Fluid & Electrolytes Notes PDF

Fluid & Electrolytes 🍂 (If you know everything here, you’re in the clear!) 1. Fluid and electrolyte balance is described as the process of regulating the extracellular and intracellular fluid volume, body fluid osmolality and plasma concentrations of...

Fluid & Electrolytes 🍂 (If you know everything here, you’re in the clear!) 1. Fluid and electrolyte balance is described as the process of regulating the extracellular and intracellular fluid volume, body fluid osmolality and plasma concentrations of electrolytes 2. Describe the basic principles a. Osmosis i. Movement of water molecules across a selectively permeable membrane from an area of low solute concentration to an area of high solute concentration. ii. Goal is always to equalize the concentration on both sides of the membrane iii. The normal fluid osmolality value for plasma is 290 b. Diffusion i. Passive movement of molecules (particles like gas, ions, or small molecules) from an area of higher concentration to an area of lower concentration ii. Example Imagery: dumping koolaid powder in a pool or airing out a bad smell c. Filtration i. Movement of water and solutes across a membrane driven by hydrostatic pressure ii. Pressure is absolutely necessary iii. Typically force exerted by blood pressure iv. Fluid passes through capillaries but large molecules like proteins are held back d. Active transport i. Movement of molecules across a cell membrane against their concentration gradient ii. Process requires ATP and involves carrier proteins e. Intracellular i. Anything occurring inside the cells f. Extracellular i. Anything outside of the cells g. Isotonic i. Solution that has the same concentration as the inside of a cell h. Hypertonic i. Solution that has higher concentration of solutes compared to inside of cell i. Hypotonic  i. Solution that has a lower concentration of solutes compared to inside of cell 3. Assessment a. Labs i. Basic metabolic panel 1. Sodium a. Normal Level: 135-145 2. Potassium a. Normal Level: 3.5-5.0 3. Chloride a. Normal Level: 96-106 4. Carbon Dioxide a. Normal Level: 23-30 b. Reflective of bicarbonate levels and helps asses acid and base balance c. Abnormalities i. metabolic acidosis (low CO) ii. Metabolic alkalosis (high CO) 5. BUN a. Normal Level: 7-20 b. Indicates kidney function + hydration status c. Abnormalities: i. Elevated dehydration or kidney dysfunction 6. Glucose: a. Normal Level: 70-10 b. *****provides energy + regulates metabolism 7. Calcium a. Normal Level: 8.5-10.2 b. Important for bones, muscles, and nerves 8. Bonus: Magnesium a. Normal Level: 1.7-2.2 b. Not in BMP ii. 24 hour urine 1. Measures how well kidneys excrete electrolytes + other substances in a full day 2. We don’t use the first morning urine, urine needs to be stored in a cool place 3. Measures Excretion of: a. Volume b. Creatinine c. Protein d. Sodium e. Potassium f. Calcium  g. Magnesium h. Phosphate i. Cortisol j. Oxalate k. Citrate l. Chloride m. Sulfate n. Nitrogen o. Uric acid p. Ammonia 4. Exemplars a. Specific electrolyte imbalances b. Dehydration c. Fluid Volume Overload 5. Nursing Process a. Specific electrolyte imbalances b. Dehydration 6. Risk Factors Related to Electrolyte Imbalances a. Dehydration ♥ i. Risks: 1. Inadequate fluid intake 2. Excessive fluid loss 3. Increased urination 4. Elderly age (decreased thirst sensation) 5. Hot climates or strenuous exercise ii. Prevention Strategies: 1. Encourage adequate hydration 2. Teach signs of dehydration a. Dry mouth b. Thirst c. Dark Urine 3. Adjust Fluid Intake Based on Needs iii. What occurs during dehydration: 1. Heart rate increases. 2. Peripheral pulses are weak, difficult to find, and easily blocked. 