the body * Serum electrolyte levels remain normal retains water and serum sodium levels * Dehydration: state in which the body loses water decrease and serum sodium levels increase Causes * Vomiting * Heart failure (HF) * Diarrhea * Renal failure * Gl suctioning * Cirrhosis, liver failure * Sweating * Excessive ingestion of table salt * Inadequate fluid intake * Overhydration with sodium-containing fluid * Massive edema, as in initial stage of major burns * Poorly controlled IV therapy, especially in * Ascites young and old clients * Older adults forgetting to drink Symptoms * Weight loss (| liter of fluid weight loss or gain is * Peripheral edema approximately equal to 2.2 pounds or | kilogram) | ¢ Increased bounding pulse * Decreased skin turgor * Elevated BP * Oliguria (concentrated urine) * Distended neck and hand veins * Dry and sticky mucous membranes * Dyspnea; moist crackles heard when lungs * Postural hypotension or weak, rapid pulse auscultated * Attention loss, confusion, aphasia * Altered level of consciousness Lab findings * Elevated BUN and creatinine * Decreased BUN * Decreased hemoglobin and hematocrit * Decreased serum osmolality * Decreased urine osmolality and specific gravity Treatment and nursing care * Strict 1&O * Replacement of fluids isotonically, preferably orally » Water is a hypotonic fluid. * If intravenous hydration is needed, isotonic fluids are used. * Diuretics * Fluid restriction * Strict 1I&O * Sodium-restricted diet * Weighed dalily * Serum K* monitored 1:20 ratio. concentrated.” HESI Hint » FLUID VOLUME DEFICIT: DEHYDRATION * Elevated blood urea nitrogen (BUN):The BUN measures the amount of urea nitrogen in the blood. Urea is formed in the liver as the end product of protein metabolism.The BUN is directly related to the metabolic function of the liver and the excretory function of the kidneys. * Creatinine, as with BUN, is excreted entirely by the kidneys and is therefore directly proportional to renal excretory function. However, unlike BUN, the creatinine level is affected very little by dehydration, malnutrition, or hepatic function. The daily production of creatinine depends on muscle mass, which fluctuates very little. Therefore, it is a better test of renal function than is the BUN. Creatinine is generally used in conjunction with the BUN test, and they are normally in a * Urine osmolality and specific gravity increase. » Serum osmolality measures the concentration of particles in a solution. It refers to the fact that the same amount of solute is present, but the amount of solvent (fluid) is decreased. Therefore, the blood can be considered “more