Nursing Care of At Risk Adult Clients: Fluid & Electrolyte Balance (PDF)

Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal) Lesson 1: Body Fluids and Electrolytes: A Review on Normal Composition, Functions and Regulations BO...

Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal) Lesson 1: Body Fluids and Electrolytes: A Review on Normal Composition, Functions and Regulations BODY FLUIDS AND ELECTROLYTES  60% - Approximately of weight of an adult consists of fluids (water and Electrolytes).  Younger people o Higher percentage of body fluid than older people  Men Figure 5.1 Body Fluids Distribution o Have proportionately more body B. Body water distribution according to age and fluid than women. sex  Obese 1. Infant - 80% of bodyweight: prone to o Have less fluid than those who are dehydration thin because of fat cells containing 2. Male adult - 60% of body weight little water. 3. Female adult - 50% of body weight  The skeleton 4. Old - 45-55% of body weight o Also has a lower water content. C. Functions of body water  Muscle, skin, and blood  ECF – maintains blood volume; transport o Are known to have the highest system to and from the cell (plasma part) amount of water in the body.  ICF – internal aqueous medium for cellular I. AMOUNT AND COMPOSITION OF BODY chemical function FLUIDS  Maintenance of normal body temperature A. Body Fluids Per Compartments  E.g perspiration lower body temp 1. Intracellular Fluids (ICF)  Elimination of waste products  70% D. Factors that affect total body water  Fluids inside the cell 1. Age  Located primarily in the skeletal 2. Gender muscle mass 3. Input and Output 2. Extracellular Fluids  30% Ways for Fluid Output:  Fluids outside the cells between a) Sensible fluid loss cells, and cavities b) Insensible fluid loss Interstitial Fluids (ISF) II. ORGANS FOR FLUID LOSS  Fluids between cells; it contains 11 to 12 L 1. Kidney Intravascular Fluids (IVF)  1-2 L of urine output in adults  General rule: 1 ml of urine/kg/hr  Blood plasma; approximately 3 L  E.g. 70 kg=70ml Transcellular Fluids (TF) 2. Skin  The smallest division among the ECF  Accounts on insensible fluid loss via compartments. sweat; 600ml/day  Examples are CSF, serosa, synovial fluids,  The chief solutes in sweat are humors of the eyeball, digestive juices, urine Sodium, Chloride and Potassium 1 KEANA WIN Y. ACENAS SN. | BSN 3F | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal) 3. Lungs  In osmosis (right), the solvent moves from  Water vapor from respiration; lower to higher approximately 300ml/day c. Facilitated Diffusion 4. GIT  This process does not require ATP but does  Approximately 8 liters of fluid require cell membrane proteins which are circulate through the GI system called carrier proteins to carry the molecules every 24 hours across the cell membrane from an area of  The usual loss of GI tract is 100 to higher concentration to an area of lower 200 ml daily. concentration.  If substances required by the cell (eg. Glucose) is unable to pass through the semi- permeable membrane, a protein channel (that is opened by insulin) is activated for them to go into the cell  E.g. Vitamin C, glucose, amino acids Sample oxidation of c  C₁₆H₃₂O₂ + 23 O₂ 16 CO₂ + 16 H₂O III. FLUID MOVEMENTS BETWEEN COMPARTMENTS 1. PASSIVE TRANSPORT MECHANISM a. Diffusion (simple)  Transport of solutes from area of (↑) 2. ACTIVE TRANSPORT MECHANISM concentration to area of (↓) concentration a. Sodium-Potassium Pump across a semi-permeable membrane  Transport of Na+ and K+ into and out of the b. Osmosis (simple) cell requiring an energy (ATP) to cause the  Transport of solvent from area of ↓ movement concentration to area of ↑concentration across a semi-permeable membrane  Left area is of lower concentration than the right in both cases Figure 5.4 Sodium-Potassium Pump  Yellow dots (solute), blue shade (solvent), Action potential (neuromuscular junction) broken line in middle (semi permeable  Signal from brain to muscle to contract membrane  Ca release of acetylcholine from  In diffusion, (left) the solutes moves from higher to lower presynaptic cleft bind to junction to muscle 2 KEANA WIN Y. ACENAS SN. | BSN 3F | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal)  Protein channel will open influx of Na o Hypotonic - Cell swells if on ↓ entering and K exiting osmotic pressure  Imbalance of Na and K Na-K pump o E.g. Red blood cell: if exposed on  Na ↑ extracellular, intravenously, Na is ↑ hypotonic solution will swell o If exposed on hypertonic solution 3. HYDROSTATIC PRESSURE will shrink  The “pushing force” of the blood pressing against the blood vessels walls. 