Fluids and Electrolytes Part 1 NYCCT Nur-1130 PDF

New York City College of Technology Fluids & Electrolytes Part 1 Med-Surgical Nursing Nur-1130 Dr. Gibson Dr. Ryan Fluid and Electrolytes Objectives: What are electrolytes? How do they affect us? How does fluid affect us? Common Electrolytes (Pa...

New York City College of Technology Fluids & Electrolytes Part 1 Med-Surgical Nursing Nur-1130 Dr. Gibson Dr. Ryan Fluid and Electrolytes Objectives: What are electrolytes? How do they affect us? How does fluid affect us? Common Electrolytes (Part 2) Critical Thinking!!!!!  Fluid and Electrolytes ACID - BASE Acid: Acids release hydrogen ions into a solution. The strength of the acid affects how easily the ions are released. Base (alkali): Bases that are stronger have an easier time accepting hydrogen ions while in a solution. This is because they have a greater ability to bind with the hydrogen ions. 1._____: The measure of hydrogen ion concentration Can range from 1 to 14 Hydrogen Quality pH Neutral Ion is a pH of 7 Low Alkalinity High (High) High Acidity (High) Low  Fluid and Electrolytes Buffers NOTE Buffers are solutions that prevent major pH shifts by Hydrogen Levels and Carbon removing or releasing dioxide levels are directly related. hydrogen ions An increase in one results an Bicarbonate-carbonic acid increase in the other. buffer system: Neutralization of hydrochloric acid (HCl) into Increased hydrogen correlates to carbonic acid and salt increased CO2 and decreased pH Protein buffer system: Increased bicarbonate correlates Intracellular/Extracellular Plasma to decreased hydrogen and and proteins increased pH Phosphate buffer system: Sodium and other cations combined with phosphate  Fluid and Electrolytes Key Definitions Homeostasis Maintenance of a constant state of internal equilibrium in a biological system that involves positive and negative feedback mechanisms Acidosis NOTE Increase in H+ (Hydrogen) concentration Decrease in Blood pH Hydrogen Levels and Carbon Low arterial pH d/t low bicarbonate = Metabolic Acidosis dioxide levels are directly Low arterial pH d/t increased PCO2 = 2. ___________________ related. An increase in one results an Alkalosis increase in the other. Reduction in H+ concentration Increased Blood pH Increased hydrogen correlates to High arterial pH d/t increase bicarbonate = Metabolic increased CO2 and decreased pH Alkalosis High arterial pH d/t decreased PCO2 = Respiratory Alkalosis Increased bicarbonate correlates to decreased hydrogen and Active Transport increased pH A pump that moves fluid from a lower concentration to a higher concentration Requires adenosine triphosphate for energy Diffusion Solutes move from a higher concentration to a lower concentration Does not require energy  Fluid and Electrolytes 3. ________________ Solutes move from a higher concentration to lower concentration Does not require energy Osmolarity The number of milliosmoles per liter of solution (mOsm/L) Describes the concentration of solutes or dissolved particles Osmolality The number of milliosmoles per Kg of solvent(mOsm/Kg) Is used more often than Osmolarity to evaluate serum and urine Hypotonic Solution A solution with a osmolality lower than that of the serum Hypertonic Solution A Solution with a osmolality higher that of that of the serum 4. ________________ A Solution with a same osmolality as serum and other body fluids Fluid and Electrolytes  Fluid and Electrolytes Body Fluids Water Comprises 60% of adult weight Mostly Fluids and Electrolytes Factors Influencing body Fluid Content Age Gender Body Fat Intracellular Fluid = 80% of total body water Extracellular Fluid=20% of total Body water Interstitial Intravascular (Plasma) Other Fluids: Cerebrospinal, Intraocular, Bone water,GI secretions  Fluid and Electrolytes Electrolytes compounds that separate into charged particles called ions Cations - positively charged ions such as Na Anions - negatively charged ions such as Cl Cations  Fluid and Electrolytes Mechanism of fluid balance 1.__________________ Regulate fluid and electrolytes, secrete renin Lungs Regulate CO2 levels. Water vapor Skin Regulate fluid losses (sweat) Hormonal Control ADH (Antidiuretic hormone) Aldosterone  Fluid and Electrolytes Hypovolemia FVD(Fluid Volume Deficit) Signs and Symptoms Loss of extracellular volume Decrease Body Temp exceeds the intake of fluid Hypotension, Low CVP Causes of FVD Tachycardia 6. V______, D________, D________, Weak Thready Pulse GI suctioning Tachypnea Decreased intake d/t Nausea, lack of access to fluids Weakness Nausea, Vomiting Third-space fluid shifts Due to burns, ascites BUN elevated, Increased HCT/HBG Diabetes insipidus, adrenal Weight Loss, Low Urine Output insufficiency, hemorrhage Note: Central Venous Pressure (CVP): Pressure of the vena cava/atrium of the heart.  Fluid and Electrolytes Fluid Volume Deficit—Nursing Management I&O at least every 8 hours, sometimes hourly 1. D_____ w______ Vital signs closely monitored Skin and tongue turgor, mucosa, urine output, mental status Measures to minimize fluid loss Administration of oral fluids Administration of parenteral fluids  Management Notes  Fluid and Electrolytes Negative Fluid Balance (Gradient)/ Hypovolemia/ Fluid Volume Deficit (FVD) Fluid Input 7 8 9 10 11 12 13 14 15 16 17 18 19 Shift Total IV Piggy Back/Vancomycin 0 IV Piggy Back/Cefepime 0 This is IVF/ Normal Saline 0 why we do PO Fluids 240 120 120 240 720 strict I/Os Fluid Output Suction Cannister 0 Urine output via Foley Cath 300 120 350 250 180 150 200 400 300 140 180 200 350 3120 Patient is Void 0 Negative BM 2.4 Chest Tube 1 10 10 20 Liters (Hypovolemic Chest Tube 2 10 10 20 ) Emesis 0 IV Fluids Fluid Balance/Fluid Gradient: -2440 Needed  Fluid and Electrolytes Hypervolemia Fluid Volume Excess (FVE) Signs and Symptoms excess of water and electrolytes in the ECF or Weight Gain Diminished homeostatic Cardiac Enlargement mechanisms Cyanosis, Wheezing, Crackles Occurs in CHF, Renal Failure, Malnutrition, Iatrogenic Low HCT and HGB Admin of IVF fluids, Puffy Eyelids, Edema Psychogenic Polydipsia, Liver Cirrhosis Bounding Pulse, Distended Neck Veins, High CVP Contributing factors: Warm moist skin, Muscle Consumption of excessive Spasms amounts of table salt or Note: Central Venous Pressure (CVP): Pressure other sodium salt of the vena cava/atrium of the heart.  Fluid and Electrolytes 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  Safe Positioning, Use caution when laying flat  Fluid and Electrolytes Positive Fluid Balance (Gradient)/ Hypervolemia/ (FVE)Fluid Volume ExcessFluid Input 7 8 9 10 11 12 13 14 15 16 17 18 19 Shift Total IV Piggy Back/Vancomycin 200 200 400 IV Piggy Back/Cefepime 200 200 200 600 IVF/ Normal Saline 75 75 75 75 75 75 75 75 75 75 75 75 75 975 This is PO Fluids 240 120 240 240 360 1200 why we do strict I/Os Fluid Output Suction Cannister 0 Urine output via Foley Cath 10 30 40 30 50 30 60 40 30 50 30 15 30 445 Void 0 Patient BM is Chest Tube 1 10 10 20 9.______ Chest Tube 2 10 10 20 _ 2.7 Liters Emesis 0 (Hypervolemic) Fluid Balance/Fluid Gradient: 2690 8. List appropriate treatments for this problem:_________________________________________  Fluid and Electrolytes Good or Dry Lung Bad or FVO Lung Laying this patient flat can prevent him from breathing  Fluid and Electrolytes Intravenous Fluid Administration Solution Tonicity Name of IV Fluid Normal Saline (NS) 0.9% Isotonic Lactated Ringers (LR) D5 0.45NS (D=Dextrose) D5NS Hypertonic D5LR 1/2NS or 0.45% Saline 10. H______ *D5W is isotonic but metabolizes as hypotonic  New York City College of Technology H20 CL- NA + Part #1 Lesson K+ Ca2+ Completion Mg2 +