Fluid and Electrolyte Imbalances in Nursing

Fluid and Electrolyte Imbalances

• Outcomes: Describe safe, patient-centered, evidence-based nursing care for adults, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to provide quality patient care.

Competency

• Describe factors creating a culture of safety related to medication administration.
• Discuss critical thinking and clinical judgment used for accurate, safe medication administration.

Concept

• Fluid and Electrolyte: Physiological mechanisms maintaining fluid and electrolyte balance promoting bodily functions.

Unit Outcomes

• Describe the nursing process and collaborative management when caring for patients with fluid and electrolyte imbalances.
• Fluid imbalances:
  • Extracellular fluid volume deficit
  • Extracellular fluid volume excess

Fluid and Electrolyte Imbalances Overview

• Directly caused by illness or disease (e.g., burns, heart failure).
• Result of therapeutic measures (e.g., IV fluids, diuretics).
• Classified as deficits or excesses.
• Example: Prolonged nasogastric suction may cause Na+, K+ deficiency; fluid volume deficit, and metabolic alkalosis.
• Imbalances commonly occur in patients with major illnesses or injuries due to disrupted homeostatic mechanisms. Imbalances can be directly caused by illness or disease, or by therapeutic measures (e.g., IV fluids/medications).

Extracellular Fluid Volume Imbalances

• Deficit (Hypovolemia): Not the same as dehydration. Dehydration is only water loss, whereas Hypovolemia involves loss of both water and sodium. This results in decreased blood volume (intravascular fluid), and increased interstitial fluid (edema)
  • Intracellular fluid contains: Solutes (oxygen, electrolytes, glucose). Cations (potassium, magnesium). Anions (phosphate, sulfate).
  • Extracellular fluid contains: Principal electrolytes (sodium, chloride, bicarbonate). Interstitial fluid (surrounds cells). Intravascular fluid (plasma). Transcellular and lymph fluids.
• Excess (Hypervolemia/Edema): Increased intravascular fluid.

Possible Causes of ECF Volume Deficit (Hypovolemia)

• Abnormal loss of body fluids (e.g., vomiting, diarrhea, GI suctioning, fistulas, chronic laxative/enema use).
• Renal losses (e.g., diuretics, renal disorders, endocrine disorders).
• Hemorrhage.
• Excessive sweating, increased temperature.
• Inadequate intake.

Fluid Volume Deficit Clinical Manifestations

• Initial signs: thirst, dry mucus membranes, decreased urine output, weakness, lethargy, postural hypotension.
• Possible hypovolemic shock: hypotension, tachycardia, tachypnea, decreased/absent urine output, decreased cardiac output. Coma, death.
• Assessments: intake and output, vital signs (orthostatic blood pressure/pulse), skin turgor, mucous membrane moisture, capillary refill.
• Labs may show an increased hematocrit due to relative concentration of RBCs with less fluid in the vasculature.

Fluid Volume Deficit Management (Hypovolemia)

• Treatment: Replace water and electrolytes.
• PO fluids
• IV fluids (Lactated Ringers or isotonic 0.9% sodium chloride): used for rapid volume replacement when caused by blood loss/ volume loss and isotonic 0.9% sodium chloride when needed rapid volume replacement.
• Evaluation: Monitor intake and output, blood pressure.

Possible Causes of ECF Volume Excess (Hypervolemia)

• Retention of sodium and water (e.g., heart failure, liver cirrhosis, renal failure, increased ADH & aldosterone in stress conditions).
• Excessive intake of sodium-containing foods, drugs causing sodium retention, sodium-containing IV fluids.

Fluid Volume Excess Clinical Manifestations

• Excess volume: weight gain ( > 5% body weight)
• Circulatory overload: bounding pulse, jugular vein distention, increased central venous pressure.
• Respiratory distress: Dyspnea/orthopnea, crackles, cough (pulmonary edema).
• Other: Polyuria, ascites, edema.

Nursing Implementation for Fluid Imbalances

• Daily weights: Weigh patients at the same time each day, wearing the same clothes, using the same calibrated scale. A 1 kg (2.2 lbs) weight gain is equal to about 1000 ml (1 L) of fluid retention.

• Monitor intake and output (I&O): Oral, IV, tube feedings; urine output, perspiration, wound drainage, vomiting, diarrhea).

• Monitor fluid volume status: Include checking for changes in vital signs (blood pressure, pulse force, jugular venous distention), ECG changes, and orthostatic hypotension.

• Assess neurologic function: Level of consciousness, pupillary response, voluntary movement.

• Assess respiratory changes: Pulmonary congestion, shortness of breath, and crackles.

• Other Assessments: Skin assessment (turgor), mucous membranes (moisture).