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FLUID AND ELECTROLYTE BALANCE Competencies: Relate principles of fluid & electrolyte balance Discuss the nursing process for patients with fluid or electrolyte imbalances Identify nursing interventions related to fluid & electrolyte imbalance  Transportin Transporting nutrient...

FLUID AND ELECTROLYTE BALANCE Competencies: Relate principles of fluid & electrolyte balance Discuss the nursing process for patients with fluid or electrolyte imbalances Identify nursing interventions related to fluid & electrolyte imbalance  Transportin Transporting nutrients to cells and wastes from cells g PRIMARY Transportin g Transporting hormones, enzymes, blood platelets, and red and white blood cells FUNCTION Facilitating Facilitating cellular metabolism and proper cellular chemical functioning OF WATER Acting Acting as a solvent for electrolytes and nonelectrolytes IN THE Helping Helping maintain normal body temperature BODY Facilitating Facilitating digestion and promoting elimination Acting Acting as a tissue lubricant  Intracellular fluid (ICF): fluid TWO within cells (70%) COMPARTMEN TS OF FLUID IN Extracellular THE BODY fluid (ECF): fluid Includes intravascular outside cells and interstitial fluids (30%) TOTAL BODY FLUID REPRESENTING 50%–60% OF BODY WEIGHT OF NORMAL ADULT  VARIATIONS IN FLUID CONTENT An infant has Gender and Healthy person: considerably more amount of fat cells total body water is body fluid and ECF affect body water; 50% to 60% of than an adult; women and obese body weight. more prone to fluid people have less volume deficits. body water.  Ingested liquids SOURCE OF FLUIDS Food FOR THE BODY Byproduct of metabolism  Kidneys: urine Intestinal tract: feces FLUID LOSSES Skin: perspiration Insensible water loss Lungs FLUID INTAKE AND LOSSES: ABOUT EQUAL IN HEALTH  NURSING PROCESS: ASSESSMENT OF FLUID BALANCE CURRENT/PAST MEDICAL VITAL SIGNS HISTORY I&O MEDS & TREATMENTS URINE CONCENTRATION FOOD/FLUID INTAKE, FLUID BODY WEIGHT OUTPUT FACE/EYES FLUID/ELECTROLYTE/ACID- SKIN TURGOR BASE IMBALANCES. EDEMA MOUTH AND TONGUE LAB VALUES  Instruct patient & family re: rationale for I&O Place on patient plan of care GUIDELIN Posted signs may be helpful ES FOR MEASURI Measure I&O (don’t estimate) NG I&O Total for each shift, then for 24 hours Intake includes all fluids and foods that are liquid at room temperature… FLUID BALANCE AND IMBALANCE FLUID AND ELECTROLYTE BALANCE Solutes: Solvents: substances liquids that hold dissolved in a a substance in solution solution (electrolytes (water) and nonelectrolytes)  Osmosis: water passes from an area of lesser solute concentration to TRANSPORTI greater concentration until NG BODY equilibrium is established FLUIDS Diffusion: tendency of solutes to move from area of higher concentration to area of lower concentration BALANCING OF FLUID AND ELECTROLYTES OSMOSIS DIFFUSION  Isotonic: same concentration of particles as plasma OSMOLARI Hypertonic: greater TY OF A concentration of particles SOLUTION than plasma Hypotonic: lesser concentration of particles than plasma  TYPES OF IV FLUIDS ISOTONIC SOLUTIONS : CIRCULATING FLUID VOLUME INCREASES WITHOUT AFFECTING VOLUMES OF ANY OTHER FLUIDS LACTATED RINGERS 0.9% NORMAL SALINE HYPOTONIC SOLUTIONS CIRCULATING FLUID VOLUME DECREASES, WHILE CELLULAR FLUID VOLUME INCREASES 0.33% NACL 0.45% NACL HYPERTONIC SOLUTION CIRCULATING FLUID VOLUME INCREASES, WHILE OTHER BODY FLUIDS DECREASE D5LR D5NACL  INVOLVE EITHER VOLUME OR FLUID DISTRIBUTIO IMBALANCES N OF WATER OR ELECTROLYT ES  Pathophysiology underlying acute and chronic illnesses Abnormal losses of body fluids RISK FACTORS Burns FOR IMBALANC Trauma ES Surgery Therapies that disrupt fluid and electrolyte balance  FLUID VOLUME EXCESS FLUID VOLUME EXCESS: EXCESSIVE RETENTION OF WATER AND SODIUM IN ECF: RESULTS FROM : EXCESSIVE WATER AND SODIUM INTAKE CAUSES: IMPAIRED KIDNEY FUNCTION HEART FAILURE HYPERVOLEMIA: EXCESSIVE ECF ACCUMULATION IN INTRAVASCULAR COMPARTMENT EDEMA: EXCESSIVE ACCUMULATION OF FLUID IN INTERSTITIAL SPACE. EDEMA  FLUID VOLUME EXCESS SUBJECTIVE AND OBJECTIVE ASSESSMENT FINDINGS INTERVENTIONS EDEMA ( WEIGHT GAIN) PREVENT OR CORRECT SOB DIETARY MODIFICATIONS ADVENTITIOUS LUNG SOUNDS FLUID INTAKE MODIFICATIONS BLOOD PRESSURE INCREASE MONITOR LABS PULSE QUALITY INCREASE MEDICATION ADMINISTRATION WEAK AND FATIGUED DECREASE ANXIETIES CHANGE IN LAB VALUES PATIENT AND FAMILY TEACHING FLUID VOLUME DEFICIT FLUID VOLUME DEFICIT : DEFICIENCY OF WATER AND SOLUTES (ELECTROLYTES). THIRD-SPACE FLUID SHIFT: DISTRIBUTIONAL SHIFT OF BODY FLUIDS INTO POTENTIAL BODY SPACES  FLUID VOLUME DEFICIT SUBJECTIVE AND OBJECTIVE INTERVENTIONS ASSESSMENT FINDINGS CHANGE IN MENTAL STATUS PREVENT OR CORRECT INCREASE TEMP DIETARY MODIFICATIONS INCREASE PULSE ( TACHYCARDIA) FLUID INTAKE MODIFICATIONS DECREASE BLOOD PRESSURE MONITOR OUTPUT CHANGE IN LAB VALUES MONITOR LABS DRY MUCOSA, CRACKED LIPS, MEDICATION ADMINISTRATION FURROWED TONGUE PATIENT AND FAMILY TEACHING DECREASE SKIN TURGOR ASSESS FOR ELECTROLYTE SCANT DARK URINE OUTPUT IMBALANCE SUDDEN WEIGHT LOSS ( 5 LBS.) ELECTROLYT ES  Maintai Maintain fluid balance n FUNCTION Contrib Contribute to acid-base regulation OF ute ELECTROLYT Facilitat Facilitate enzyme reactions e ES Transmi Transmit neuromuscular reactions t  Sodium : chief electrolyte of ECF: controls and regulates volume of body fluids. Potassium : major cation of ICF: chief regulator of cellular enzyme activity and water content CHIEF Calcium : nerve impulse, blood clotting, ELECTROLY muscle contraction, B12 absorption TES AND Magnesium : metabolism of carbohydrates FUNCTION and proteins, vital actions involving enzymes Phosphate : energy storage and bone and teeth formation. Chloride : maintains osmotic pressure in blood, produces hydrochloric acid.  ELECTROLYTE IMBALANCES HYPONATREMIA AND HYPERNATREMIA HYPOKALEMIA AND HYPERKALEMIA HYPOCALCEMIA AND HYPERCALCEMIA HYPOMAGNESEMIA AND HYPERMAGNESEMIA HYPOPHOSPHATEMIA AND HYPERPHOSPHATEMIA HYPOCHLOREMIA AND HYPERCHLOREMIA  ELECTROLYTE IMBALANCES HYPONATUREMIA-INCREASE WATER HYPERNATUREMIA-EXCESS WATER INTAKE OR LOSS OF SODIUM LOSS OR INCREASE SODIUM INTAKE VOMITING, DIARRHEA, DIURETICS, BURNS, FLUID DEPRIVATION, SWEATING DIARRHEA, EXCESS SALT CONSUMPTION CONFUSION, MUSCLE CRAMPS, WEAKNESS, RESTLESSNESS, INCREASED THIRST, DRY TONGUE  ELECTROLYTE IMBALANCES HYPOKALEMIA HYPERKALEMIA LOST THROUGH VOMITING, GASTRIC RENAL FAILURE, POTASSIUM