3. Blood pressure and pulse pressure decrease, with a greater decrease in systolic blood pressure. a. Hypotension is more severe standing than sitting or lying (orthostatic hypotension). 4. Causes light-headedness and dizziness, increasing the risk for falling, 5. Neck and hand veins are flat when supine or hands below heart level.  6. Remember: Laboratory findings consistent with dehydration may indicate hemoconcentration a. This causes an elevation in the levels of: i. Hemoglobin ii. Hematocrit iii. Serum osmolarity iv. Glucose v. Protein vi. Blood urea nitrogen vii. Electrolytes b. Fluid Overload (Hypervolemia) ♥ i. Risks: 1. Kidney failure 2. Congestive heart failure 3. Liver cirrhosis 4. Excessive intravenous fluid administration 5. Hormonal imbalances a. High levels of aldosterone (causes water retention) ii. Prevention Strategies: 1. Monitor daily fluid intake 2. Follow fluid restriction orders 3. Limit sodium intake (often found in processed foods + canned foods) 4. Encourage daily weight checks a. report sudden gain of 2+ lbs/day iii. Changes that occur as a result of hypervolemia: 1. Increased pulse rate 2. Bounding pulse quality 3. Elevated blood pressure 4. Decreased pulse pressure 5. Elevated central venous pressure 6. Distended neck and hand veins 7. Engorged varicose veins 8. Weight gain 9. Increased respiratory rate 10. Pitting edema in dependent areas 11. c. Hypernatremia ♥ i. High Sodium Levels8 ii. Can cause dehydration + altered mental status iii. Risks: 1. Dehydration 2. Diabetes insipidus (leads to excessive water loss)  3. Excessive sodium intake (dietary or from infusion) a. Sources of sodium: iv. Prevention: 1. Follow a low-sodium diet a. Avoid canned/processed foods 2. Ensure adequate fluid intake 3. Monitor for signs! a. Thirst, confusion d. Hyponatremia ♥ i. Low Sodium Levels ii. Can cause confusion + seizures iii. Risks: 1. Excessive water intake 2. Syndrome of inappropriate antidiuretic hormone 3. Diuretic use (especially thiazides) 4. Severe vomiting or diarrhea 5. Heart Failure +Liver disease that affects fluid balance iv. Prevention: 1. Follow fluid restrictions in conditions like heart failure 2. Encourage appropriate sodium intake (especially in patients with GI problems) 3. Monitor sodium levels regularly in at-risk patients v. Changes that occur 1. Increased motility 2. Nausea 3. Diarrhea 4. Abdominal cramping 5. Deep tendon reflexes diminish. 6. Muscle weakness is worse in the legs and arms. e. Hypercalcemia ♥ i. High Calcium Levels ii. Can cause weakness + confusion iii. Risks: 1. Hyperparathyroidism 2. Cancer (specifically bone metastasis or certain tumors) 3. Excessive vitamin D intake 4. Prolonged immobilization (causes bone breakdown + increased calcium release) 5. Use of thiazide diuretics iv. Prevention 1. Limit calcium and vitamin D intake in at risk patients a. 2Patients with hyperparathyroidism are at increased risk 2. Encourage hydration to prevent kidney stones 3. Promote physical activity to prevent calcium release from bones  v. Changes that occur: 1. Short attention span, agitation, and confusion 2. Muscle weakness + twitching 3. Reduced deep tendon reflexes 4. Increased pulse rate 5. Peripheral pulses difficult to palpate and easily blocked 6. Hypotension 7. Severe orthostatic hypotension 8. Reduced pulse pressure 9. 