Fluid and Electrolyte Imbalances Explained Simply - PDF

Fluid and Electrolyte Imbalances Explained Simply 1. Fluid & Electrolyte Levels ​ Sodium (Na⁺): 135-145 mEq/L ○​ Helps control fluid balance, nerve function, and muscle function. ​ Potassium (K⁺): 3.5-5.0 mEq/L ○​ Essential for nerve function, muscle function, and heart rhy...

Fluid and Electrolyte Imbalances Explained Simply 1. Fluid & Electrolyte Levels ​ Sodium (Na⁺): 135-145 mEq/L ○​ Helps control fluid balance, nerve function, and muscle function. ​ Potassium (K⁺): 3.5-5.0 mEq/L ○​ Essential for nerve function, muscle function, and heart rhythm. ​ Chloride (Cl⁻): 98-106 mEq/L ○​ Works with sodium to maintain fluid balance and acid-base balance. ​ Calcium (Ca²⁺): 8.5-10.5 mg/dL ○​ Important for bone health, nerve function, and muscle contraction. ​ Magnesium (Mg²⁺): 1.5-2.5 mg/dL ○​ Supports muscle and nerve function, blood sugar regulation, and bone health. ​ Phosphate (PO₄³⁻): 2.5-4.5 mg/dL ○​ Involved in energy production, bone health, and cellular function. 2. Blood Gas Values (ABGs) ​ pH: 7.35-7.45 (Normal range for blood acidity) ​ PaCO₂ (Partial Pressure of CO₂): 35-45 mmHg ○​ Reflects lung function in regulating acid-base balance. ​ HCO₃⁻ (Bicarbonate): 22-28 mEq/L ○​ Reflects kidney function in regulating acid-base balance. ​ PaO₂ (Partial Pressure of O₂): 80-100 mmHg ○​ Oxygen levels in the blood. 3. Other Key Fluid Parameters ​ Urine Specific Gravity: 1.005-1.030 ○​ Measures urine concentration, indicating hydration status. ​ Urine Output: 0.5-1.0 mL/kg/hr ○​ Reflects kidney function and fluid balance. A. Extracellular Fluid Volume Imbalances 1.​ Fluid Volume Deficit (Dehydration) ○​ Cause (Etiology): Not drinking enough water, vomiting, diarrhea, excessive sweating, or blood loss. ○​ Lab Findings: High sodium levels, increased blood concentration (high hematocrit), and high urine concentration.  ○​ Symptoms: Dry mouth, thirst, low blood pressure, fast heartbeat, dizziness, confusion. ○​ Nursing Care & Treatment: Give fluids (IV or by mouth), monitor vital signs, check urine output, and find the cause. 2.​ Fluid Volume Excess (Overhydration) ○​ Cause (Etiology): Too much IV fluid, kidney problems, heart failure, or too much sodium. ○​ Lab Findings: Low sodium levels, low blood concentration (low hematocrit), and diluted urine. ○​ Symptoms: Swelling (edema), high blood pressure, shortness of breath, weight gain, puffiness. ○​ Nursing Care & Treatment: Limit fluids, give diuretics (water pills), monitor weight, and check for breathing issues. B. Sodium Imbalances 1.​ Hypernatremia (Too Much Sodium) ○​ Cause: Dehydration, too much salt, kidney problems, or fever. ○​ Lab Findings: High sodium levels in blood. ○​ Symptoms: Thirst, dry skin, confusion, muscle twitching, seizures. ○​ Nursing Care & Treatment: Give fluids, reduce salt intake, and monitor neurological status. 2.​ Hyponatremia (Too Little Sodium) ○​ Cause: Drinking too much water, kidney disease, vomiting, diarrhea. ○​ Lab Findings: Low sodium levels in blood. ○​ Symptoms: Confusion, headache, nausea, muscle weakness, seizures. ○​ Nursing Care & Treatment: Limit water intake, give sodium (IV fluids or diet), and monitor for neurological issues. C. Potassium Imbalances 1.