Welcome future nurses! As you gear up to conquer the NCLEX, understanding intravenous fluids, dehydration, and fluid balance is paramount to ensuring your success. Let’s dive in.

Dehydration 

When the body lacks enough fluids, it can happen for various reasons: difficulty in swallowing, extreme weakness, confusion, or coma, making it hard to drink; losing lots of fluids due to vomiting, diarrhea, bleeding, sweating, or medication that makes you urinate frequently.

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When this happens, water moves out of cells into other spaces, causing dehydration. Treating dehydration involves giving fluids orally, through IVs, or using tubes for feeding. For those who can’t drink for a while, a feeding tube or total parenteral nutrition might be necessary.

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Assessing Dehydration

Checking for dehydration by pinching the skin isn’t reliable in older adults or infants, but in infants, sunken fontanels can indicate dehydration. The most reliable to assess hydration in patients with normal kidney function  is urine output. In hospitalized patients we measure and record this each shift or hourly.

Weight 

Another way to measure how much fluid someone’s gained or lost is by tracking their weight. A change of about 2.2 pounds (1 kilogram) in a day equals a change of about 1 liter of fluid.

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Older Adults 

Seniors are more likely to have less fluid in their bodies due to age-related changes, decreased thirst, and taste perception, making them prone to dehydration. Urinary issues might make them hesitant to drink enough. For older adults, feeling thirsty might not happen until dehydration is already a problem.

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Signs of Dehydration and Overhydration 

Dehydration can show up as thirst, dry skin, weight loss, weakness, dizziness, decreased urine, dark urine, dry lips, tongue, and mucous membranes, sunken eyes, thick saliva, and more. Overhydration, on the other hand, might lead to weight gain, a slow pulse, high blood pressure, swollen tissues, and possibly lung sounds when listened to with a stethoscope.

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Orthostatic Hypotension

Orthostatic hypotension, or a drop in blood pressure when changing positions, can signal low fluid volume. Checking blood pressure and pulse lying down, sitting, and standing helps detect this.

Nausea and Vomiting

Nausea and vomiting are responses to discomfort or irritation in the stomach or elsewhere. Prolonged vomiting and diarrhea can lead to electrolyte imbalances and other issues. Treatment includes antiemetic drugs, keeping the patient from eating until vomiting stops, and gradually reintroducing clear liquids and then solid foods. Diarrhea can cause dehydration and nutrient loss, and treatment involves resting the stomach, gradually reintroducing foods, and medications depending on the cause.

Edema and Electrolyte Imbalances 

Edema, or fluid retention, can happen due to various reasons, including heart issues or changes in capillary pressure. Electrolyte imbalances, like low sodium (hyponatremia) or low potassium (hypokalemia), can cause serious problems and might need dietary changes or supplements. High levels of these electrolytes (hypernatremia or hyperkalemia) can also be dangerous, affecting cell function and potentially causing heart issues.

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Excess Fluid Volume

Sometimes, the body holds onto too much water, usually in the spaces outside the cells. This can happen if someone receives fluids too quickly through IVs, drinks more than they can get rid of, or has issues with eliminating fluids due to conditions like kidney failure. When this occurs, it can lead to water intoxication. Problems with eliminating fluids, such as in renal failure, are a significant cause of excess fluid volume.

Detecting excess fluid can be done by checking the hematocrit, which measures the percentage of red blood cells in the blood. If there’s too much water, the hematocrit might be lower than normal due to dilution. Urine concentration, measured through specific gravity, can also give clues about fluid levels.

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Edema

Edema, the buildup of fluid around cells, can cause swelling in various parts of the body, like puffy eyelids or swollen hands. Sometimes, this swelling happens in body cavities or more generally throughout the body. Factors contributing to edema can include increased pressure in the blood vessels, loss of proteins, problems with lymphatic circulation, or increased capillary permeability.

Dependent edema, particularly noted in the feet, ankles, and lower legs of patients who spend a lot of time sitting or lying down, can be relieved by elevating the affected areas and repositioning the patient regularly. Pitting edema is common in dependent edema, where pressing the skin leaves a temporary depression.

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Electrolyte Imbalances

Electrolytes play crucial roles in the body, and imbalances can lead to health issues. Shifting levels of electrolytes, like sodium and potassium, can cause problems when they’re too high or too low in the bloodstream or within the cells.

Sodium Imbalances

Too little sodium (hyponatremia) is the most common electrolyte imbalance and can result from sodium loss or excessive water intake. On the flip side, too much sodium (hypernatremia) often occurs due to water loss from fever, respiratory infections, or diarrhea. Both conditions can have serious effects on the body’s functions.

Potassium Imbalances

Low potassium (hypokalemia) can stem from various causes and can create severe issues, even leading to cardiac problems. On the other hand, high potassium (hyperkalemia) can also be dangerous, especially causing heart rhythm disturbances. Treatment for both involves managing the levels through dietary changes, supplements, or medications as needed. Treating both conditions involves managing the levels through dietary changes, supplements, or medications as needed.

Managing Fluid Issues

Addressing issues related to fluid balance involves various strategies. For dehydration, rehydration through oral intake or intravenous administration helps replenish lost fluids. Treating vomiting involves medications called antiemetics, and for diarrhea, it’s essential to give the intestines and stomach a rest, then slowly reintroduce liquids and a gentle diet.

Similarly, addressing edema includes measures to reduce swelling, like elevating affected body parts and managing underlying conditions causing fluid retention. Electrolyte imbalances often require specific dietary adjustments, supplements, or medications to correct the levels.

Understanding these conditions and their symptoms allows healthcare providers to intervene promptly, ensuring appropriate treatment to restore the body’s fluid and electrolyte balance, thereby preventing further complications. Try nursing practice questions on this topic or keep reviewing more lectures.