Fluids & Electrolytes 2024 PDF

Medical-Surgical Nursing: FLUID, ELECTROLYTE, & ACID-BASE BALANCE  Distribution of Body Fluids: Approximately 60 % of typical adult's weight consist of fluids (water and electrolytes) Factors that influence the amount of body fluids: a) Age – younge...

Medical-Surgical Nursing: FLUID, ELECTROLYTE, & ACID-BASE BALANCE  Distribution of Body Fluids: Approximately 60 % of typical adult's weight consist of fluids (water and electrolytes) Factors that influence the amount of body fluids: a) Age – younger people have a higher body fluids than older people b) Gender – Men have more body fluids than women c) Fats – Obese people have less fluids than thin people, because fat cells have less water Electrolytes Functions: Maintenance of good pH level Regulation of the heart & other muscles Blood coagulation Neuromuscular excitability Production of ATP from glucose  Body fluids is located in two fluid compartments: Intracellular space (fluid in the cell) – two thirds of body fluid is located primarily in skeletal muscle mass. Extracellular space (fluid outside the cell) a) Intravascular space – fluids within the blood vessels which contains plasma (3 liters out 6 liters of blood) b) Interstitial space – contains fluids that surrounds the cell and has a total of 8 liters in adult. Example lymph (fluids present in the vessels in the lymphatic system) c) Transcellular space – smallest division of ECF and contains 1 liter of fluids. Ex: CSF, synovial, pleural, sweats and digestive secretions Body fluids normally shift between two major compartments or spaces to maintain equilibrium. Third spacing – loss of ECF into a space that does not contribute equilibrium between ICF and ECF. Ex: ascites, burns, peritonitis and bowel obstruction. Signs of third spacing: Decrease urine output Increase heart rate Decrease BP Decrease CVP Edema Increase body weight Intake and Output imbalances ELECTROLYTES – active chemicals (cations- carries positively charges and anions which carries negatively charges). Major Cations in body fluids: a. Sodium b. Potassium c. Calcium d. Magnesium e. Hydrogen ions Major Anions: a. Chloride b. Bicarbonate c. Phospate d. Sulfate e. Proteinate ions IV Solutions: HYPERTONIC SOLUTION – a solution with an osmolality higher than that of serum. Ex. 3% or 5% sodium chloride HYPOTONIC SOLUTION - a solution with an osmolality lower than that of serum. Ex. 0.45% NaCl and 0.3% Nacl ISOTONIC SOLUTION – a solution with the same osmolality as serum and other body fluids. Ex. PLR and 0.9 NaCl  Isotonic solution  A solution that has the same salt concentration as the normal cells of the body and the blood.  Ex: 1- 0.9% NaCl. 2- Ringer Lactate. 3- Blood Component. 4- D5W. 5 –PLR  Hypertonic solution:  A solution with a higher salts concentration than in normal cells of the body and the blood.  Ex: 1- D5W in normal Saline solution. 2-D5W in half normal Saline. 3- D10W. 4.- 3% or 5% sodium chloride  Hypotonic solution  A solution with a lower salts concentration than in normal cells of the body and the blood.  EX: 1-0.45% NaCl. 2- 0.33% NaCl. 3 -0.3% Nacl Homeostasis The maintenance of the body’s internal environment within a narrow range of normal values. It is an ongoing process, with changes constantly occurring in the body. Maintaining homeostasis is essential to life.  Water Water constitutes approximately 60% of the total body weight of an adult. It is involved in many of the physical and physiological process of the body. Fluctuations in the amount of water in the body (EDEMA & DEHYDRATION) can have harmful and even fatal consequences. Fluid & Electrolyte Balance Human life is suspended in a saline solution having a salt concentration of 0.9%. For life to continue and cells to properly function, body fluids must remain fairly constant with regard to amount of water and specific electrolytes of which they are composed. Substance Movement Substances must be able to both enter and leave cells. The ability of a membrane to permit substances to pass through it is called permeability. Substances move by passive or active transport. Types of Passive Transport Diffusion. Osmosis. Filtration. Diffusion The tendency of molecules to move from a region of higher molecular concentration to a region of lower molecular concentration until an equilibrium is reached. Osmosis The diffusion of water through a semi- permeable membrane from a region of lower water concentration to a region of higher water concentration. Filtration Fluids and the substances dissolved in them are forced through cell membranes by hydrostatic pressure. Hydrostatic pressure is the pressure that the fluid exerts against the membrane. Active Transport Accomplished by means of carrier molecules, which can latch onto specific molecules and transport them in or out of the cell. Examples of important ions transported by this process are calcium, sodium, potassium, and magnesium. Edema/Fluid Volume Excess When the amount of interstitial fluid (fluid in tissue spaces around each cell) returned to the circulatory system lessens and the fluid accumulates in the tissue spaces, the tissues become swollen. This condition is