4. ONCOTIC PRESSURE/COLLOID OSMOTIC PRESSURE  Pressure needed to overcome the pull Figure 5.6 The Effects of Tonicity of CHON. 2. TONIC SOLUTION o E.g. albumin  Pull or absorb fluid a. Isotonic Solution from interstitial spaces  Solute concentration of solution = solute concentration of blood plasma  No fluid movement or change in volume within the cell  No change on the cell size  Example: o Plain NSS or 0.9 NaCl o D5W o Lactated Ringer’s Solution IV. FLUID CONCENTRATION  Indication: for intravenous dehydration Osmolarity b. Hypotonic Solution  concentration of solute per liter of solution  ↓ solute concentration than the blood plasma Osmolality  concentration of solute per kg of solution;  When exposed to hypotonic solution, cells concentration of particles - 275 – will swell 295mOsm/kg  Example: 0.45 NaCl, 0.25 NaCl Serum (blood) osmolality  Indication: for intracellular dehydration  concentration of particles in the plasma Tonicity  the effect of water/solution on the water’s osmotic pressure 1. OSMOTIC PRESSURE  The power of a solution to draw water across a semi-permeable membrane (e.g. cell membrane) o ↑ osmotic pressure: ↑ pulling force c. Hypertonic solution o Hypertonic - Cell shrinks if on ↑  ↑ solute concentration than plasma osmotic pressure  When exposed to hypertonic solution, cells will shrink 3 KEANA WIN Y. ACENAS SN. | BSN 3F | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal)  E.g. D5LR, D10W, D5NSS 3. Distribute Body Water between Fluid  Indication: for intracellular overload Compartments V. MECHANISMS THAT CONTROL BODY 4. Regulate Acid–base balance FLUIDS Lesson 2: Management of the Clients with 1. Thirst – helps in regulation Body Fluid Imbalances 2. Kidneys Types Fluid Imbalances 3. ADH (Anti-diuretic hormone) 1. Fluid Volume Deficit  Causes kidney to release less water o Isotonic / Iso-osmolar 4. RAAS (Renin-Angiotensin- Aldosterone- o Hypertonic / Hyperosmolar System) 2. Fluid Volume Excess  Renin – converts angiotensinogen 1. Isotonic / Iso-osmolar FVE angiotensin I 2. Hypertonic / Hyperosmolar FVE  Angiotensin (II to be exact) – A. Fluid Volume Deficit (FVD) vasoconstriction, water/salt retention 1. Risk Factors: o Angiotensin-I-converting enzyme a) Age/Gender (ACE inhibitors / “pril” ) - converts b) Illness (ex. Fever - ↑ loss) angiotensin I → angiotensin II o c) Environmental factors o Angiotensin Receptor Blocker d) Lifestyle and Diet (ARB/ “sartan”) blocks angiotensin II receptors 2. Two Forms: 5. Atrial (heart) Natriuretic Hormone, a) Isotonic/Iso-osmolar FVD Baroreceptors (baro-pressure), Osmoreceptors b) Hypertonic/Hyperosmolar FVD (osmo-concentration of gradient) VI. ELECTROLYTES  Chemical compounds in solution that have the ability to conduct an electrical current Intracellular Extracellular Cation K+ (Potassium) NA+ (Sodium) Anion HPO4- Cl- (Chloride) (Phosphate)  IONS - Break into charged particles called o CATIONS – (+) charged ions Table 5.3 Comparing Isotonic and Hypertonic FVD o ANIONS – (-) charged ions Manifestations  Thirst  Weight loss  Elevated temperature  Dry mouth  Warm, flushed, dry skin  Soft, sunken eyeballs  Tachycardia, low BP, Tachypnea, Altered Table 5.2 Normal Laboratory Values for Electrolytes LOC General Functions of Electrolytes Diagnostic Test 1. Promote Neuromuscular Activity 1. ↑ HCT (rbc or solid/plasma or fluid) and 2. Maintain Body Fluid Volume and Osmolality BUN 4 KEANA WIN Y. ACENAS SN. | BSN 3F | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal) 2. ↑ urine specific gravity Signs and Symptoms 3. ↑ Plasma Concentration  Altered LOC 4. ↑ Serum Osmolality  Hyperventilation (fluid through the lungs) 5. ↑ Na+ level  Sudden weight gain Nursing Diagnosis  Warm, moist skin 1. Fluid Volume Deficit r/t diarrhea  ↑ ICP, ↑ BP, ↓ HR (usually ↑ HR) 2. Ineffective Tissue Perfusion r/t fluid loss  Low serum Na+ levels 3. Risk For Impaired Skin Integrity  Edema / peripheral edema 4. Risk for Imbalanced Nutrition: Less than Diagnostic Test body requirements 1. CVP increases 5. Risk for Injury r/t loss of electrolytes 2. Serum Na+ increases 6. Activity Intolerance (alter LOC) 3. Chest x-ray Medical Management 4. ↓ serum osmolality 1. Fluid Replacement: 5. ↑ BUN, creatinine (KIDNEY)  Oral replacement Nursing Diagnosis o Volume per volume replacement 1. Fluid Volume Excess r/t fluid overload o E.g. if 