SUCTIONING, USE OF DIURETICS SPARING DIURETICS, NSAIDS CARDIAC ARREST, GI ISSUES MUSCLE WEAKNESS, LEG CRAMPS, DYSRHYTHMIAS, ANOREXIA, PARESTHESIA  ELECTROLYTE IMBALANCES HYPOCALCEMIA HYPERCALCEMIA INADEQUATE CALCIUM INTAKE, CANCER, HYPERPARATHYROIDISM IMPAIRED CALCIUM ABSORPTION, EXCESS CALCIUM LOSS CONSTIPATION, KIDNEY STONES, NUMBNESS/TINGLING OF FINGERS, BONE PAIN, MOUTH OR FEET, TETANY  ELECTROLYTE IMBALANCES HYPOMAGNESEMIA HYPERMAGNESEMIA ETOH WITHDRAWAL, DIARRHEA, NG RENAL FAILURE, EXCESS TUBE SUCTION, TUBE FEEDINGS, CONSUMPTION OF MAGNESIUM BURNS CONTAINING ANTACIDS SEIZURES, ALTERED MENTAL STATUS, HYPERACTIVE DEEP TENDON LOSS OF DEEP TENDON REFLEXES, REFLEXES RESP. DEPRESSION, COMA, CARDIAC ARREST  ELECTROLYTE IMBALANCES HYPOPHOSPHATEMIA HYPERPHOSPHATEMIA ALCOHOL WITHDRAWAL. DKA, IMPAIRED KIDNEY FUNCTION, HYPERVENTILATION, DIURETIC USE HYPOPARATHYROIDISM FATIGUE, WEAKNESS, PARESTHESIA, TETANY, ANOREXIA, MUSCLE CONFUSION WEAKNESS, TACHYCARDIA  ELECTROLYTE IMBALANCES HYPOCHLOREMIA HYPERCHLOREMIA VOMITING, DIARRHEA, NG TUBE HEAD TRAUMA, INCREASED DRAINAGE, DIURETICS, BURNS PERSPIRATION, DECREASED GLOMERULAR FILTRATION HYPER-EXCITABILITY OF MUSCLES, TETANY, HYPERACTIVE DTRS, TACHYPNEA, WEAKNESS, LETHARGY, WEAKNESS, MUSCLE CRAMPS DECREASED COGNITION, HYPERTENSION  Complete blood count LAB STUDIES Serum electrolytes, blood urea nitrogen, and creatinine levels TO ASSESS FOR Urine pH and specific gravity IMBALANC ES Arterial blood gases  LABS Hemoglobin decreased → blood loss (anemia) | increased dehydration Hematocrit if decreased → anemia|if increased → dehydration Blood urea nitrogen increased → severe dehydration | decreased → malnutrition, over hydration Creatinine increased → dehydration Electrolyte values: refer to work sheet  Sodium 135-145 mEq/L:. Potassium 3.5-5.0 mEq/L: ELECTROLY Calcium 8.6-10.2 mg/dL: TES LABS VALUES Magnesium 1.3-2.3 mEq/L Phosphate 2.5-4.5 mg/dL: Chloride 97-107 mEq/L:  HTTPS://WWW.YOUTUBE.COM/WATCH?V=JZWGNWLFCJ0 Nurse Bass: Fluids and Electrolytes IV FLUIDS AND DIURETICS  Review skills for IV rates (pump and drops/min.) NURSING Assess VTBI and check IV bag hourly INTERVENTI ONS FOR Alarms: CLIENTS RECEIVING IV FLUIDS: IV flow by gravity- Follow policy re: frequency to change IV tubing, bag, etc.  COMPLICATIONS OF IV THERAPY INFILTRATION EXTRAVASATION PHLEBITIS INFILTRATION PHLEBITIS EXTRAVASATION ASSESS DIURETICS  DIURETICS DRUGS THAT ACCELERATE THE RATE OF URINE FORMATION  DIURETICS- CARBONIC ANHYDRASE INHIBITORS ACETAZOLAMIDE (DIAMOX) ACTION- INHIBIT THE ACTIVITY OF THE ENZYME CARBONIC ANHYDRASE FOUND IN THE KIDNEY AND EYES. INCREASES NA AND H2O EXCRETION USES- TREATMENT OF GLAUCOMA, EDEMA AND HIGH-ALTITUDE SICKNESS CARBONIC Contraindications- ANHYDRA ↓ Na or K, renal failure SE Adverse effects- INHIBITOR Interactions: digoxin, S corticosteroids-  furosemide (Lasix) torsemide (Demadex), LOOP bumetanide (Bumex) DIURETIC S Action- potent diuretics that block chloride and sodium reabsorption in the loop Uses- of Henle edema (heart failure), HTN, renal failure, hypercalcemia, pulmonary edema  Contraindications- LOOP Adverse effects- dizziness, DIURETIC tinnitus, N/V/D, hypokalemia, hyperglycemia S Interactions- vancomycin, digoxin, NSAIDS  OSMOTIC DIURETICS