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Fluid & Electrolyte Imbalance

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Fluid & Electrolyte Imbalance N132 Fluid Imbalance Fluid Volume Deficit (Hypovolemia, Isotonic Dehydration) Common Causes Hemorrhage Vomiting Diarrhea Burns Diuretic ... – PowerPoint PPT presentation

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Title: Fluid & Electrolyte Imbalance


1
Fluid Electrolyte Imbalance
  • N132

2
Fluid Imbalance
3
Fluid Volume Deficit(Hypovolemia, Isotonic
Dehydration)
  • Common Causes
  • Hemorrhage
  • Vomiting
  • Diarrhea
  • Burns
  • Diuretic therapy
  • Fever
  • Impaired thirst

4
Clinical Manifestations
  • Signs/Symptoms
  • Weight loss
  • Thirst
  • Orthostatic changes in pulse rate and bp
  • Weak, rapid pulse
  • Decreased urine output
  • Dry mucous membranes
  • Poor skin turgor

5
Treatment/Interventions (FVD)
  • Fluid Management
  • Diet therapy Mild to moderate dehydration.
    Correct with oral fluid replacement.
  • Oral rehydration therapy Solutions containing
    glucose and electrolytes. E.g., Pedialyte,
    Rehydralyte.
  • IV therapy Type of fluid ordered depends on the
    type of dehydration and the clients
    cardiovascular status.

6
Safety Alert
7
Nursing Implications
  • Monitor postural heart rate and bp when getting
    patients out of bed

8
Fluid Volume Excess
  • Common Causes
  • Congestive Heart Failure
  • Early renal failure
  • IV therapy
  • Excessive sodium ingestion
  • SIADH
  • Corticosteroid

9
Clinical Manifestations
  • Signs/Symptoms
  • Increased BP
  • Bounding pulse
  • Venous distention
  • Pulmonary edema
  • Dyspnea
  • Orthopnea (diff. breathing when supine)
  • crackles

10
Treatment/Interventions (FVE)
  • Drug therapy
  • Diuretics may be ordered if renal failure is not
    the cause.
  • Restriction of sodium and saline intake
  • I/O
  • Weight

11
More to consider?
  • Age
  • Infants
  • Older adults
  • Prior medical history
  • Acute illness
  • Chronic illness
  • Environmental factors
  • Diet
  • Lifestyle
  • Medications

12
  • Physical Assessment
  • Body systems
  • I/O
  • Weight
  • Labs

13
Electrolyte Imbalance

14
Hypokalemia (lt3.5mEq/L)
  • Pathophysiology
  • Decrease in K causes decreased excitability of
    cells, therefore cells are less responsive to
    normal stimuli

15
Hypokalemia (lt3.5mEq/L)
  • Contributing factors
  • Diuretics
  • Shift into cells
  • Digitalis
  • Water intoxication
  • Corticosteroids
  • Diarrhea
  • Vomiting

16
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17
Hypokalemia (lt3.5mEq/L)
  • Interventions
  • Assess and identify those at risk
  • Encourage potassium-rich foods
  • K replacement (IV or PO)
  • Monitor lab values
  • D/c potassium-wasting diuretics
  • Treat underlying cause

18
Hyperkalemia (gt5.0mEq/L)
  • Pathophysiology An inc. in K causes increased
    excitability of cells.

19
Hyperkalemia (gt5.0mEq/L)
  • Contributing factors
  • Increase in K intake
  • Renal failure
  • K sparing diuretics
  • Shift of K out of the cells

20
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21
Hyperkalemia (gt5.0mEq/L)
  • Interventions
  • Need to restore normal K balance
  • Eliminate K administration
  • Inc. K excretion
  • Lasix
  • Kayexalate (Polystyrene sulfonate)
  • Infuse glucose and insulin
  • Cardiac Monitoring

22
Hyponatremia (lt135mEq/L)
  • Contributing Factors
  • Excessive diaphoresis
  • Wound Drainage
  • NPO
  • CHF
  • Low salt diet
  • Renal Disease
  • Diuretics

23
Hyponatremia (lt135mEq/L)
  • Assessment findings
  • Neuro - Generalized skeletal muscle weakness.
    Headache / personality changes.
  • Resp.- Shallow respirations
  • CV - Cardiac changes depend on fluid volume
  • GI Increased GI motility, Nausea, Diarrhea
    (explosive)
  • GU - Increased urine output

24
Hyponatremia (lt135mEq/L)
  • Interventions/Treatment
  • Restore Na levels to normal and prevent further
    decreases in Na.
  • Drug Therapy
  • (FVD) - IV therapy to restore both fluid and Na.
    If severe may see 2-3 saline.
  • (FVE) Administer osmotic diuretic (Mannitol) to
    excrete the water rather than the sodium.
  • Increase oral sodium intake and restrict oral
    fluid intake.

25
Hypernatremia (gt145mEq/L)
  • Contributing Factors
  • Hyperaldosteronism
  • Renal failure
  • Corticosteroids
  • Increase in oral Na intake
  • Na containing IV fluids
  • Decreased urine output with increased urine
    concentration

26
Hypernatremia (gt145mEq/L)
  • Contributing factors (contd)
  • Diarrhea
  • Dehydration
  • Fever
  • Hyperventilation

27
Hypernatremia (gt145mEq/L)
  • Assessment findings
  • Neuro - Spontaneous muscle twitches. Irregular
    contractions. Skeletal muscle wkness.
    Diminished deep tendon reflexes
  • Resp. Pulmonary edema
  • CV Diminished CO. HR and BP depend on
    vascular volume.