2Slow to normal bounding pulses 10. Peripheral pulses that are full and difficult to block 11. Neck veins that are distended, even in an upright position 12. Increased blood pressure, especially diastolic blood pressure 13. f. Hypocalcemia i. Low Calcium Levels ii. Can cause muscle spasms + cardiac arrhythmias iii. Risks: 1. Vitamin D deficiency 2. Hypoparathyroidism 3. Chronic kidney disease 4. Magnesium deficiency iv. Prevention 1. Encourage a calcium-rich diet a. (dairy, leafy green vegetables) 2. Ensure adequate vitamin D intake for calcium absorption 3. Monitor calcium levels in patients with thyroid or parathyroid disorders g. Hyperkalemia ♥ i. High Potassium Levels ii. Can cause life-threatening arrhythmias iii. Risks: 1. Kidney failure (impaired potassium excretion) 2. Use of potassium-sparing diuretics 3. Adrenal insufficiency (reduced aldosterone, reduced potassium excretion) 4. Excessive potassium intake a. Sources of potassium: 5. Tissue damage (which releases potassium) iv. Prevention: 1. Limit potassium-rich food intake a. Bananas, oranges, potatoes, etc.) 2. Regularly check medications  3. Monitor potassium levels in patients with kidney issues or on medications h. Hypokalemia ♥ i. Low Potassium Levels ii. Can cause arrhythmias + muscle weakness iii. Risks: 1. Use of diuretics 2. Severe vomiting or diarrhea 3. Excessive laxative use 4. Alkalosis (shifts potassium into cells) 5. Inadequate potassium diet intake iv. Prevention: 1. Encourage potassium rich foods a. (bananas, spinach, oranges, potatoes) 2. Monitor diuretic usage and promote potassium supplementation if necessary 3. Teach athletes/patients who sweat excessively to replace potassium loss i. Hyperphosphatemia i. High Phosphate Levels ii. Risks: 1. Chronic kidney disease (impaired excretion) 2. Hypoparathyroidism (reduced parathyroid hormone leads to less excretion) 3. Excessive phosphate intake or IV intake 4. Rhabdomyolysis or tumor lysis syndrome (massive cell breakdown releases phosphate) j. Hypermagnesemia i. High Magnesium Levels ii. Risks 1. Chronic kidney disease (impaired excretion) 2. Excessive magnesium intake (from supplements or laxatives) 3. Adrenal insufficiency 4. Medicines with magnesium (antacids or laxatives2) iii. Prevention 1. Limit magnesium-containing medications a. Such as laxatives and antacids 2. Monitor magnesium levels especially in patients with kidney disease 3. Educate on signs! a. Muscle weakness, lethargy, slow reflexes k. Hypomagnesemia i. Low Magnesium Levels ii. RIsks  1. Chronic alcoholism 2. Diuretic use (especially loop diuretics) 3. Severe diarrhea/vomiting 4. Malabsorption disorders (such as Chron’s) 5. Inadequate dietary intake iii. Prevention 1. Promote magnesium rich foods a. Nuts, seeds, whole grains, leafy greens 2. Monitor diuretic use 3. Monitor alcohol use 7. Pharmacology a. Types of Intravenous Fluids i. Isotonic Solutions 1. Definition: Solutions that have the same osmotic pressure as blood plasma. 2. Common Examples: Normal Saline (0.9% NaCl), Lactated Ringer's, Dextrose 5% in water (D5W). ii. Hypertonic Solutions 1. Definition: Solutions that have a higher osmotic pressure than blood plasma, causing fluid to move out of cells. 2. Common Examples: 3% Sodium Chloride, Dextrose 10% in water (D10W). iii. Hypotonic Solutions 1. Definition: Solutions that have a lower osmotic pressure than blood plasma, causing fluid to move into cells. 2. Common Examples: 0.45% Sodium Chloride (half-normal saline), Dextrose 2.5% in water. b. Electrolyte Replacements i. Sodium 1. Role: Essential for fluid balance, nerve function, and muscle contraction. 2. Replacement Methods: Administered via IV fluids (e.g., normal saline) or oral supplements. ii. Magnesium 1. Role: Important for muscle and nerve function, enzyme activity, and bone health. 2. Replacement Methods: Administered via magnesium sulfate or oral magnesium supplements. iii. Phosphorus 1. Role: Vital for energy production, bone health, and cell membrane integrity. 2. Replacement Methods: Administered via potassium phosphate or oral phosphorus supplements. iv. Calcium 1. Role: Crucial for bone health, muscle function, and nerve signaling. 2. Replacement Methods: Administered via calcium gluconate or calcium chloride, and oral calcium supplements.