MANNITOL (OSMITROL) ACTION- INCREASES OSMOTIC PRESSURE AND PULLS FLUID INTO THE RENAL TUBULES AND REDUCES CEREBRAL EDEMA USES- RENAL FAILURE, EXCRETION OF TOXIC SUBSTANCES AND CEREBRAL EDEMA  OSMOTIC DIURETICS CONTRAINDICATIONS- SEVERE RENAL DISEASE, PULMONARY EDEMA (USE LOOP DIURETICS INSTEAD), INTRACRANIAL BLEED ADVERSE EFFECTS- INTERACTIONS-  spironolactone (Aldactone) amiloride (Midamor) POTASSIU triamterene (Dyrenium) M-SPARING DIURETICS Action- block aldosterone receptors, causing Na and H2O excretion (weak diuretic effect) Uses- HTN, and used in conjunction with loop diuretics to prevent K loss, heart failure  Contraindications- POTASSIU Adverse effects- dizziness, M-SPARING headache, cramps, N/V/D, DIURETICS hyperkalemia Interactions- lithium, ACE inhibitors or K-supplements can result in significant hyperkalemia!!  hydrochlorothiazide (HCTZ) THIAZIDE (hydrodiuril) & metolazone (Zaroxolyn) THIAZIDE -LIKE Action- inhibit reabsorption DIURETIC of Na, Cl and K in the distal S tubule Uses-  THIAZIDE & THIAZIDE-LIKE DIURETICS Adverse Contraindication effects- N/V/D, Interactions- s- liver (hepatic) hypokalemia, steroids, digoxin, coma, anuria hyperglycemia oral and severe renal , increased hypoglycemics failure uric acid  Identify Identify patients at risk for imbalances. Determin Determine that a specific imbalance is present and its e severity, etiology, and characteristics. NURSING Determin ASSESSMEN e Determine the care plan, nursing diagnoses or collaborative problems. TS Identify Identify specific outcomes and associated interventions for the patient. Determin Determine effectiveness of the care plan. e  PARAMETERS OF ASSESSMENT NURSING FLUID INTAKE DAILY WEIGHTS LABORATORY HISTORY AND AND OUTPUT STUDIES PHYSICAL ASSESSMENT NURSING Excess fluid volume DIAGNOSE S Deficient fluid volume RELATED TO Risk for deficient fluid IMBALANC volume ES  Maintain approximate fluid intake and output balance (2,500-mL intake and output over 3 days). EXPECTE D Maintain urine specific gravity within normal range (1.005– OUTCOME 1.030). S Practice self-care behaviors to promote balance.  Dietary modifications Modifications of fluid intake Medication administration IMPLEMENTI IV therapy NG Diminish patient anxiety as needed Appropriate patient and family teaching Blood and blood products Can also include: replacement TPN  VS I&O Weights NURSING Physical assessment: skin turgor, edema, lung IMPLEMENTATI sounds, SOB, lethargy Assess nutritional and fluid needs ON Assess lab results Have patient change positions slowly Administer diuretics in the morning  Collaboration of health care team members (MD, pharmacists, dieticians, nurses): For pts with fluid/electrolyte problems is needed to ensure the INTER- imbalances are corrected immediately PROFESSIONAL & maintained to regain homeostasis. COMMUNICATIO Communication & collaboration: N Ensures safety & manages care efficiently because a number of body systems & organs are involved in regulating the volume & composition of body fluids.  RELATE PRINCIPLES OF FLUID & ELECTROLYTE BALANCE DISCUSS THE NURSING PROCESS FOR OBJECTIV PATIENTS WITH FLUID OR ELECTROLYTE ES MET IMBALANCES IDENTIFY NURSING INTERVENTIONS RELATED TO FLUID & ELECTROLYTE IMBALANCE