Fluid & Electrolytes PDF

FLUID & ELECTROLYTES C. Washington RN, MSNEd Homeostasis Depends On Homeostasis Depends on   Fluid Balance  Body Fluid Distribution  ICF  Potassium, magnesium, & phosphate  Glucose, oxygen  ECF  Sodium, chloride, bicarbonate, calcium  High Na+ concent...

FLUID & ELECTROLYTES C. Washington RN, MSNEd Homeostasis Depends On Homeostasis Depends on   Fluid Balance  Body Fluid Distribution  ICF  Potassium, magnesium, & phosphate  Glucose, oxygen  ECF  Sodium, chloride, bicarbonate, calcium  High Na+ concentration regulates body fluid volume Body Fluid Movement  Body Fluid Movement  Osmolality 275-295 mOsm/kg  Used to describe concentration of body fluids  # solutes /kg H20 (by weight)  Estimated by doubling serum Na concentration  Osmolarity of ECF depends on Na+  Body Fluid Movement Diffusion  Molecules → from an area of ↑ concentration to an area of ↓ concentration Osmotic Pressure  Power of fluid to draw H20 across a membrane  Body Fluid Movement  Filtration  H2O & dissolved substances → from an area of > hydrostatic pressure to an area of < hydrostatic pressure Body Fluid Movement Fluid Replacement Fluid Replacement  Why should you care?  ↑ sodium concentration in ECF  Causes H2O to shift from ICF → ECF compartment  Treatment: 0.45% NS (hypotonic) facilitates H2O back into intracellular space Body Fluid Regulation Renin-Angiotensin-Aldosterone System Hydration: Important for Good Health Assessment of Fluid Balance  Diagnostic and Laboratory Data Osborn page 420 Assessing Fluid Balance Assessing Fluid Balance Assessing Fluid Balance Assessing Fluid Balance Nursing Diagnosis: Fluid Imbalances  Fluid volume excess  Breathing pattern,  Fluid volume deficit ineffective  Fluid volume deficit, risk  Anxiety for  Thought processes,  Gas exchange, impaired altered  Cardiac output,  Injury, risk for decreased  Oral mucous membrane,  Knowledge deficit altered Fluid Balance: Common Interventions  Monitoring daily  Initiating oral fluid weight therapy  Measuring vital signs  Maintaining tube  Measuring intake feeding and output  Monitoring  Providing oral intravenous therapy hygiene  Fluid & Electrolyte disorders  Excess fluids result from excessive intake or decreased output, from any cause  Fluid deficits result from poor intake or excessive output, from any cause  Both occur from shifts that occur with various health disorders FVD: Cause FVD: Cause FVD: Cause FVD: Cause Fluid Volume Deficit  Hypovolemia  Loss of extracellular fluid volume  Isotonic fluid volume deficit  Electrolytes loss along with fluid  FVD  Third spacing  Shift of fluid into vascular space  abdomen, pleural/ peritoneal space Signs & Symptoms: FVD  Weight loss 1 liter of body fluid weighs 1 kg (2.2lb)  ↓interstitial fluid→ diminished skin turgor  ↓skin turgor less accurate in elderly  More accurate indicator of FVD  Assess tongue for size, dryness, longitudinal furrows Test Yourself  You are caring for a patient taking the diuretic furosemide.  Yesterday, the patient’s weight was 62 kg.  After the dose of furosemide yesterday, the patient’s urine output was 2,500 ml.  What do you expect the patient’s weight to be today?  Signs & Symptoms: FVD  Hypovolemia  Orthostatic hypotension >15 mmHg drop in SBP from lying to standing  Loss of intravascular volume ↑HCT  Venous pressure falls Flat neck veins Signs & Symptoms: FVD  To conserve water & sodium pt may experience  Tachycardia  Pale,cool skin (vasoconstriction)  Decreased urine output  Specific gravity increases as water is reabsorbed in the tubules Diagnostic Tests: FVD  Serum electrolytes  Isotonicdeficit Na+ wnl  Water loss only Na+ ↑  ↓ K+ common  Serum osmolality ↑ with water loss  Serum Hgb & Hct ↑  Urine specific gravity & osmolality ↑  Assessment: FVD  Health History  Medication  Renal or endocrine disease  Hot weather  Excessive exercise  Lack of access to fluids  Recent illness accompanied by fever, vomiting/diarrhea  Assessment: FVD Physical Assessment  Weight  Skin color  Vital signs  Temperature  Peripheral  Turgor pulses/capillary refill  LOC/mentation  Jugular neck vein  Urine output Fluid Management: FVD Isotonic Electrolyte solutions  0.9% NaCL/Ringer’s solution  Expand plasma volume (↓ BP pt’s)  Replace abnormal losses  Total body water deficits  D5W  Dextrose is metabolized to carbon dioxide & water →availability of free water for tissue needs Fluid Imbalance  Nursing Process: Patient Care Plan for Dehydration Osborn page 421 Dehydration  When more water is lost from the body than is replaced.  Dehydration refers to loss of water alone  Caused by water deprivation, excessive urine production, profuse sweating, diarrhea, and extended periods of vomiting. Nursing Diagnosis: FVD  Deficient Fluid Volume  Ineffective Tissue Perfusion  Risk for Injury Test Yourself  In prioritizing patient care, you recognize that the pt most at risk for FVD is A 30 year old man with a fractured tibia  An 82 year old women with a fractured hip  A 62 year old man with a heart attack  A 35 year old woman who just delivered a baby  Ms. Hicks  39 year old female  urine output of 20  history of vomiting & mL/hr diarrhea from the flu  skin turgor poor with  rapid pulse tenting  orthostatic  increased respiratory hypotension rate Ms. Hicks Which type of dehydration do you suspect that this Ms. Hicks has? Explain your answer.  