​ Hyperkalemia (Too Much Potassium) ○​ Cause: Kidney failure, certain medications, severe injury or burns. ○​ Lab Findings: High potassium levels in blood. ○​ Symptoms: Irregular heartbeat, muscle weakness, numbness, or tingling. ○​ Nursing Care & Treatment: Give medications to lower potassium, monitor the heart, and possibly dialysis if severe. 2.​ Hypokalemia (Too Little Potassium) ○​ Cause: Vomiting, diarrhea, diuretics (water pills), not enough potassium in diet. ○​ Lab Findings: Low potassium levels in blood. ○​ Symptoms: Muscle cramps, weakness, irregular heartbeat, fatigue.  ○​ Nursing Care & Treatment: Give potassium (by IV or diet), monitor heart rhythm, and treat the cause. D. Magnesium Imbalances 1.​ Hypermagnesemia (Too Much Magnesium) ○​ Cause: Kidney failure, too many magnesium supplements or laxatives. ○​ Lab Findings: High magnesium levels in blood. ○​ Symptoms: Weak muscles, slow heartbeat, low blood pressure, drowsiness. ○​ Nursing Care & Treatment: Stop magnesium intake, give IV fluids, and monitor the heart. 2.​ Hypomagnesemia (Too Little Magnesium) ○​ Cause: Alcoholism, poor nutrition, diarrhea, or certain medications. ○​ Lab Findings: Low magnesium levels in blood. ○​ Symptoms: Tremors, muscle cramps, fast heartbeat, confusion. ○​ Nursing Care & Treatment: Give magnesium (IV or diet), monitor heart and muscle function. E. Phosphorus Imbalances 1.​ Hyperphosphatemia (Too Much Phosphorus) ○​ Cause: Kidney disease, too much phosphorus in diet, or certain medications. ○​ Lab Findings: High phosphorus levels in blood. ○​ Symptoms: Muscle cramps, itchy skin, weak bones, numbness. ○​ Nursing Care & Treatment: Limit phosphorus in diet, give phosphate binders, and manage kidney function. 2.​ Hypophosphatemia (Too Little Phosphorus) ○​ Cause: Malnutrition, alcoholism, severe burns, or too many antacids. ○​ Lab Findings: Low phosphorus levels in blood. ○​ Symptoms: Weakness, trouble breathing, confusion, weak bones. ○​ Nursing Care & Treatment: Give phosphorus supplements (IV or diet), monitor for weakness, and find the cause. Infusion Therapy Overview 1. Indications for Infusion Therapy (Why Do Patients Need IV Therapy?) Infusion therapy is used when patients need fluids, medications, or nutrients directly into their bloodstream. Some reasons include: ​ Dehydration: Patients who cannot drink enough fluids due to vomiting, diarrhea, or severe illness.  ​ Electrolyte Imbalances: When sodium, potassium, or other electrolytes are too high or too low. ​ Blood Loss: IV fluids or blood transfusions help replace lost blood. ​ Medications: Some drugs, like antibiotics or chemotherapy, must be given through an IV for faster and more effective absorption. ​ Nutrition (Parenteral Nutrition): For patients who cannot eat or absorb nutrients properly. ​ Pain Management: IV pain medications are given after surgery or for severe pain conditions. 2. Characteristics of Common IV Solutions IV fluids are categorized based on how they affect body fluids: 1.​ Isotonic Solutions (Same Concentration as Blood) ○​ Examples: Normal Saline (0.9% NaCl), Lactated Ringer’s (LR), Dextrose 5% in Water (D5W) ○​ Uses: Hydration, blood loss, surgery, mild dehydration ○​ Effect: Increases fluid without changing cell size 2.​ Hypotonic Solutions (Less Concentrated than Blood) ○​ Examples: 0.45% NaCl (Half Normal Saline), 0.33% NaCl ○​ Uses: Severe dehydration, diabetic ketoacidosis (DKA) ○​ Effect: Moves water into cells, making them swell 3.​ Hypertonic Solutions (More Concentrated than Blood) ○​ Examples: 3% NaCl, 5% NaCl, Dextrose 10% in Water (D10W) ○​ Uses: Severe sodium loss (hyponatremia), brain swelling ○​ Effect: Pulls water out of cells, making them shrink 3. Potential Complications & Prevention Strategies 1.​ Infiltration (IV Fluid Leaks into Tissue) ○​ Symptoms: Swelling, cool skin, pain at IV site ○​ Prevention: Secure IV, monitor site, use smallest catheter needed ○​ Treatment: Stop IV, elevate limb, apply warm/cold compress 2.​ Phlebitis (Vein Inflammation) ○​ Symptoms: Redness, warmth, pain, hard vein ○​ Prevention: Rotate IV sites every 72 hours, use proper IV size ○​ Treatment: Remove IV, apply warm compress, monitor for infection 3.​ Extravasation (Toxic IV Medication Leaks into Tissue) ○​ Symptoms: Severe pain, burning, tissue damage ○​ Prevention: Use central lines for strong medications, check IV frequently  ○​ Treatment: Stop IV, give antidote if available, apply cold compress 4.​ Fluid Overload (Too Much Fluid in the Body) ○​ Symptoms: Swelling, shortness of breath, high blood pressure ○​ Prevention: Monitor IV rate, use infusion pumps, watch for weight gain ○​ Treatment: Stop or slow fluids, give diuretics (water pills), raise head of bed 5.​ Air Embolism (Air Enters the Bloodstream) ○​ Symptoms: Sudden shortness of breath, chest pain, confusion ○​ Prevention: Remove air from IV tubing, clamp catheters before removing ○​ Treatment: Position patient on left side, give oxygen, call for emergency help 6.​ Infection (Bacteria Enter the Bloodstream) ○​ Symptoms: Fever, redness, pus, chills ○​ Prevention: Use sterile technique, change dressings regularly ○​ Treatment: Remove IV, start antibiotics, monitor for sepsis To ChatGPT said: Acid-Base Balance Overview 1. Processes Involved in Maintaining Acid-Base Balance The body maintains a stable pH (normal range: 7.35 - 7.45) using three main systems: 1.​ Buffer Systems (Immediate Response) ○​ Bicarbonate (HCO₃⁻) Buffer System: The main system that regulates pH by balancing acids (H⁺) and bases (HCO₃⁻). ○​ Protein Buffers: Hemoglobin and albumin help maintain pH by absorbing or releasing hydrogen ions. ○​ Phosphate Buffer System: Works inside cells and in the kidneys to stabilize pH. 2.​ Respiratory System (Fast Response - Minutes to Hours) ○​ The lungs control carbon dioxide (CO₂), which affects pH. ○​ If pH is too low (acidic): Breathing speeds up (hyperventilation) to remove CO₂. ○​ If pH is too high (alkaline): Breathing slows down (hypoventilation) to retain CO₂. 3.