Fluid and Electrolytes Spring 2025 Student PDF

Fluid and Electrolyes Jessica Mathisen, MSN, RN, CNE, CHSE Student Learning Outcomes 1. Identify signs and symptoms of fluid and electrolyte imbalances. 2. Apply knowledge of pathophysiology and clinical manifestations when caring for a client with for fluid and electrolyte imbalances....

Fluid and Electrolyes Jessica Mathisen, MSN, RN, CNE, CHSE Student Learning Outcomes 1. Identify signs and symptoms of fluid and electrolyte imbalances. 2. Apply knowledge of pathophysiology and clinical manifestations when caring for a client with for fluid and electrolyte imbalances. 3. Manage care of the client with fluid and electrolyte imbalances. 4. Evaluate the client’s response to interventions to correct fluid and electrolyte imbalances. Body Fluid and Solutes Water Solutes: solid substances that dissolve in water Electrolytes: (Na+, K+ Cl-) develop an electrical charge when dissolved in water Nonelectrolytes: (Glucose, Urea) do not conduct electricity Body Fluid and Solutes Body Fluid Compartments (Where water lives) Intracellular fluid: Within the cells Extracellular fluid: Outside the cells – carries nutrients to cells/removes waste from cells Interstitial fluid: Space between cells. Increased fluid in this area cells is called edema. Intravascular fluid: plasma in blood. Transport blood cells Transcellular fluid: specialized fluid contained in body spaces (cerebrospinal fluid, peritoneal fluid, synovial fluid) and digestive juices Body Fluid and Solutes “Third-spacing” and the Interstitial Space Electrolytes in Body Fluid Electrolytes: Cation: Positive charged Anions: Negative charge ICF Electrolytes: Potassium/Magnesium/Phosphate ECF Electrolytes: Sodium/Chloride/Bicarbonate Fluid and Electrolyte Movement Selectively permeable membranes separate ICF and ECF Movement of fluid and electrolytes through membranes Passive transport Osmosis: movement of water from less concentration to higher concentration (dilutes higher concentrations of solutes) Solutes: crystalloids – easily dissolve in water (electrolytes) colloids: large molecules that do not dissolve in water (protein) osmolality: concentration of solutes creating pressures in body fluid Fluid and Electrolyte Movement Diffusion: Molecules of solute move from higher concentration to a lower concentration (movement stops when both ICF and ECF have equal concentrations of solute). Example: Fish swimming with the current – solutes go with the flow Active Transport: Electrolytes move across cell membranes from an area of low concentration to a higher concentration of solutes - requires energy. (ATP). Example Fish swimming against the current – takes energy. Fluid regulation Fluid Intake: oral, IV Fluid loss: Insensible – cannot be measured - lungs, skin Sensible – Can be measured: Urination, defecation, wounds Fluid regulation Thirst 1. Body fluid loss or increase in salt intake = increase ECF Kidneys osmolality 1. Water Loss – conserve 2. Results in dry mucous water (concentrated urine) membrane 2. Water Excess – excrete 3. Stimulate Thirst water 4. Fluid ingested absorbed into (Dilute urine) bloodstream 5. Fluid moves and decrease concentration of solutes Maintaining Antidiuretic Balance Hormone (ADH) Atrial Natriuretic 1. Released = increase osmolality or decrease in Peptide (ANP) blood volume 1. Stored in atria in heart Increases water Renin-angiotensin- 2. Blood pressure/blood volume reabsorption in kidneys aldosterone system rise = stretch atria. = concentrated urine 1. Decrease blood to kidneys = 3. ANP shuts off renin system 2. Not released = releases renin – production of 4. Stabilizes blood pressure decrease serum angiotensin II - osmolality or increase (vasoconstrictor) increase blood blood volume. pressure Kidneys = less 2. Increase blood flow to kidneys concentrated urine = decrease renin – normalize blood pressure Populations at Risk for fluid volume imbalance Infants - dependant on others to provide fluids Older adults - decreased thirst sensation Unconscious client - dependant on others to provide fluid Clients on NPO status - decrease fluid intake Renal failure Liver failure Heart failure Fluid Volume Imbalance Measurements of fluid volume balance Vital signs BP HR Urine output Body weight Physical assessment Skin turgor Mucous membrane Capillary refill time Edema Fluid Volume Imbalance Normal fluid balance - manifestations Vital signs Urine output Body weight Physical assessment Skin turgor Mucous membrane Capillary refill time Edema Fluid Volume imbalance Fluid volume deficit (FVD) – hypovolemia Causes 1. Excessive loss of fluids GI loss of fluid: vomiting, diarrhea, NG suctioning Increased perspiration without fluid replacement Hemorrhage 2. Insufficient fluid intake Medical/surgical conditions such as stroke, neck trauma, Altered thirst mechanism - older adults Infants 3. Fluid Shifts (Third spacing) Edema Fluid Volume imbalance Fluid volume deficit – hypovolemia Clinical manifestation Vital signs: Heart rate = increased Blood pressure = decreased Respirations = clear Skin turgor: decreased Edema: none ? depends Urine output: decreased Fluid Volume imbalance Fluid volume deficit – hypovolemia Nursing Management Health history Physical assessment Review diagnostic results I/O Fluid Volume Imbalance Fluid Volume Excess- hypervolemia Causes: 1. Increase sodium and water retention Diseases: cirrhosis, heart failure, renal failure, adrenal gland disorder, corticosteroids Clinical Manifestations: Weight = increased Vital Signs: Heart rate increased Blood pressure increased Respirations – crackles or wheezing/increased rate Skin turgor: increased Edema: dependent Urine output: normal to low Fluid Volume Imbalance Fluid Volume Excess- hypervolemia Nursing Management Health History Physical Assessment Reviewing labs Monitoring weight I/O Fluid Volume Imbalance Fluid Volume Excess- hypervolemia Case study Sodium – Na+ Sodium – major cation located in ECF Normal Ranges 135 mEq/L-145 mEq/L Regulates fluid volume Helps maintain blood volume Interacts with calcium to maintain muscle contractions Stimulates conduction of nerve impulse Sodium – Na+ (135 mEq-145 mEq) Sodium Regulation –Sodium and water are partners Kidneys Sodium levels low – Kidneys retain sodium Sodium levels high – Kidneys excrete sodium If kidneys cannot excrete sodium – increase sodium and water in blood Increase blood volume High blood pressure Gastrointestinal Tract Excreted through sweat Sodium – Na+ (135 mEq-145 mEq) Sodium Regulation –Sodium and water are partners Thirst Hormones Antidiuretic Hormone: sodium level increase – release of ADH Kidneys retain water – normalizes sodium levels Aldosterone in adrenal cortex Stimulates renal tubules to conserve water and sodium Sodium-potassium pump Moves sodium and potassium across the cell to establish balance Sodium – Na+ Hyponatremia Hyponatremia – Sodium level < 135 mEq/L Regulation dysfunction Sodium levels decrease – fluid moves from extracellular to intracellular space Results in hypovolemia (lower fluid volume in ECF) Cerebral edema - water moves into brain Sodium – Na+ Hyponatremia Hyponatremia causes Hypovolemic hyponatremia (Sodium Loss) Sodium and water levels decrease but sodium loss is greater Vomiting Diarrhea Excess sweating Renal (kidney) dysfunction Nasogastric suctioning Sodium – Na+ Hyponatremia Hyponatremia causes Hypervolemic hyponatremia (Water Gain) Both water and sodium increase in ECF but water gain is greater Sodium levels diluted Causes Heart failure Renal failure Liver failure Sodium – Na+ Hyponatremia Nursing Care Physical Assessment Changes Neurological Lethargy Headache Confusion Nausea Vomiting Seizures Coma Death GI changes Increased motility Hyperactive bowel sounds Abdominal cramping Nausea Sodium – Na+ Hyponatremia Nursing Care Additional Assessments Vital signs – based on ECF Monitor sodium level Monitor I/O Interventions Seizure precautions (Sodium < 120 mEq/L) Bed rails Suction Oxygen Client Education Fluid and sodium intake Client Education Sodium related foods – frozen pizza, soup, pretzels, chips, breads