28
Hypernatremia (gt145mEq/L)
  • GU Dec. urine output. Inc. specific gravity
  • Skin Dry, flaky skin. Edema r/t fluid volume
    changes.

29
Hypernatremia (gt145mEq/L)
  • Interventions/Treatment
  • Drug therapy
  • (FVD) .45 NSS. If caused by both Na and fluid
    loss, will administer NaCL. If inadequate renal
    excretion of sodium, will administer diuretics.
  • Diet therapy
  • Mild Ensure water intake

30
Hypocalcemia (lt9.0mg/dL)
  • Contributing factors
  • Dec. oral intake
  • Lactose intolerance
  • Dec. Vitamin D intake
  • End stage renal disease
  • Diarrhea

31
Hypocalcemia (lt9.0mg/dL)
  • Contributing factors (contd)
  • Acute pancreatitis
  • Hyperphosphatemia
  • Immobility
  • Removal or destruction of parathyroid gland

32
Hypocalcemia (lt9.0mg/dL)
  • Assessment findings
  • Neuro Irritable muscle twitches.
  • Positive Trousseaus sign.
  • Positive Chvosteks sign.
  • Resp. Resp. failure d/t muscle tetany.
  • CV Dec. HR., dec. BP, diminished peripheral
    pulses
  • GI Inc. motility. Inc. BS. Diarrhea

33
Positive Trousseaus Sign
34
Positive Chvosteks Sign
35
Hypocalcemia (lt9.0mg/dL)
  • Interventions/Treatment
  • Drug Therapy
  • Calcium supplements
  • Vitamin D
  • Diet Therapy
  • High calcium diet
  • Prevention of Injury
  • Seizure precautions

36
Hypercalcemia (gt10.5mg/dL)
  • Contributing factors
  • Excessive calcium intake
  • Excessive vitamin D intake
  • Renal failure
  • Hyperparathyroidism
  • Malignancy
  • Hyperthyroidism

37
Hypercalcemia (gt10.5mg/dL)
  • Assessment findings
  • Neuro Disorientation, lethargy, coma, profound
    muscle weakness
  • Resp. Ineffective resp. movement
  • CV - Inc. HR, Inc. BP. , Bounding peripheral
    pulses, Positive Homans sign.
  • Late Phase Bradycardia, Cardiac arrest
  • GI Dec. motility. Dec. BS. Constipation
  • GU Inc. urine output. Formation of renal
    calculi

38
Hypercalcemia (gt10.5mg/dL)
  • Interventions/Treatment
  • Eliminate calcium administration
  • Drug Therapy
  • Isotonic NaCL (Inc. the excretion of Ca)
  • Diuretics
  • Calcium reabsorption inhibitors (Phosphorus)
  • Cardiac Monitoring

39
Hypophosphatemia (lt2.5mg/L)
  • Contributing Factors
  • Malnutrition
  • Starvation
  • Hypercalcemia
  • Renal failure
  • Uncontrolled DM

40
Hypophosphatemia (lt2.5mg/L)
  • Assessment findings (Chart 13-7)
  • Neuro Irritability, confusion
  • CV Dec. contractility
  • Resp. Shallow respirations
  • Musculoskeletal - Rhabdomyolysis
  • Hematologic Inc. bleeding
  • Dec. platelet aggregation

41
Hypophosphatemia (lt2.5mg/L)
  • Interventions
  • Treat underlying cause
  • Oral replacement with vit. D
  • IV phosphorus (Severe)
  • Diet therapy
  • Foods high in oral phosphate

42
Hyperphosphatemia (gt4.5mg/L)
  • Causes few direct problems with body function.
    Care is directed to hypocalcemia.
  • Rarely occurs

43
Hypomagnesemia (lt1.4mEq/L)
  • Contributing factors
  • Malnutrition
  • Starvation
  • Diuretics
  • Aminoglcoside antibiotics
  • Hyperglycemia
  • Insulin administration

44
Hypomagnesemia (lt1.4mEq/L)
  • Assessment findings
  • Neuro - Positive Trousseaus sign. Positive
    Chvosteks sign. Hyperreflexia. Seizures
  • CV ECG changes. Dysrhythmias. HTN
  • Resp. Shallow resp.
  • GI Dec. motility. Anorexia. Nausea

45
Hypomagnesemia (lt1.4mEq/L)
  • Interventions
  • Eliminate contributing drugs
  • IV MgSO4
  • Assess DTRs hourly with MgSO4
  • Diet Therapy

46
Hypermagnesemia (gt2.0mEq/L)
  • Contributing factors
  • Increased Mag intake
  • Decreased renal excretion

47
Hypermagnesemia (gt2.0mEq/L)
  • Assessment findings
  • Neuro Reduced or weak DTRs. Weak voluntary
    muscle contractions. Drowsy to the point of
    lethargy
  • CV Bradycardia, peripheral vasodilatation,
    hypotension. ECG changes.

48
Hypermagnesemia (gt2.0mg/dL)
  • Interventions
  • Eliminate contributing drugs
  • Administer diuretic
  • Calcium gluconate reverses cardiac effects
  • Diet restrictions
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