Fluid and Electrolytes Balance and Disturbance Session 4 2024 PDF

Chapter 13 Session - 4 Fluid and Electrolytes: Balance and Disturbance Page No- 259-264 LEARNING OBJECTIVES Describe the causes, diagnosis, clinical manifestations and nursing management for patient with fluid imbalances 1. Fluid volume deficit (Hypovolemia) 2. Fluid volume ex...

Chapter 13 Session - 4 Fluid and Electrolytes: Balance and Disturbance Page No- 259-264 LEARNING OBJECTIVES Describe the causes, diagnosis, clinical manifestations and nursing management for patient with fluid imbalances 1. Fluid volume deficit (Hypovolemia) 2. Fluid volume excess (Hypervolemia) Copyright © 2018 Wolters Kluwer · All Rights Reserved  1. __________% of adult’s body weight composed of fluids? 2. Who has more body fluids? Younger & older people? Men or woman? 3. Why obese people have less fluid compared to thin people? Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Body Fluid 1/3 2/3rd Extracellular fluid Intracellular Fluid (ECF) (ICF) Plasma + Intravascular RBC, WBC, (6L) Platelets Interstitial Lymph (11-12L) Transcellular CSF, Pleural, (1L) pericardial & 6 synovial fluid Copyright © 2018 Wolters Kluwer · All Rights Reserved Electrolytes ❖ Active chemicals that carry positive (cations) and negative (anions) electrical charges o Major cations: sodium, potassium, calcium, magnesium, hydrogen ions o Major anions: chloride, bicarbonate, phosphate, sulfate, proteinate ions o Expressed in terms of millequivalents (mEq) ❖ Electrolyte concentrations differ in fluid compartments Copyright © 2018 Wolters Kluwer · All Rights Reserved Regulation of Body Fluid Osmosis & Osmolality Diffusion Filtration Na-K Pump Copyright © 2018 Wolters Kluwer · All Rights Reserved Regulation of Fluid #2 ❖ Osmosis: fluid moves from area of low solute concentration to area of high solute concentration ❖ Diffusion: solutes move from area of higher concentration to one of lower concentration ❖ Filtration: movement of water, solutes occurs from area of high hydrostatic pressure to area of low hydrostatic pressure Copyright © 2018 Wolters Kluwer · All Rights Reserved Routes of Gains and Losses #1 ❖ Gain o Healthy people gain fluids by drinking and eating o Daily I&O of water are equal Copyright © 2018 Wolters Kluwer · All Rights Reserved Routes of Gains and Losses #2 ❖ Loss o Kidney: urine output of 1mL/kg/hr o Skin loss: sensible due to sweating and insensible due to fever, exercise, and burns o Lungs: 300 mL everyday, greater with increased RR o GI tract: large losses due to diarrhea Copyright © 2018 Wolters Kluwer · All Rights Reserved Fluid Volume Imbalances ❖ Fluid volume deficit (FVD): hypovolemia ❖ Fluid volume excess (FVE): hypervolemia Copyright © 2018 Wolters Kluwer · All Rights Reserved Fluid Volume Deficit (FVD) or Hypovolemia ❖ May occur alone or in combination with other imbalances ❖ Loss of extracellular fluid exceeds the intake of fluid. ❖ It occurs when electrolytes & water are lost in same proportion ❖ Dehydration o Not the same as FVD o Loss of water alone, with increased serum sodium levels Copyright © 2018 Wolters Kluwer · All Rights Reserved Causes of Fluid Volume Deficit ❖ Abnormal fluid losses o Vomiting, diarrhea, sweating, GI suctioning ❖ Decreased intake o Nausea, lack of access to fluids ❖ Third-space fluid shifts o Due to burns, ascites ❖ Additional causes o Diabetes insipidus, hemorrhage Copyright © 2018 Wolters Kluwer · All Rights Reserved  Hypovolemia: Causes Low intake Vomiting Diarrhea GI suction Sweating Fever Hemorrhage Edema (Burns) Ascites (liver dysfunction) 15 Copyright © 2018 Wolters Kluwer · All Rights Reserved Clinical Manifestations - pg # 259 table 13-4 ❖ Acute weight loss ❖ Poor skin turgor ❖ Oliguria & Concentrated urine ❖ Delayed capillary refill ❖ Decreased CVP ❖ Low BP, increase HR ❖ Fattened neck veins, Weak, rapid pulse, ❖ weakness, dizziness, confusion, thirst ❖ Nausea, Cold skin Copyright © 2018 Wolters Kluwer · All Rights Reserved 16 Fluid Volume Deficit—Nursing Management ❖ I&O at least every 8 hours, sometimes hourly ❖ Daily weight ❖ Vital signs closely monitored ❖ Skin and tongue turgor, mucosa, urine output, mental status ❖ Measures to stop the cause. ❖ Measures to minimize fluid loss ❖ Administration of oral fluids, ORS, ❖ Administration of parenteral fluids Copyright © 2018 Wolters Kluwer · All Rights Reserved  Nursing Management Check daily body wt 0.5kg loss=loss of Fluid administration 500ml of fluid Oral Intake & IV Monitor skin turgor, urine Monitor and measure specific gravity Intake & output q8h or qh (every hour) Monitor vital signs Weak, rapid pulse, orthostatic hypotension Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Fluid Volume Excess (FVE) ❖ Isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF ❖ Secondary to an increase in the total body sodium content Copyright © 2018 Wolters Kluwer · All Rights Reserved Causes of FVE ❖ Due to fluid overload or diminished homeostatic mechanisms ❖ Heart failure, kidney injury, cirrhosis of liver ❖ Contributing factors: Consumption of excessive amounts of table salt or other sodium salts ❖ Excessive administration of sodium-containing fluids Copyright © 2018 Wolters Kluwer · All Rights Reserved  Sodium Heart containing failure fluids Renal Hypervolemia Contributing failure factors Liver Excessive Cirrhosis intake of table salt Copyright © 2018 Wolters Kluwer · All Rights Reserved  Renal failure Heart failure Liver failure Copyright © 2018 Wolters Kluwer · All Rights Reserved  Hypervolemia Clinical Manifestations Edema Distended neck vein Crackle Increased BP & CVP &Output SOB Wt gain Copyright © 2018 Wolters Kluwer · All Rights Reserved  Pharmacologic Treat the cause therapy Nutritional therapy Administer Restriction of sodium Diuretics (mild restriction to Medical Eg: 250mg only) Management Furosemide or Normal Na : Lasix 6-15gm/day Use lemon,onion,garlic Fluid restriction for seasoning Read the label of Dialysis (Renal Failure) drinking water for Na To remove nitrogenous waste and control K and acid base balance Copyright © 2018 Wolters Kluwer · All Rights Reserved  Nursing Management Control hypervolemia Rest, Na restriction Check daily body wt Monitor Parenteral (IV) 0.5kg loss=loss of fluid therapy Semi fowlers position 500ml of fluid for dyspnea Prevent hypervolemia by Monitor and measure sodium & fluid restriction Intake & output Check for edema Pitting edema (Turn the patient to prevent skin break down) Elevation to reduce edema Copyright © 2018 Wolters Kluwer · All Rights Reserved Fluid Volume Excess—Nursing Management ❖ I&O and daily weights; assess lung sounds, edema, other symptoms ❖ Monitor responses to medications—diuretics and parenteral fluids ❖ Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions ❖ Monitor, avoid sources of excessive sodium, including medications ❖ Promote rest Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved