Fluid & Electrolyte Imbalance PDF

Fluid & Electrolyte Imbalance Tammy Blatnick Spring 2025 Fluid Imbalance Sources of Body Water Gains and Losses in the Adult  Fluid Volume Deficit (Hypovolemia, Isotonic Dehydration)  Common Causes – Hemorrhage – Vomiting – Diarrhea – Burns – Diu...

Fluid & Electrolyte Imbalance Tammy Blatnick Spring 2025 Fluid Imbalance Sources of Body Water Gains and Losses in the Adult  Fluid Volume Deficit (Hypovolemia, Isotonic Dehydration)  Common Causes – Hemorrhage – Vomiting – Diarrhea – Burns – Diuretic therapy – Fever – Impaired thirst  Clinical Manifestations  Signs/Symptoms – Weight loss – Thirst – Orthostatic changes in pulse rate and bp – Weak, rapid pulse – Decreased urine output – Dry mucous membranes – Poor skin turgor Orthostatic Hypotension  Blood pressure drop over 20 mm Hg systolic or 10 mg Hg diastolic or both  Labs show  Increased hgb and hct  Increased urine specific gravity  Increased BUN and creatinine  Normal levels of lab Hemoglobin:  Men 13.5 to 17.5 grams per deciliter  women 12.0 to 15.5 grams per deciliter Hematocrit:  Men 45% to 52%  Women 37% to 48% Treatment/Interventions (FVD)  Fluid Management – Diet therapy – Mild to moderate dehydration. Correct with oral fluid replacement. – Oral rehydration therapy – Solutions containing glucose and electrolytes. E.g., Pedialyte – IV therapy – Type of fluid ordered depends on the type of dehydration and the client’s cardiovascular status.  Nursing Implications  Monitorpostural heart rate and bp when getting patients out of bed  Fluid Volume Excess  Common Causes: – Congestive Heart Failure – Early renal failure – IV therapy – Excessive sodium ingestion – SIADH – Corticosteroid  Clinical Manifestations  Signs/Symptoms – Increased BP – Edema – Weight gain – Bounding pulse – Venous distention – Pulmonary edema  Dyspnea  Orthopnea (diff. breathing when supine)  crackles  Labs show  Decreased HGB and HCT  Decreased urine specific gravity  Urine specific gravity  Normal range 1.002 and 1.030  A high specific gravity (over 1.030) is seen in dehydration (fluid volume deficit)  A low specific gravity (over 1.002) is suggestive of the kidneys inability to concentrate urine/fluid volume excess Treatment/Interventions (FVE)  Drug therapy – Diuretics may be ordered if renal failure is not the cause.  Restriction of sodium and saline intake  Strict I/O  May restrict PO fluids  Daily Weight  More to consider?  Age – Infants – Older adults  Prior medical history – Acute illness – Chronic illness – Environmental factors – Diet – Lifestyle – Medications  Physical Assessment – Body systems – I/O – Weight – Labs  Gerontological hydration considerations  Elderly are more sensitive to changes in fluid volume  Skin turgor is not very reliable on elderly  May deliberately restrict fluid intake to prevent incontinence  Fluid loss needs to be replaced more slowly and cautiously in the elderly Electrolyte Imbalance  Potassium  Potassium regulates muscle contraction (esp heart)  Normal 3.5-5.2 in adults  Hypokalemia (5.0mEq/L)  Interventions – Need to restore normal K+ balance: – Eliminate K+ administration – Inc. K+ excretion  Lasix (loop diuretic)  Kayexalate (Polystyrene sulfonate) – Infuse glucose and insulin – Cardiac Monitoring Kayexalate  Causes loss of K + through the bowel  Kayexalate binds with K+ in the bowel  Normal sodium (Na) blood levels  135 and 145 milliequivalents per liter  Hyponatremia (145mEq/L)  Assessment findings: – Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes – Resp. – Pulmonary edema – CV – HR and BP depend on vascular volume. Hypernatremia (>145mEq/L) GU – Dec. urine output. Inc. specific gravity Skin – Dry, flaky skin. Edema r/t fluid volume changes.  Hypernatremia (>145mEq/L)  Interventions/Treatment – Drug therapy  (FVD).45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics. – Diet therapy  Mild – Ensure water intake  Hypocalcemia (