called edema. Dehydration/Fluid Volume Deficit When more water is lost from the body than is replaced. Caused by water deprivation, excessive urine production, profuse sweating, diarrhea, and extended periods of vomiting. Sources of Fluid Loss Skin (loss of 300 to 400ml. per day by diffusion and perspiration). Lungs (300 to 400ml. per day with expired air, saturated with water vapor). Gastrointestinal Tract (200ml. per day in feces). Kidneys (1,200 to 1,500ml. per day). Disturbances in Electrolyte Balance Around these primary areas: Sodium. Potassium. Calcium. Magnesium. Phosphate. Chloride. Sodium 135-145 mEq/L Hyponatremia (subnormal serum sodium value). Causes – SIADH, Enemas, Hypergylcemia Hypernatremia (above normal serum sodium value). Causes – hypertonic enteral feeding, near drowning, malfunction of hemodialysis Sodium Deficit (Hyponatremia) – refers to a serum sodium level that is below normal (less than 135 mEq/L). Clinical Manifestations: Depends on the cause, magnitude, and speed with which the deficit occurs Poor skin turgor Dry mucusa Decrease saliva production orthostatic fall in blood pressure nausea abdominal cramping  When the serum sodium level drops below 115 Meq/L, signs of intracranial pressure may occur: Lethargy Confusion Muscle twitching Hemiparesis Papilledema (optic disc swelling) Seizures Medical Management: Sodium Replacement: Careful administration of sodium by mouth, nasogastric tube, or parenteral means. Lactated Ringer’s solution or isotonic saline (0.9% sodium chloride) solution may be prescribed. Nursing Management: 1. Monitor I & O 2. Monitor daily wt. 3. Observe for GI manifestations (anorexia, nausea, vomiting and abdominal cramping 4. Monitor/Assess CNS changes a. Lethargy b. confusion c. muscle twitching d. seizures 5. Monitor sodium level and specific gravity Sodium Excess (Hypernatremia): Is a higher than normal serum sodium level (exceeding 145mEq/L) Clinical Manifestations: The clinical manifestations of hypernatremia are primarily neurologic because of cellular dehydration. Moderate hypernatremia:Restlessness and Weakness Severe hypernatremia: disorientation, delusions and hallucinations Medical Management: 1. Hypotonic solution (0.3% Nacl) or an isotonic nonsaline solution (destrose 5% in water D5W). 2. Reduce the serum sodium level not more than 2mEq/L/H. to allow readjustment through diffusion across fluid compartments. 3. Diuretics Nursing Management: 1. Assess for abnormal loss of water or low intake of water and large gains of sodium. 2. Avoid OTC medications 3. Obtain medication history 4. Note the patient’s thirst and elevated temperature 5. Monitor changes in behavior, restlessness, disorientation and lethargy. Significance of Potassium: Potassium is the major intracellular electrolyte 98% of body’s potassium is inside the cell. The remaining 2% is in the ECF. Potassium influences both skeletal and cardiac muscle activity. The normal potassium concentration ranges from 3.5 to 5.5 mEq/L. Potassium 3.5-5.5 mEq/L Hypokalemia (subnormal serum potassium value). Hyperkalemia (above normal serum potassium value).  Potassium Deficit (hypokalemia) Causes: 1. GI loss – most common cause of potassium depletion 2. Vomiting 3. Gastric suctioning 4. Loss in kidneys 5. Diarrhea 6. Drugs (potassium-losing diuretics) Ex. Thiazides Clinical Manifestations: 1. Fatigue 2. Anorexia 3. Nausea 4. Vomiting 5. Muscle weakness 6. Leg cramps 7. Decrease bowel motility 8. paresthesias (numbness and tingling) 9. Dysrhythmias 10. Death due to cardiac and respiratory arrest Medical Management: 1. Oral or IV replacement therapy. 2. Administration of 40-80 mEq/day of potassium 3. Diet containing potassium for hypokalemia. 50-100 mEq/day average adult. 4. Foods high in potassium include fruits (raisins, bananas, oranges) Nursing Management: 1. Monitor: fatigue, anorexia, muscle weakness, dysrhythmias and paresthesias) 2. Observe/ read ECG or cardiac monitor 3. Observe signs for digitalis toxicity 4. Monitor I & O  Potassium Excess (Hyperkalemia) Major cause of hyperkalemia is renal retention of potassium: Clinical Manifestation: 1. Skeletal muscle weakness 2. Flaccid quadriplegia 3. Paralysis of respiratory muscle 4. nausea 5. diarrhea Medical Management: 1. Immediate ECG to detect changes 2. Diet restriction 3. Oral potassium restriction 4. Hemodialysis and peritoneal Emergency Pharmocologic Management: 1. Administer IV calcium gluconate – antagonizes cardiac conduction abnormalities. 2. Administration of sodium bicarbonate to antagonized the cardiac/respiratory effects of potassium Nursing Management: 1. Monitor/assess patients suffering from renal failure. 2. Observe signs of muscle weakness and dysrhythmias 3. Observe for GI symptoms (nausea and vomiting) 4. Monitor/measure serum potassium level 5. Avoid prolonged use of tourniquet in drawing blood sample. Calcium imbalances Most in ECF Regulated by: Parathyroid hormone Increase blood Ca by stimulating osteoclasts Increase GI absorption & renal retention Calcitonin from the thyroid gland Promotes bone formation Increase renal excretion Hypercalcemia Results from Hyperparathyroidism Renal disease Excessive intake of Vitamin D Malignant tumors (hypercalcemia of malignancy) Tumor products promote bone breakdown\ Tumor growth in bone causing Ca release Hypercalcemia Effects Increase formation of kidney stones and pancreatic stones Muscle cramps Bradycardia -> cardiac arrest Fractures  Hypercalcemia mgt. 1. Monitor VS, Cardiac rhythm, I and O 2. Monitor for signs of renal stones, skeletal fractures. Strain all urine. 