Fluid and Electrolytes Balance and Disturbance Session 4 2024 PDF

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Summary

This document details fluid and electrolyte balance and disturbance, specifically covering causes, diagnosis, and nursing management. It includes various aspects of the content from the pages provided including diagrams and tables.

Full Transcript

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

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