​ Renal System (Slow Response - Hours to Days) ○​ The kidneys regulate bicarbonate (HCO₃⁻) and hydrogen ions (H⁺). ○​ If pH is too low (acidic): The kidneys remove hydrogen ions and keep bicarbonate. ○​ If pH is too high (alkaline): The kidneys remove bicarbonate and keep hydrogen ions. 2. Acid-Base Imbalances A. Metabolic Acidosis (Too Much Acid, Too Little Bicarbonate)  ​ Causes (Etiology): ○​ Kidney failure (can’t remove acid) ○​ Diabetic ketoacidosis (DKA) ○​ Severe diarrhea (losing too much bicarbonate) ○​ Lactic acidosis (shock, sepsis) ​ Lab Findings: ○​ Low pH (26 mEq/L) ○​ Normal or high CO₂ (if lungs compensate) ​ Symptoms (Clinical Manifestations): ○​ Confusion, dizziness ○​ Muscle twitching, numbness ○​ Slow, shallow breathing (to retain CO₂) ○​ Weakness, nausea ​ Management (Nursing & Interprofessional Care): ○​ Stop vomiting or treat the cause ○​ Give IV fluids with normal saline (NaCl) ○​ Replace potassium if needed ○​ Monitor electrolytes and heart rhythm C. Respiratory Acidosis (Too Much CO₂, Too Much Acid)  ​ Causes (Etiology): ○​ Slow or ineffective breathing (hypoventilation) due to: ​ COPD, asthma, pneumonia ​ Drug overdose (opioids, sedatives) ​ Airway obstruction ​ Lab Findings: ○​ Low pH (45 mmHg) ○​ Normal or high bicarbonate (if kidneys compensate) ​ Symptoms (Clinical Manifestations): ○​ Confusion, drowsiness ○​ Shortness of breath ○​ Low blood pressure, headache ○​ Cyanosis (bluish skin from low oxygen) ​ Management (Nursing & Interprofessional Care): ○​ Improve breathing (oxygen therapy, bronchodilators) ○​ Mechanical ventilation if severe ○​ Monitor respiratory status and pH levels D. Respiratory Alkalosis (Too Little CO₂, Too Little Acid) ​ Causes (Etiology): ○​ Fast breathing (hyperventilation) due to: ​ Anxiety, panic attacks ​ Fever, pain ​ High altitudes ​ Lab Findings: ○​ High pH (>7.45) ○​ Low CO₂ ( 45 mmHg (Too much CO₂)​ 🔹 Cause: HYPOventilation (not breathing enough) → CO₂ builds up → Carbonic acid increases 🩺 System-Specific Assessments → "HYPO" 🔹 Hypoventilation → Slow, shallow breathing​ 🔹 Hyperkalemia → High potassium (K⁺) → Risk for dysrhythmias​ 🔹 Yes, LOC (Level of Consciousness) is decreased (drowsy, confused)​ 🔹 Pressure (Blood Pressure) decreased​ 🔹 Oxygen in blood low → Early signs of acidosis: Restlessness, increased heart rate 🚑 First-Do Priority Interventions → "BREATHES" 1️⃣ Breath sounds assess (crackles, wheezes?), VS, SaO₂, mucous color​ 2️⃣ Reposition Semi/High-Fowler's → Helps with deep breathing ​ Turn q2 hours to prevent atelectasis ​ Post-op: Turn, Cough, Deep Breathe (TC & DB) ​ Limit narcotics (they depress RR)​ 3️⃣ Encourage incentive spirometry (helps open airways)​ 4️⃣ Administer O₂ cautiously (risk of CO₂ narcosis in COPD patients) ​ Maintain airway (suction if needed) ​ Monitor ABG values​ 5️⃣ Treat with meds: ​ Bronchodilators (open airways) ​ Humidity for O₂​ 6️⃣ Hydration → Keeps mucus thin; oral care q2 hours​ 7️⃣ Evaluate hyperkalemia (Monitor ECG for spiked T waves)​ 8️⃣ Support renal function (to help compensate for acidosis) ​ Mechanical ventilation if breathing is failing 📈 Evaluate Outcomes → "HYPO" (Back to Normal!) ✅ Hypoventilation → Not present (Normal breathing)​ ✅ Hyperkalemia → Not present (Normal potassium)​ ✅ Yes, LOC WDL (Within Defined Limits)​ ✅ Pressure (Blood Pressure) WDL​ ✅ Oxygen WDL (Normal ABGs, no signs of acidosis) 🎯 INSANELY EASY TIP! 🫁💨 Clients who HYPOventilate retain CO₂.​ Your #1 PRIORITY is to get the client to "BREATHE"! 🔵 SAFETY Concept: Acid-Base Balance → Respiratory Alkalosis 💨 Respiratory Alkalosis = CO₂ Loss (Hyperventilation) → ↓ H⁺ → High pH 🔹 pH > 7.45 (Alkalotic)​ 🔹 PaCO₂ < 35 mmHg (Too little CO₂)​ 🔹 Cause: HYPERventilation (breathing too fast) → CO₂ gets blown off → Low carbonic acid 🩺 System-Specific Assessments → "HYPER" 🔹 Hyperventilation → Rapid, deep breathing​ 🔹 Hyperreflexia → Overactive reflexes, possible muscle spasms​ 🔹 Yes, muscles weak & tingling (paresthesia in hands/feet)​ 🔹 Potassium low → Risk for arrhythmias (watch ECG)​ 🔹 Pulse increased (tachycardia)​ 🔹 Evaluate for CNS stimulation → Confusion, irritability, anxiety, seizures 🚑 First-Do Priority Interventions → "SLOWER" 1️⃣ Should always begin with determining the cause (pain, anxiety, fever, mechanical ventilation issue?)​ 2️⃣ Lower ventilation by adjusting ventilator rate & tidal volume (HCP order)​ 3️⃣ Oxygen given only if hypoxemia is the cause​ 4️⃣ With psychological hyperventilation: ​ Reassure the client, remain calm, reduce stress  ​ Use breathing techniques (paper bag, rebreather mask)​ 5️⃣ Evaluate ABGs (monitor PaCO₂ levels)​ 6️⃣ Review need for sedation (if anxiety is severe) 📈 Evaluate Outcomes → "HYPER" (Back to Normal!) ✅ Hyperventilation → Not present (normal breathing)​ ✅ Hyperreflexia → None​ ✅ Yes, muscles are weak/tingling → None (normal nerve function)​ ✅ Potassium WDL (3.5-5 mEq/L); Pulse WDL (no arrhythmias)​ ✅ Evaluate for CNS symptoms → No confusion, seizures, irritability​ ✅ Rapid and deep respirations → Not present (normal RR)​ ✅ ABGs WDL 🎯 INSANELY EASY TIP! Respiratory Alkalosis = Hyperventilation = Blowing off CO₂​ Your #1 PRIORITY is to slow the breathing ("SLOWER") to retain CO₂ and restore balance! 🔵 SAFETY Concept: Acid-Base Balance → Metabolic Acidosis ⚖️ Metabolic Acidosis = Loss of HCO₃⁻ (Base) OR Too Much H⁺ (Acidic Buildup) 🔹 pH < 7.35 (Acidic)​ 🔹 HCO₃⁻ < 22 mEq/L (Low bicarbonate)​ 🔹 Cause: Loss of base (HCO₃⁻) or buildup of acid (H⁺) ​ Diarrhea → "Comes out the Bottom = Losing Base" ​ Diabetic ketoacidosis (DKA) → Excess ketones ​ Renal failure → Can't excrete H⁺ or retain HCO₃⁻ ​ Lactic acidosis → Shock, sepsis, cardiac arrest 🩺 System-Specific Assessments → "Ds" 🔹 Deep, rapid respirations (Kussmaul breathing) → Lungs try to compensate by "blowing off" CO₂​ 🔹 Diarrhea, nausea, vomiting → Loss of HCO₃⁻​ 🔹 Decreased BP & HR; weak peripheral pulses → Hypotension​ 🔹 Dysrhythmias (irregular heartbeats) → Hyperkalemia (high K⁺)​ 🔹 Drowsiness, disorientation, headache, seizures → CNS depression​ 🔹 Diabetes Mellitus (ketones in urine) → Common cause (DKA)​ 🔹 Decrease in muscle strength, ↓ reflexes → Weakness, fatigue​ 🔹 Dry, flushed skin → Poor perfusion (esp. in DKA) 🚑 First-Do Priority Interventions → "RESPIRATE" 1️⃣ Review the cause → Find the underlying problem (DKA, diarrhea, kidney failure, etc.)​ 2️⃣ Evaluate RR & support breathing → Promote compensation​ 3️⃣ SaO₂, pH, and HCO₃⁻ levels → Monitor ABGs closely​ 4️⃣ Place on ECG monitor → Watch for dysrhythmias (hyperkalemia)​ 5️⃣ Intake & output monitoring → Assess kidney function & hydration​ 6️⃣ Rehydrate with IV fluids (Start IV) ​ DKA → Give insulin to stop ketone production ​ GI losses → May need antidiarrheal (if not food poisoning)​ 7️⃣ Administer sodium bicarbonate (only if severe acidosis)​ 8️⃣ Teach client the rationale for care & meds​ 9️⃣ Evaluate labs → Check for hyperkalemia, renal function, ketones 📈 Evaluate Outcomes → "Ds" (Back to Normal!) ✅ Deep, rapid breathing (Kussmaul) → Gone (normal RR)​ ✅ Diarrhea, nausea, vomiting → None​ ✅ Decreased BP → WDL (Within Normal Limits)​ ✅ Dysrhythmias from hyperkalemia → None (normal ECG)​ ✅ Drowsiness, confusion, seizures → None 🎯 INSANELY EASY TIP! 💡 "If it comes out the bottom, the client loses BASE = ACIDOSIS!"​ 💡 To compensate, help the client "RESPIRATE" to blow off CO₂! 🔵 SAFETY Concept: Acid-Base Balance → Metabolic Alkalosis ⚖️ Metabolic Alkalosis = Excess HCO₃⁻ (Base) OR Loss of H⁺ (Acid Loss) 🔹 pH > 7.45 (Alkalotic)​ 🔹 HCO₃⁻ > 26 mEq/L (High bicarbonate)​ 🔹 Cause: Loss of acid (H⁺) or excess base (HCO₃⁻) ​ Vomiting → "Losing Acid" (HCl from stomach) ​ NG suction → Loss of gastric acid ​ Diuretics (Loop & Thiazide) → Loss of K⁺ & H⁺ ​ Corticosteroids, excessive antacids, sodium bicarbonate ​ Hypokalemia → Kidneys hold onto K⁺ and excrete H⁺ 🩺 System-Specific Assessments → "EMESIS" 🔹 Elevated heart rate (dysrhythmias from hypokalemia & hypomagnesemia)​ 🔹 Muscle weakness, numbness, tingling (due to ↓ K⁺ & Mg²⁺)​ 🔹 Evaluate weight (vomiting, anorexia)​ 🔹 Signs of Chvostek’s & Trousseau’s (due to ↓ Mg²⁺)​ 🔹 Irritability, anxiety, nausea, vomiting​ 🔹 Sensorium (confusion, seizures) 🚑 First-Do Priority Interventions → "WEIGHT" 1️⃣ Weigh daily → Monitor for fluid & electrolyte imbalances​ 2️⃣ Evaluate VS, cardiac rhythm, RR, & LOC​ 3️⃣ Irrigate NG tube with normal saline (NOT tap water!) to prevent loss of Cl⁻ & H⁺​ 4️⃣ Give antiemetics to stop vomiting​ 5️⃣ Have seizure precautions ready (low Mg²⁺ can trigger seizures)​ 6️⃣ Treat underlying causes: ​ Diuretics (Loop & Thiazides)? → May need K⁺ supplementation ​ Electrolyte imbalance? → Replace K⁺ & Mg²⁺ via IV or diet ​ Gastric suctioning? → Adjust NG irrigation & fluid replacement 📈 Evaluate Outcomes → "EMESIS" (Back to Normal!) ✅ Elevated heart rate (dysrhythmias) → None (normal ECG, K⁺ & Mg²⁺ WDL)​ ✅ Muscle weakness, numbness, tingling → None​ ✅ Evaluate weight (WDL); emesis, anorexia → None​ ✅ Signs of Chvostek’s & Trousseau’s → None​ ✅ Irritability, anxiety, nausea, vomiting → None​ ✅ Sensorium (confusion, seizures) → None; ABGs WDL 🎯 INSANELY EASY TIP! 💡 "If the client is vomiting (EMESIS), they're losing acid = RISK for Metabolic Alkalosis!"​ 💡 If vomiting a lot, they may lose WEIGHT → Focus on stopping emesis & replacing K⁺! SAFETY Concept: Acid-Base Balance → Respiratory Alkalosis ⚖️ Respiratory Alkalosis = Excessive loss of CO₂ (from hyperventilation!) 🔹 pH ↑ (>7.45) (Alkalotic)​ 🔹 PaCO₂ ↓ (