50 cc loss = 50 cc secondary HF, RF, etc. replacement 2. Ineffective Breathing Pattern r/t fluid  IV and ECF replacement overload in the lungs secondary to o PLR, PNSS, D5W (if isotonic) pulmonary edema o 0.45 PNSS (hypo) for hypertonic Collaborative Management condition 1. Strict Fluid Restriction o KCl (hypokalemia via titration 2. Low Salt Diet Nursing Management 3. Administration of Diuretics 1. Monitor VS, I&O weight q4 4. Infusion of hypertonic IV solution 2. Monitor Skin Turgor, mucosa and tongue 5. Assessment Status 3. Safety measures such as side rails (if 6. Monitor I&O, weight, VS, electrolyte status ALOC) 7. Comfort Measures, skincare for edema B. Fluid Volume Excess EDEMA 1. Risk Factors  Accumulation of fluids in the interstitial a) Excessive Administration Of Hypotonic spaces or ECF Solution  Causes: b) ↑ production of ADH (syndrome of o Excess body water and Na+ inappropriate ADH or SIADH o Hypertension (↑ Hydrostatic pressure) c) Problem in Elimination (Renal Failure) o Renal failure 2. Two Forms o ↓ oncotic pressure (pt. with liver disease) a) Isotonic/Iso-osmolar FVE o ↑ hydrostatic pressure b) Hypotonic/Hypo-osmolar FVE 5 KEANA WIN Y. ACENAS SN. | BSN 3F | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal) Lesson 3: Management of the Clients with  Excessive diaphoresis Electrolyte Imbalances Signs and Symptoms (↓ ECF, ↑ ICF)  Sodium (Na+) – “Na” latin word Natrium  Headache  Potassium (K+) – “K” latin word Kalium  Muscle weakness  Fatigue and apathy  Postural hypotension  Anorexia, n&v  Abdominal cramps  Weight loss A. SODIUM  Feelings of apprehension  Major electrolyte for water regulations  Seizures and coma  Necessary for glucose to be transported to  Dry skin and oral mucosa the cells  ALOC (hypotonic blood cerebral edema)  Controls ECF osmotic pressure Diagnostic Test  Necessary for neuromuscular functioning, 1. Serum Na level intracellular chemical reactions 2. ↓ Specific gravity  Maintains acid – base balance 3. ↓ serum osmolality  “water follows sodium” Medical Management Daily requirement 1. IV Fluid Replacement  is minimum of 2gm/day  Isotonic Solution (PNSS)  Serum sodium level: 135 – 145 mEq/L  Hypertonic Solution (0.3 saline solution)  Urine sodium level: 20 – 220 mEq/L 2. Replace Other Electrolytes Depleted  Sources: canned, processed, instant goods, (K, Ca, HCO3) junk foods, seasoning, seafoods Nursing Management Different Regulatory Mechanism for Sodium 1. Monitor serum Na+, I&O, VS especially PR 1. Thirst 2. Restrict excessive water intake 2. Glomerular Filtration (excretion & 3. Salt, salty foods in diet reabsorption) 4. Safety Precautions 3. RAAS 5. Monitor LOC 4. Osmotic Pressure (ex.  osmo - pressure A.2 Hypernatremia (Sodium Excess) conserve Na)  Na+ excess with water excess or loss; > 5. Aldosterone (RAAS) 135mEq/L 6. Na-K Pump  Either FVD or FVE with ↑ serum osmolality Two Forms of Sodium Imbalances  Causes: A.1 Hyponatremia (Sodium Deficit)  More water than Na+ is lost from  Na+ loss with water loss or excess the body (dilution)  High Na+ intake, low water intake  Causes:  ↑ sensible loss  Treatment with diuretics  Rapid infusion of Saline/IV  Low sodium intake  Diabetes Insipidus  GI losses (vomiting, diarrhea)  Cushing’s Syndrome  ↓ Aldosterone secretion Signs and Symptoms  Burns, small bowel obstruction  Extreme thirst 6 KEANA WIN Y. ACENAS SN. | BSN 3F | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems with Fluid & Electrolyte Balance UNIT 5: (Fluids & Electrolytes: The Normal and Deviation from Normal)  Dry, sticky mucous membrane  ↑ insulin : ↑ K permeability =  serum K  Oliguria  Hyperkalemia: GI sol’n (d50 50 + insulin)  Excitement, agitation, tremors, muscle 2. Catecholamine twitching  ↑ K : ↑ heart contraction  Red, dry, swollen tongue  Activates RAAS → ↑ Na+ and H2O  Tachycardia, possible hypertension retention → ↑ K excretion  Restlessness followed by fatigue 3. Aldosterone  Disorientation and hallucination  ↑ aldosterone : ↓ K+  Edema  Relationship: ex. ↑ Na, K; ↑Ca HPO4; Diagnostic Test ↑Ca = ↑ Mg 1. Serum Na+ level 4. ADH 2. ↑ specific gravity  ↑ADH:↓K+ 3. ↑ osmolality Two Forms of Potassium Imbalance Medical Management B.1 Hypokalemia  IV infusion + diuretics  K+ loss; 5.5 mEq/L 3. Calcitonin -  Ca  Causes: Two Forms of Potassium Imbalance  ↑ Ca intake C.1 Hypocalcemia  Kidney dysfunction  5.5mEq/L  Causes:  Renal failure  Diabetic ketoacidosis 10 KEANA WIN Y. ACENAS SN. | BSN 3F | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY|