Nursing Fluid and Electrolyte Management Quiz

Fluid and Electrolyte Balance and Disturbances

• Fluid and electrolyte balance is essential for life and homeostasis
• Fluid and electrolyte balance depends on dynamic processes
• Homeostasis is the maintenance of internal equilibrium through positive and negative feedback mechanisms
• Fluid and electrolyte imbalances can occur in healthy and ill individuals, influenced by changes like exercise, environmental temperature, and dietary intake.

Fluid Distribution/Compartments

• Total body water accounts for about 60% of body weight
• Intracellular fluid (ICF) is about 2/3 of total body water
• Extracellular fluid (ECF) is about 1/3 of total body water
• Intravascular fluid (plasma) makes up about 25% of total body water
• Interstitial fluid makes up about 75% of total body water

Systemic Routes of Gains and Losses

• Healthy individuals' fluid intake and output are approximately equal
• Major intake routes include oral, food, and water of oxidation
• Major output routes include urine, stool, skin, and lungs
• Daily averages may vary based on factors such as environment and activity.

Laboratory Tests for Evaluating Fluid Status

• Osmolality is the concentration of fluid affecting water movement
• Normal serum osmolality ranges from 275 to 290 mOsm/kg
• Urine-specific gravity measures kidney function in fluid excretion and conservation
• Normal urine specific gravity is 1.010 to 1.025
• BUN (Blood Urea Nitrogen) is a liver metabolism byproduct, typically 10 to 20 mg/dL (3.6 to 7.2 mmol/L)
• Creatinine, the byproduct of muscle metabolism, is typically 0.7 to 1.4 mg/dL (62 to 124 mmol/L)
• Hematocrit measures the percentage of red blood cells, typically 42% to 52% in men and 35% to 47% in women

Homeostatic Mechanisms

• Kidneys filter about 180 L of plasma daily and excrete 1 to 2 L of urine
• Heart and blood vessels circulate blood through the kidneys, maintaining pressure for urine formation.
• Lungs remove approximately 300 mL of water daily through exhalation
• Hypothalamus produces ADH stored in the posterior pituitary, conserving water
• Adrenal function affects sodium retention and potassium loss through aldosterone production.
• Parathyroid hormone affects bone reabsorption, calcium absorption from intestines and renal tubules.

Other Mechanisms

• Baroreceptors in the heart regulate blood volume and sympathetic/parasympathetic nervous system activity
• Renin-Angiotensin-Aldosterone System (RAAS) regulates blood pressure and fluid balance
• Antidiuretic Hormone (ADH) and thirst control oral fluid intake via osmoreceptors in the hypothalamus

Fluid Volume Deficit (FVD)

• FVD, also known as hypovolemia, occurs when fluid loss exceeds intake

• Dehydration is a specific type of FVD where water loss alone increases serum sodium concentration

• Possible causes: Vomiting, diarrhea, excessive sweating, third- space fluid shifts (e.g., burns), decreased fluid intake.

Signs and Symptoms of FVD

• Early signs: Weight loss, decreased skin turgor, concentrated urine, and decreased capillary filling time
• Late signs: Dry skin, sunken eyes, tachycardia, hypotension, cold extremities, dizziness, weakness, mental status changes, and thirst.

Medical Management of FVD

• Treatment approach: Oral fluids first, then intravenous fluids, if losses severe
• Solutions: Isotonic fluids (e.g., lactated Ringer's solution or 0.9% sodium chloride)

Assessment and Monitoring of FVD

• Weigh daily, monitor I&O, and assess skin turgor, capillary refill, and mucous membranes
• Monitor vital signs and perform lab tests (electrolytes, urine specific gravity, hematocrit).

Fluid Volume Excess (FVE)

• FVE, also known as hypervolemia, occurs when fluid and sodium retention exceed intake

• Possible causes: Excessive fluid intake, renal or liver diseases, heart failure, excessive sodium intake from certain foods or medications

Signs and Symptoms of FVE

• Early signs: Weight gain, peripheral edema, crackles in the lungs, elevated jugular venous pressure, and increased blood pressure
• Late signs: Shortness of breath, hypertension, tachycardia, rapid heart rate, and pulmonary edema

Medical Management of FVE

• Treatment approach: Sodium and fluid restriction and administration of diuretics (e.g., Lasix) or dialysis, depending on severity
• Solutions: Isotonic fluids (e.g., 0.9% saline initially if hypotension is present) and adjusting fluid intake/output

Nutritional Therapy for FVE

• Sodium restriction for patients with FVE
• Potassium might be restricted if patients are taking potassium-sparing diuretics.

