Fluid & Electrolyte Summer Notes PDF

NUR 105: Adult Health Fluid & Electrolytes Module A Module A learning objectives  Define terms associated with fluid and electrolyte homeostasis.  Explain the physiology of fluids an...

NUR 105: Adult Health Fluid & Electrolytes Module A Module A learning objectives  Define terms associated with fluid and electrolyte homeostasis.  Explain the physiology of fluids and electrolytes.  Explain how the body’s regulators systemically maintain homeostasis.  Identify causes of fluid and electrolyte imbalance.  Interpret clinical manifestations to determine types of fluid and electrolyte imbalance.  Identify treatment modalities for maintaining fluid and electrolyte homeostasis.  Evaluate outcomes of treatment modalities for maintaining fluid and electrolyte homeostasis. What is Homeostasis?  When the characteristics of body fluid remain in balance: o Volume, concentration (osmolality), composition (electrolytes) and acidity (pH)  Achieved by moving fluid and electrolytes between the intracellular and extracellular spaces at constant intervals o Changes in these fluids and electrolyte levels can be potentially dangerous to the body o When in balance the body is stable. Two Types of Fluid in the Body Intracellular Fluid (ICF) Extracellular Fluid (ECF) o Blood o Lymph o Interstitial Fluid  Fluid located between the cells  “Third spacing”- Ascites, Burns  Solutes & Solvents  Solution o Composed of the following:  Solvent – Fluid in the body  Solutes – Electrolytes and nutrients in the body How does our body maintain Cellular Homeostasis?  Diffusion- Solute o Free movement of particles across a permeable membrane from areas of higher concentration to lower concentration  Important in transport of most electrolytes  Osmosis- Solvent o Free movement of fluid through a selectively permeable membrane  A membrane must separate two fluid spaces and one space must contain particles that cannot move through the membrane  To achieve homeostasis, the water molecules move from an area of higher concentration to an area of lower concentration until both sides contain the same proportions of solute and solvents How does our body maintain fluid balance?  Intake & Output--- Fluid balanced is maintained by intake and output  Routes of fluid ingestion and excretion o Average adult takes in 2300mL of fluid daily from food and liquids o Fluid loss occurs through various sources but the most important is the kidneys  Urine  Amount excreted daily depends on the amount of fluid taken in and the body’s need to conserve fluid and maintain homeostasis  The minimum amount of urine per day needed to excrete toxic waste products from the body is 400 to 600 mL. o If the urine output falls below this amount, wastes are retained within the body and build up causing lethal electrolyte imbalances, acidosis, and toxic levels of nitrogen  Insensible Water Loss---Water loss from the skin, lungs, and stool o 500-1000mL/day   Hormonal Regulation of Fluid Balance---3 hormones help control fluid and electrolyte imbalance o Aldosterone: Secreted when Na+ levels are low in the ECF  Aldosterone is secreted and triggers the kidneys to reabsorb sodium and water from the urine back into the blood helping maintain homeostasis o Antidiuretic hormone (ADH): Secreted when blood osmolarity levels increase  ADH is secreted to retain water within the body and decrease the blood osmolarity o Natriuretic peptides: Secreted from the cells of the heart when there is an increased amount of blood volume and blood pressure  Does the opposite of aldosterone.  Kidneys will increase the amount of sodium and water excreted in the urine to decrease blood volume and osmolarity  Renin-Angiotensin II Pathway o Important in the maintenance of blood volume sufficient enough to maintain adequate blood pressure within the body (perfusion) o Ensures adequate perfusion and gas exchange to all organs and tissues Electrolyte Balances & Imbalances  Normal ranges of electrolyte concentrations within the body are very narrow so even small changes can cause major problems for the patient o See Electrolyte Handout  Imbalances can range from mild and easy to treat to severe and life-threatening  Older patients, patients with kidney disease, as well as patients who are just in-general terms ‘ill’, will have the greatest risks for developing these imbalances  When determining a patient’s electrolyte levels, we draw a patient’s blood and conduct specific tests on that blood to give us the amounts of the electrolytes within the blood. o Lab Tests  Basic Metabolic Profile (BMP)  Complete Metabolic Profile (CMP)  Individual Electrolyte Levels---K+; Na+ How Balance is Maintained  Example: A patient ingests a diet high in potassium with foods such as meats and citrus. The patient’s kidneys can compensate for this increased amount of potassium because they excrete the potassium in the urine at the same pace the patient consumes those foods high in potassium. o As patients age, their organs experience a natural deterioration. Therefore, their kidneys are no longer able to excrete the same amount of potassium it once could. If the patient does not monitor the amount of potassium consumed, then there is a risk of developing high levels of potassium in the blood. Dehydration  Fluid intake or retention of fluid is less than what is needed to meet the body’s fluid needs o Occurs with too little fluid intake or too great of fluid loss  Nursing Diagnosis: Fluid Volume Deficit  With significant dehydration, blood volume is decreased resulting in hypovolemia o Leads to inadequate tissue perfusion of organs and tissues o Body compensates by vasoconstriction of peripheral vessels and shunting that blood back to systemic circulation to maintain perfusion of vital organs and tissues  Causes of dehydration: o GI Causes:  Diarrhea/vomiting  Continuous GI irrigation  GI Suctioning o Medications  Diuretics and Laxatives (prescription or OTC) o Mental Status  Forget to drink? o Environmental Exposures  Heat--- Sweating o Kidney or Endocrine disease o Fever  Physical Assessment o Weight Measurement  1 liter of water weighs 2.2 pounds or 1 kilogram  Changes in daily weights are the best indicator for fluid losses or gains  Weigh the patient directly. Do not ask the patient what they weigh. o Cardiovascular  Tachycardia  Attempt to maintain BP with decrease in blood volume  Orthostatic Hypotension   Decreased blood pressure when the patient moves from a lying to sitting position and then from a sitting to standing position  May become light-headed are dizzy when these movements occur due to the decreased blood flow to the brain  Increases the risk for falls, especially in the older adult  Weak, thready peripheral pulses  Flattened neck and hand veins o Respiratory  Tachypnea  Body’s attempt to compensate for the decreased perfusion of the body since the blood volume is low  Bring in more oxygen  Hypoxia o Skin  Mucous membranes--- dry and scaly with thick, sticky coating may be present with cracks or fissures  Turgor---poor skin turgor with the tent remaining for minutes after pinching the skin o Neurological  Mental Status  Confusion – Especially in the older adult o Kidney  Urine volume decreases  Urine concentration increases  Concentration measured by urine specific gravity lab test o Normal results 1.002 - 1.030 o Results greater than 1.030 would indicate dehydration  Color is dark amber with strong odor o Results less than 1.002 would indicate fluid volume overload  Compare total output with total input and daily weights o Total output less than 500mL/day for a patient without kidney disease is major cause for concern   Laboratory Assessment o Usually laboratory findings with dehydration will show elevated levels due to concentration of the solvents from lack of fluid  Interventions o Nursing priorities include:  Patient Safety:  Monitor vital signs--- HR and BP  Assess muscle strength, gait stability, and level of alertness  Increased risk for falls related to orthostatic hypotension  Level of consciousness  Fluid Replacement---Key to correcting dehydration  Type of IV fluid given depends on the patient’s blood volume concentration  Oral fluids--- Assess patients LOC before giving any oral fluid replacement  Monitor intake and output, weight o Drug Therapy  Restores fluid balance by controlling the cause of dehydration  Antidiarrheal - Diarrhea  Antiemetic -Vomiting  Antipyretic - Fever Fluid Overload  Excess of body fluid; Fluid intake or retention is greater than the body’s needs; hypervolemia  Causes of Fluid Overload: o Excessive fluid replacement  IV/Oral o Kidney Failure/ Heart Failure o Long term steroid therapy  Diagnosed based on assessment findings and laboratory findings o Electrolyte levels will be normal but hemoglobin and hematocrit may increase from excessive water levels present in the blood causing hemodilution  Physical Assessment o Weight Gain  Weigh the patient at the same time each day, usually before breakfast, always using the same scale  Teach patient to keep a record of their daily weights at home to show to health provider during follow-ups Instruct patient to notify healthcare provider for more than a 3- pound gain in a week or a 2-pound gain in 24 hours. o Cardiovascular  Tachycardia and hypertension  Bounding Pulse  Distended neck and hand veins o Respiratory  Tachypnea  Dyspnea and Cough  Crackles upon auscultation  o Skin  Pitting edema with skin pale and cool to touch  Interventions o Monitor and assess patient at least every 2 hours for the development of fluid overload  Pulse  Neck Veins  Lung Sounds  Pulmonary edema can develop very quickly and lead to death  What position is best for a client experiencing fluid overload?  Edema  Reduced Urine Output  Skin  At risk for breakdown o Use pressure-reducing mattress  Assess skin pressure areas daily o Especially around areas of the face where the patient may have an oxygen mask on for long periods of time o Assist patient in changing positions every 2 hours o Drug Therapy---Assists in removing the excess fluid  Diuretics  Monitor urine output and daily weights  Monitor ECG for changes in heart rhythm  Indicates changes in electrolyte levels especially K+  Monitor electrolyte levels every 8 hours o Especially Na+ and K+ o Nutrition Therapy  Fluid restriction  Sodium restriction  No added salt  2gram/day to 4gram/day sodium restricted diet o Teach the patients and caregivers to read food labels to check sodium content and be able to keep track of ingested sodium