Administer medication as prescribed Sodium – Na+ hypernatremia Sodium Levels greater than 145 mEq/L Increase sodium level ECF Fluid moves from ICF to ECF Cells shrink – especially in central nervous system Neurological impairment Signs of hypervolemia – see sign of hypervolemia Causes Inability to drink fluids - thirst is main defense against hypernatremia Infants and elderly are high risk Sodium – Na+ Hypernatremia Causes Water deficit Insensible water loss – fever, heat stroke Sensible water loss – vomiting, watery diarrhea Excessive sodium intake High sodium foods Medications Sodium – Na+ Hypernatremia Nursing Care Physical Assessment Changes Neurologic deficits Restlessness Confusion Seizures Coma GI Thirst Dry membranes Nausea Vomiting Sodium – Na+ Hypernatremia Nursing Care Additional Assessment Vital signs I/O Interventions Seizure precaution Bed rails Suction Oxygen Fluids as prescribed Weigh daily Client education Low-sodium diet Potassium – K+ 3.5 mEq/L to 5.0 mEq/L Major cation inside cell (ICF) Maintains Neuromuscular transmission of nerve impulses Skeletal and cardiac muscle contraction and electrical conductivity Acid/base balance Potassium – K+ (3.5 mEq/L to 5.0 mEq/L Potassium regulation Body cannot conserve Ingest daily 80% excreted in urine Sodium/potassium pump moves potassium from ICF to ECF Potassium - Hypokalemia Hypokalemia = Potassium levels < 3.5 mEq/L Causes Inadequate potassium intake NPO IV fluids without potassium GI loss GI suction Diarrhea Laxative abuse Drugs Excess urine excretion Potassium - hypokalemia Nursing Care Physical Assessment Changes Neurologic - alter mental status Cardiac – EKG changes GI Hypoactive bowel sounds Nausea Vomiting Constipation Muscular weakness Potassium - hypokalemia Nursing Care Additional Assessment Vital Sign: decrease in blood pressure Cardiac rhythm – EKG Level of consciousness – altered mental status Urine Output Monitor potassium levels Monitor potassium replacement as prescribed Interventions Client education Potassium foods – bananas, oranges, raisins, potato, cantaloupe, kidney beans Administer medications as prescribed Potassium - Hyperkalemia Hyperkalemia - Potassium Levels > 5.0 mEq/L Movement of potassium out of cells Causes Actual potassium excess Decrease in renal function Increase use of salt substitutes Medications Relative potassium Decrease insulin production Tissue damage Potassium - Hyperkalemia Nursing Care Physical Assessment Changes Muscle – restless, weakness Cardiac - EKG changes (can cause cardiac arrest) GI – increase motility Potassium - Hyperkalemia Nursing Care Additional Assessment Vital signs – slow irregular pulse, hypotension Monitor cardiac rhythm through EKG Assess for muscle weakness Interventions Fall precautions Client teaching Avoid food high in potassium Administer medications as prescribed Calcium – Ca+ 8.2 mg/dl – 10.2 mg/dl Calcium: cation found in ICF and ECF Function: Maintain cell structure Formation and structure of bones and teeth Nerve impulse transmission Calcium – Ca+ 8.2 mg/dl – 10.2 mg/dl Calcium regulation GI tract – absorption from food and excretion through feces Bone – resorption (Ca loss in bones) and reabsorption (Ca gain in bones) Kidneys – reabsorption and excretion in urine Calcium – Ca+ 8.2 mg/dl – 10.2 mg/dl Calcium regulation Dietary intake and existing stores of calcium affect blood levels Parathyroid hormone is released when calcium is low Draws calcium from bones Promotes kidney reabsorption Calcitonin hormone is released when calcium is high Inhibit calcium release from bones Vitamin D Promotes calcium absorption Phosphorus Inhibits calcium absorption Calcium – Ca+ Hypocalcemia < 8.2 mg/dl Hypocalcemia – Calcium levels below 8.2 mg/dl Causes Inadequate intake Alcoholics Lactose intolerance Malabsorption issues in GI system Increased intestinal motility Diarrhea Chronic malabsorption issues Disruptions in hormone balance Calcium – Ca+ Hypocalcemia < 8.2 mg/dl Nursing Care Physical Assessment Changes Numbness of fingers, lips Tetany Muscle twitches/spasms Seizures +Chvostek’s sign +Trousseau's sign https://www.youtube.com/watch?v=kvmwsTU0InQ Hyperactive bowel sounds Diarrhea Calcium – Ca+ Hypocalcemia < 8.2 mg/dl Nursing Care Additional Assessment Monitor vital signs Interventions Seizure precautions Avoid overstimulation Client education Food high in calcium – milk, orange or grapefruit juice, ice cream, eggs, broccoli Administer medications as prescribed Oral supplements IV medications via pump Calcium – Ca+ Hypercalcemia >10.2 mg/dl Hypercalcemia – calcium levels greater than 10.2 mg/dl Causes Kidney disease Hyperparathyroidism Hyperthyroidism Excess oral intake of calcium/vitamin D Calcium – Ca+ Hypercalcemia > 10.2 mg/dl Nursing Care Physical Assessment Changes Muscle weakness Lethargy Coma Decreased GI motility Hypoactive bowel sounds Constipation Abdominal distention Calcium – Ca+ Hypercalcemia > 10.2 mg/dl Nursing Care Additional Assessment Monitor for flank pain (kidney stones) Interventions Move clients carefully – at risk for pathological fractures Administer medications as prescribed Magnesium – Mg+ 1.6 mEq/L – 2.2 mEq/L Magnesium – cation found in ICF Function Aids in neurotransmission Makes parathyroid hormone – influences calcium levels Influences contraction of heart Produce ATP used for cellular energy Muscle contraction Magnesium – Mg+ 1.6 mEq/L – 2.2 mEq/L Magnesium regulation Kidneys - Excrete for excess (urine) Retain for deficit GI Absorb more if deficit Excrete for excess (feces) Magnesium – Mg+ Hypomagnesemia levels less than 1.5 mEq/L Hypomagnesemia less than 1.5 mEq/L Causes poor dietary intake - alcoholics at risk poor magnesium absorption in GI tract excessive magnesium loss from GI tract excessive magnesium loss from urinary tract Magnesium – Mg+ Hypomagnesemia Nursing Care Physical Assessment Changes CNS irritation Altered level of consciousness Depression Insomnia Seizures Neuromuscular signs Tremors Twitching Hyperactive deep tendon reflexes Chvostek’s sign Trousseau's sign Cardiac rhythm changes GI Nausea/vomiting anorexia Magnesium – Mg+ Hypomagnesemia Nursing Care Additional Assessment Vital signs Intake/Output Medications that affect magnesium Monitor levels Interventions Cardiac monitor Seizure precautions Fall precautions Administer medication as prescribed Client education Foods: almonds, spinach, nuts, oatmeal, avocados, chocolate milk, bananas, raisins, chocolate pudding Correct use of diuretics and laxatives Referral to AA if alcoholic Magnesium – Mg+ Hypermagnesemia Hypermagnesemia – magnesium level greater than 2.2 mEq/L Causes Renal dysfunction – retains too much magnesium Age Renal failure Addison’s disease Too much intake Hemodialysis – using magnesium dialysate TPN IV infusions that contain magnesium Magnesium – Mg+ Hypermagnesemia Nursing Care Physical Assessment Changes – CNS depression Drowsy lethargic Decreased muscle activity Facial paresthesia Generalized weakness Cardiac issues Bradycardia, cardiac arrest Vasodilation – low blood pressure Magnesium – Mg+ Hypermagnesemia Nursing Care Additional Assessments Vital signs Vasodilation – hypotension Bradycardia – lower heart rate Monitor Cardiac rhythm Respiratory depression Interventions Cardiac monitor Fall precautions Client education Avoid magnesium rich foods Limit use of magnesium-containing laxatives References Assessment Technology Institute (ATI) Nursing Education (2023). Electrolyte Imbalance. Content Mastery Series Review Module: Fundamentals for Nursing (11th ed., pp. 353-359). Assessment Technology Institute (ATI) Nursing Education (2023). Fluid Imbalance. Content Mastery Series Review Module: Fundamentals for Nursing (11 ed., pp. 349-351). Hoffman, J. & Sullivan, N. (2024). Fluid and electrolyte management. Medical-surgical Nursing, Making Connections to Practice (3rd ed., pp. 118-148). Philadelphia, PA: F.A. Davis Treas, L., Wilkinson, J., Barnett, K., Smith, M. (2022). Hydration and Homeostasis. Basic Nursing: Thinking,Doing and Caring (3rd ed.) (pp. 1485-1549). Philadelphia: F.A. Davis.