3. Provide adequate fluids- force fluids (2LPD) Cranberry juice Lowers urinary pH 4. Administer prescribed Furosemide to lower calcium levels Avoid thiazides diuretics Decreased renal excretion of Calcium 5. Administer CALCITONIN Hypocalcemia Hyperreactive neuromuscular reflexes and tetany Caused by: Renal failure Lack of Vitamin D Suppression of Parathyroid function Hypersecretion of Calcitonin Classic Sx Chvosteks sign & Trousseau’s sign  Hypocalcemia mgt.  Monitor VS and signs of HYPOcalcemia (muscle tremor, numbness or tingling sensations)  Initiate seizure precautions and management  Place a tracheostomy set. O2 tank and suction at the bedside if with Respi distress  Prepare CALCIUM gluconate IV @bedside  Provide a HIGH-calcium and LOW phosphate diet  Advise client to eat Vitamin D rich foods  Administer Phosphate binding drugs (promotes excretion through GIT)  Aluminum gel or aluminum carbonate (amphojel)  8. oral tablets of calcium salts  Calcium gluconate Fluid Balance & Nursing Diagnosis Diagnoses relevant to fluid imbalances may include: 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 & Implementation Common interventions include: Monitoring daily weight. Measuring vital signs. Measuring intake and output. Monitor hematocrit and electrolyte values. Providing oral hygiene. Initiating oral fluid therapy. Maintaining tube feeding. Monitoring intravenous therapy. Acids, Bases, and pH Acids, bases, and Ph are important for life. When blood pH falls below 7.35, acidosis occurs. When blood pH increases about 7.45, alkalosis occurs. Acid-Base Balance The body has three main control systems that regulate acid-base balance to counter acidosis or alkalosis: Buffersystems. Respiratory Regulation of Acid-Base Balance. Renal Control of Hydrogen Ion Concentration. Buffers Substances that attempt to maintain pH range or H+ ion concentration, in the presence of added acids or bases.  Buffer Systems Bicarbonate buffer system (works to regulate pH in both intracellular and extracellular fluids). Phosphate buffer system (works to regulate the pH of intracellular fluid and fluid in kidney tubules). Protein buffer system (works to regulate pH inside cells, especially red blood cells). Diagnostic and Laboratory Data The biochemical indicators of acid-base balance are assessed by measuring the arterial blood gases (ABGs). Allen’s test Ask client to make a tight fist. Apply direct pressure over the client’s ulnar and radial arteries. While pressure is applied, ask the client to open the hand. Remove pressure from the ulnar artery and assess the color of the extremity distal to the pressure point.  Acid-Base Imbalances Ph : 7.35 – 7.45 PCO2 : 35 – 45 mmHg HCO3 : 22-26 mEq/L Acid-Base Imbalances Respiratory Acidosis Metabolic Acidosis Excess H2CO3 (carbonic acid) Deficit HCO3 (bicarbonate) Caused by Most common in cases hypoventilation of kidney disease and diabetes Respiratory Alkalosis Metabolic Alkalosis Deficit H2CO3 Excess HCO3 Caused by Can be caused by hyperventilation diarrhea and steroid or diuretic therapy. Respiratory Acidosis Common interventions include: Maintain patent airway Improve ventilation Monitor for signs of respiratory distress Administer O2 Place in a semi-Fowler’s position Encourage and assist the client DBE  Prepare to administer chest physiotherapy Encourage hydration Suction client as necessary Monitor electrolyte values Avoid the use of tranquilizers, narcotics and hypnotics Administer antibiotics for infection Respiratory Alkalosis Common interventions include: Maintain a patent airway Provide emotional support and reassurance to the client Encourage appropriate breathing patterns Assist with breathing techniques (breath holding, use of rebreathing bag) Provide cautious care with ventilator clients Monitor electrolyte values Administer medications as prescribed Prepare to administer calcium gluconate for tetany as prescribed Metabolic Acidosis Common interventions include: Determine the cause of the acidosis Maintain a patent airway Assess LOC for CNS depression Monitor electrolyte values Maintain intake and output (I&O) and assist with fluid and electrolyte replacement as prescribed Initiate safety precautions for convulsions and coma Prepare to administer IV solutions as prescribed Monitor the potassium level closely when acidosis is being treated Metabolic Alkalosis Common interventions include: Maintain a patent airway Monitor vital signs Monitor input and output Monitor electrolyte values Monitor for muscle weakness  Initiate safety precautions for tetany and convulsions Prepare to replace potassium and chloride as prescribed Prepare to administer medications as prescribed to promote kidney’s excretion of bicarbonate Prepare to administer acidifying solutions Thank you.