Nursing Care of FVE

• Assessment: Monitor vital signs, daily weight, I&O, edema, skin integrity, lung sounds, and electrolyte levels.
• Interventions: Diuretics as prescribed, restrict sodium and fluids, and monitor for complications (electrolyte imbalances, etc).

Parenteral Fluid Therapy

• Intravenous (IV) fluids used when other routes are not suitable
• Isotonic solutions match extracellular fluid osmolality. examples of isotonic: 0.9% NaCl, 5% dextrose in water (D5W)
• Hypotonic solutions have a lower tonicity than that of the ECF
• Hypertonic solutions have a higher tonicity than that of the ECF

Complications of IV Therapy

• Infiltration: Fluid leaking from the vein into surrounding tissue. Characteristics: Swelling and warmth.
• Infection: Infection at the IV site. Characteristics: Purulent drainage, redness, tenderness.
• Phlebitis: Inflammation or clots along the vein. Characteristics: Pain, redness, and swelling, sometimes a red line.
• Air embolism: Air entering the vein. Characteristics: decreased BP, increased pulse, respiratory distress .

Electrolytes Imbalances

• Electrolytes are essential in maintaining body functions such as nerve signal transmission, muscle contractions, and fluid balance within cells and compartments
•   Electrolytes, which are positive or negative charge-carrying minerals, are vital for numerous bodily functions such as maintaining fluid balance, nerve impulse transmission, muscle contraction, and many more.

Roles of Major Electrolytes

• Electrolytes are important for maintaining fluid balance, nerve impulse transmission, and several physiological processes

Concentrations of Extracellular and Intracellular Electrolytes

• Tables provide reference values for different electrolytes in body fluid compartments (intracellular and extracellular) to compare

Sodium Imbalances (Deficits and Excess)

• Hyponatremia is a low serum sodium level
• Causes of hyponatremia include excessive water intake, excessive use of diuretics, loss of body fluid (e.g., vomiting or diarrhea), adrenal insufficiency.
• Symptoms of hyponatremia vary depending on the severity of sodium deficiency, and can range from mild symptoms, such as headaches to severe symptoms such as seizures
•  Hypernatremia is a high serum sodium level.
• Causes of hypernatremia include water deprivation, administration of hypertonic solutions, diabetes insipidus

Potassium Imbalances (Deficits and Excess)

• Hypokalemia is a low serum potassium level. 
• Causes of hypokalemia include excessive loss of potassium through diarrhea, vomiting, or diuretics, or inadequate intake.
•  Symptoms of hypokalemia are varied but potentially life-threatening if severe.
• Hyperkalemia is a high serum potassium level
• Causes of hyperkalemia include kidney failure, acidosis, and certain medications.

Calcium Imbalances (Deficits and Excess)

• Hypocalcemia is a low serum calcium level. 
• Causes are varied but include hypoparathyroidism, malnutrition, or pancreatitis.
• Symptoms are varied and include muscle spasms.
•  Hypercalcemia is a high serum calcium level. 
• Causes range from prolonged immobilization, cancer, or excessive intake of calcium supplements.
• Symptoms are varied but include kidney stones and cardiac arrest in severe cases.

Nursing Management for Electrolyte Imbalances

• Assessment of the patient's fluid and electrolyte status, including vital signs, serum electrolyte levels, and ECG monitoring are necessary.
• Nursing management should be tailored to address the specific electrolyte imbalance, taking into consideration the underlying causes and potential complications.

Test your knowledge on the essential concepts of fluid and electrolyte balance in nursing practice. This quiz covers topics such as IV therapy, clinical manifestations of fluid volume deficit, and factors affecting electrolyte imbalances. Ensure you're prepared for real-world nursing scenarios by answering these key questions.