Ms. Hicks In evaluating the Urine specific client’s laboratory gravity values, would you Urine volume expect the following Serum sodium values to be normal, Serum hct & hgb elevated, or BUN decreased? Serum osmolality  Ms Hicks  When assessing a patient with FVD, the nurse would expect to find:  Increased pulse rate and BP  Dyspnea and respiratory crackles  Headache and muscle cramps  Orthostatic hypotension and flat neck veins Ms Hicks  What compensatory mechanism responsible for the client’s rapid pulse? Ms Hicks  What immediate interventions are necessary to correct this client’s fluid volume imbalance? Ms Hicks  Admitted with hypovolemia. Which IV solution would the nurse anticipate administering?  Ringer’ssolution  10% dextrose in water  3% sodium chloride  0.24% sodium chloride Ms Hicks  What would be most important to monitor to determine the client’s response to corrective interventions? Mr Hicks  What assessment data would indicate that the client is having a negative response to fluid resuscitation? Fluid Volume Excess (FVE)  Results from water & sodium retention  Hypervolemia  Excess intravascular fluid  Edema  Excess interstitial fluid FVE: Causes FVE: Cause FVE: Cause FVE: Cause Signs & Symptoms: FVE Signs & Symptoms: FVE Signs & Symptoms: FVE  Weight gain >5% of body weight Diagnostic Tests: FVE  To determine cause  Serum creatinine  BUN  liver enzymes Medications: FVE  Diuretics  Inhibit Na+ & water reabsorption  Increase urine output Diuretics: Pt & Family Teaching  Take in morning and afternoon  Change position slowly  Weigh daily  Avoid salt shaker & processed foods  Read food labels  ↑ potassium foods (banana/orange juice)  Potassium sparing diuretics do not use salt substitute Assessment Data: FVE  Health history:  Meds or change of meds  Heart failure; recent illness  Acute/chronic renal or endocrine disease  Change in diet/recent weight gain  Persistent cough, SOB  Swelling of feet and ankles  Difficulty sleeping when lying down Assessment Data: FVE  Physical Assessment  Weight, vital signs  Peripheral pulses & capillary refill  Jugular neck vein distention, edema  Lung sounds (crackles or wheezes)  dyspnea, cough, & sputum  Urine output  Mental status Edema  Amount of interstitial fluid (fluid in tissue spaces around each cell) returning to the circulatory system lessens  Fluid accumulate in the tissue spaces, the tissues become swollen. Pitting Edema  Extravasation & accumulation of interstitial fluid in tissues  Dependent areas of the body  Leaves indentation when skin surface is pressed by a finger  Reflects high right atrial pressure, for example, in heart failure  More severe than non-pitting edema Nursing Diagnosis: FVE  Excess fluid volume  Risk for Impaired Skin Integrity  Risk for Impaired Gas exchange Mrs. Hsu  Admitted to the hospital with a decreased serum osmolality and a serum sodium of 126 mEq/L.  You recognize that dehydration or overhydration may accompany hypotonic conditions. Mrs. Hsu  A priority assessment for this client with FVE is:  Mental status  Weight  Postural vital signs  Urine output  Mrs Hsu  In further A. Distended hand & assessing the neck veins client, what B. Decreased urine assessment data output would indicate C. Decreased capillary that the client has refill fluid volume D. Increased rate and  Mrs. Hsu  Increased, bounding pulse Which of the following  JVD assessments would  Diminished peripheral pulses indicate that Mrs. Jones  Presence of crackles  Thirst has fluid volume  Elevated blood pressure excess?  Orthostatic hypotension  Skin pale & cool to touch  Mrs Hsu  After determining the A. Administration of 0.9% client is not NS dehydrated, which of B. Restriction of free the following water interventions would C. Administration of be appropriate to antihypertensives correct this D. Restriction of hypotonic potassium Mrs. Hsu  A patient is exhibiting sudden onset of crackles in the lungs, moist respirations, & rapid respiratory rate. Which intervention should be performed first?  Weigh the patient  Assess capillary refill  Measure edema  Reduce IV rate Mrs Hsu  What would you assess for evidence A. Mental status of a worsening B. Urine output hypotonic condition? C. Skin changes D. Bowel sounds Potassium (K+) 3.5 to 5.5 mEq/L  Major cation in the ICF  Affects cardiac muscle concentration, electrical conductivity, & cell excitability  Aids neuromuscular transmission of nerve impulses.  Alteration in K+ balance will result in acid-base imbalance  Regulation of protein synthesis  Regulation of glucose use & storage Hypokalemia K+