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Fluid & Electrolyte Imbalance

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Fluid & Electrolyte Imbalance How to keep things flowing along! Lisa B. Flatt, RN, MSN, CHPN Let s see what are the differences . Osmosis Diffusion ... – PowerPoint PPT presentation

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Title: Fluid & Electrolyte Imbalance


1
Fluid Electrolyte Imbalance
  • How to keep things flowing along!

Lisa B. Flatt, RN, MSN, CHPN
2
Body Fluids
  • Body mostly composed of
  • fluid water
  • solutes - electrolytes
  • Osmolality- the balance between fluid and solutes
    This is a delicate balance! Every organ and
    system reacts differently to an imbalance.

3
Swollen feet and ankles water is attracted to
sodium!
  • Semi-permeable membrane selected particles move
    by passive diffusion thats how sodium follows
    water.
  • Osmotic pressure is the strength of the solution
    to draw the water across the SPM.
  • Passive diffusion solutions of greater
    concentrations moves solutes to solutions of less
    concentration
  • Filtration fluid and solutes move across a
    membrane from area higher pressure to lower
    pressure
  • Active transport substances are moved from low
    to high concentration areas (metabolic energy
    enzymes are used, ie. Sodium potassium pump)

4
Lets see what are the differences.
  • Osmosis
  • Diffusion
  • Filtration
  • Active transport -

5
Where you can find Body Fluid
  • Intracellular Fluid
  • Extracellular Fluid
  • Is 2/3 to ¾ of total body fluid
  • Found inside the cells
  • Outside the cells
  • Divided into compartments
  • Intravascular fluid
  • Plasma- vascular system
  • Interstitial fluid
  • Surrounds cells lymph
  • Transcellular fluid
  • Epithelial cells (synovial fluid)

6
Potassium
  • Potassium (3.5 5.0 meQ/l)
  • Found and for intracellular- cardiac, skeletal
    and smooth muscle activity
  • Hyperkalemia- high K
  • Causes-renal failure (drug induced)
  • S/S tetany, irritability, parasthesia, GI
    hyperactivity, cardiac arrhythmias
  • Nursing interventions Kayexelate (po and pr),
    D50 and Insulin, dietary intake
  • Hypokalemia- low K
  • Causes-drug induced, NVD, gastric suctioning,
    exercise (shin splints)
  • S/S weak, fatigued, cardiac arrhythmias
  • Nursing Interventions IV and PO K, po and iv
    fluids, dietary intake

7
Magnesium
  • Magnesium (1.5 2.5 mEq/l)
  • Found and For intracellular metabolism, protein
    and DNA synthesis
  • Hypermagnesia high Mg
  • Causes-drug induced,
  • S/S lethargy, coma, impaired respirations
  • Nursing Interventions- medication, diet
  • Hypomagnesia- low Mg
  • Causes alcoholism
  • S/S confusion, disoriented, tremors,
    irritability
  • Nursing Interventions medications, diet

8
Sodium -- Salt sucks
  • Sodium (135 - 145meQ/l)
  • Found and For intraextracellular Na and K
    balance needed in body key electrolyte
  • Hypernatremia high sodium
  • Causes increased dietary intake, body system
    imbalances (kidney) dehydration of the cells,
    water gets sucked from the cells and into the
    tissue
  • S/S edema, thirst, confusion, dry mucus
    membranes, mental status changes
  • Nursing Interventions- fluid restrictions, diet
    restrictions
  • Hyponatremia low sodium
  • Causes- exercise and too much water water
    toxicity water gets sucked from the cells into
    the tissue (how most people die in the Grand
    Canyon they need to take salt pills Thank you
    Wes for the fun fact)
  • S/S muscle cramping, NV, postural hypotension,
    mental status changes, hallucinations of oasis!
  • Nursing Interventions medications, iv fluids,
    electrolytes

9
Calcium
  • Calcium (8.5 10.5 meQ/l)
  • For blood coagulation, neuromuscular activity
    and bone growth
  • Found Located in Bones
  • Hypercalcemia high Ca
  • Causes cancer with mets to bone, drugs,
    parathyroid glandular issue
  • S/S kidney stones, lethargy, weakness,
    decreased muscle tone
  • Nursing interventions safety, iv fluid
  • Hypocalcemia low Ca
  • Causes-alcoholism, low serum Mg, parathyroid
    gland removal
  • S/S numbness, tremors, cardiac arrhythmia,
    osteoporosis
  • Nursing Interventions iv fluids, medications,
    diet
  • Calcium and Phosphate work together form bone
    and teeth --- if one is high the other is lower

10
Phosphates
  • Essential for function of muscles, nerves and
    RBC
  • Involved in PRO, Fat and CHO metabolism
  • Hypophosphatemia - TPN, glucose insulin can
    cause phosphates to shift into cells
  • Alcohol withdrawal
  • Antacid use (acid base imbalance)
  • S/S weakness, pain, mental changes, seizures
  • Hyperphosphatemia Phosphates shift out of cell
    (trauma, chemo, malignant tumor), at risk
    infants fed cow milk ((Fleets phosophosoda))
  • S/S numbness, tingling Around mouth and
    fingers muscle spasm, tetany
  • Nursing interventions Diet, Medications, IV
    Fluids, Education

11
Chloride
  • Imbalances occur with Na imbalances
  • Hypochloremia low Chloride
  • Causes sweating, kidney loss, GI tract losses
  • S/S twitching, tremors, tetany
  • Hyperchloremia high Chloride
  • Causes Na retention or high potassium
  • S/S tremors, acidosis, weakness, lethargy,
    arrhythmias, coma
  • NURSING INTERVENTIONS Medication, IV Fluids

12
Electrolyte Imbalances Universality
  • Nursing Interventions diet, meds, iv fluids,
    education, assessment, labs
  • Causes Diet, Medication issues, metabolism
    (cancers, diseases)
  • S/S muscle tremors, twitches, LOC, Mental
    status, cardiac affects

13
Look at your patient- be a spy
  • Previous history? Alcoholic mg or K
  • Malnourished?
  • Objective and Subjective findings?
  • Labs the blood
  • EKG

14
Homeostatic Mechanisms
  • Control the levels of fluids and electrolytes
  • Found throughout the body
  • _kidneys________
  • __endocrine_______
  • __cardiovascular_______
  • ___GI______
  • _____Lungs____

15
Kidneys (not kidney beans!)
  • Regulate what?
  • __water____
  • __electrolytes____
  • __acid/base content of blood____
  • __all body fluids____
  • Adjust what? Reabsorption of water
  • Excrete what? Water and waste pee pee

16
Antidiuretic Hormone ADH
  • ADH regulates water excretion
  • Increases in response to increased serum (blood)
    osmolality
  • Ducts become more permeable to water and it is
    reasborbed easier into the blood and urine output
    will decrease

17
Renin-angiotensin-aldosterone system
  • Renin (enzyme) splits Angiotensinogen into
    angiotensin I and this transforms to angiotensin
    II (with the help of an ACE inhibitor).
  • Angiotensin II stimulates vasoconstriction and
    secretes aldosterone
  • Aldosterone increases Na reabsorption to
    regulate BP and electrolyte levels

18
Put it together
  • Increased osmolality need more water in blood
    so ADH secretion increases and water travels to
    the blood
  • R-A-A system renin excreted to make angiotensin
    II and secrete aldosterone
  • Aldosterone causes vasoconstriction increase bp
  • Give ACE inhibitor stops angiotensin I to II
    and aldosterone (thereby lowers BP). This may
    also affect the ability of the body to maintain
    extracellular fluid (without edema).

19
Atrial Natriuretic Factor ANF
  • Secreted from atrial heart tissue
  • Increases sodium and water elimination (urine)
  • Lowers the blood volume and decreases cardiac
    output
  • Decreases the workload of the heart
  • OPPOSITE EFFECT OF ADH

20
pH acids and bases
  • Acid substance that releases Hydrogen ion in a
    solution
  • Base low hydrogen ion concentration
  • Buffers prevent excessive ph changes by
    adjusting the ions
  • Major buffer is H2CO3
  • Kidneys and Lungs play a key

21
Factors that affect fluid and electrolyte balance
  • Sex
  • Body size
  • Age
  • Diet
  • NPO
  • General adaption syndrome (GAS) hehe
  • Altered LOC

22
More factors.
  • Body temperature
  • Renal, cardiac, pulmonary system
  • Medications
  • Steroids
  • NSAIDs
  • Diuretics
  • Laxatives
  • Electrolyte supplements

23
More factors just when you thought you were
done!
  • Dehydration
  • Surgical procedures
  • Vomiting
  • Diarrhea
  • Exercise
  • Culture and traditional foods MSG
  • Religious practices
  • Socioeconomic
  • Emotional

24
Definitions and conditions
  • Fluid volume deficit is__hypovolemia_______
  • Fluid volume excess is__hypervolemia____
  • Ascites__fluid in the abdominal cavity______
  • Edema _fluid in the interstitial space_______

25
Hypovolemia
  • Define low fluid volume
  • Causes increased sodium chloride intake (po,
    iv), dehydration, CHF, Renal failure, Cushings,
    trauma
  • Nursing ramifications identify cause and
    educate, medications, ivs, etc
  • S/S weak, nausea, low pulse, SOB, low BP

26
Hypervolemia
  • Define increased volume in vascular system
  • Causes water toxicity, iv fluids, disease states
  • Nursing ramifications medication, educate
  • S/S elevated BP, moist crackles in lungs,
    bounding pulse, SOB

27
Ascites
  • Define serous fluid in peritoneal cavity (3rd
    spaced)
  • Causes liver cardiac dx, sodium retention,
    some cancers
  • Nursing ramifications educate, diet, fluids,
    albumin (pulls fluid from 3rd space,
    interstitially back into the blood stream).
    Albumin has high osmolality.
  • S/S swelling, fluid shift the wave
  • Treatment Albumin and Pericentesis

28
Edema
  • Define fluid in the tissues
  • Causes increased sodium, electrolyte imbalances,
    poor cardiac output, kidney failure,
    hypervolemia, diseases
  • Nursing ramifications fluid restrictions,
    educate elevate body parts, sodium
    restrictions, medications
  • S/S swelling (LOL), weeping skin, pain,
    numbness, cool skin, bruised/discolored

29
Edema
  • Pitting leaves a small depression or pit
  • Areas of edema body parts, periorbital edema,
    axillary, groin, generalized
  • Note how many seconds it takes for pit to
    disappear (normally 10-30seconds)

30
Whats the Difference?
  • Dehydration
  • Overhydration
  • Define loss body fluid, normal electrolytes
  • Causes decreased fluid intake
  • Nursing ramifications IVF, educate, diet,
    assessment
  • S/S jugular vein distention, tachycardia, mental
    status changes, confusion, weight loss, dry skin,
    poor skin turgor, dry mucus membranes, increased
    thirst
  • Define water intake is greater than electrolyte
    intake
  • Causes increased fluid intake
  • Nursing ramifications education, diet,
    medications, assessment
  • S/S altered mental status, edema, SIADH (water
    toxicity), possible decreased urine output

31
Acid-Base Balance
  • Normal pH of blood_7.35-7.45____
  • Acidic pH of blood __lt7.35_____
  • Alkaline pH of blood (basic)_gt7.45___
  • Blood is acidotic if the pH is __low__
  • Blood is alkalitic if the pH is __high__

32
Metabolic condition
  • Metabolic Alkalosis
  • Metabolic Acidosis
  • HCO3 high
  • Causes excess intake of baking soda (antacid) or
    alkalitic substances lots of puking
  • The body compensates
  • CO2 is retained and carbonic acid levels increase
    to help balance the excess HCO3
  • HCO3 low
  • Causes starvation, renal impaired, DM
  • The body compensates
  • Stimulates respiratory system and eliminates CO2

33
Respiratory condition
  • Respiratory alkalosis
  • Respiratory acidosis
  • HCO3 high
  • Causes hyperventilation, fever, anxiety,
    pulmonary infections
  • The body compensates kidneys excrete HCO3 (or
    stop hyperventilation ASAP)
  • HCO3 low
  • Causes hypoventilation, lung dx, asthma, COPD
  • The body compensates
  • Kidneys retain NAHCO3 may take hours or days to
    restore pH

34
Intrepretation practice!
35
Nursing Interventions Include
  • Dietary education
  • Menus
  • Special diets
  • Oral fluid/food intake
  • Restrictions
  • Administering medications as ordered
  • IVF
  • Diuretics
  • Electrolyte supplements
  • Education on medication uses/side effects and
    complications

36
Educating on Diuretics
  • Loop diuretic Lasix/Furosemide
  • Thiazide sparing HCTZ
  • Potassium sparing - Aldactone

37
Educating on Electrolyte supplements
  • Potassium
  • Magnesium
  • Sodium Bicarbonate
  • Others? Gatorade, Power waters, Coconut water
  • What do we recommend if you are exercising in the
    heat? Water and Power/Gatorade, etc
  • Babies who have diarrhea need? Pedialyte
  • We use __kayexelate, D50 and Insulin_to reduce
    Potassium

38
Intravenous Fluids - Types
  • Hypotonic solutions .45NS, .33NS, 2.5Dextrose
    lower osmotic pressure than plasma DO not give
    if at risk for IICP
  • Hypertonic solutionsD5NS, D51/2NS, D5LR D5W
    higher osmotic pressure than plasma kidney,
    cardiac and dehydration
  • Isotonic solutions0.9 NS, LR expand vascular
    volume LR has extra ingredients, treats
    metabolic acidosis
  • Electrolyte replacement Potassium, KCL, MG,
    Banana bags!

39
Ethical consideration with IVF
  • Life sustaining?
  • Religious and/or cultural issues?
  • Comfort measure?
  • Emotional?

40
Calculations (oh no.not math!)
41
Assessing the patient
  • Urine
  • Skin
  • Mental state
  • MS
  • Bowel status

42
Further Assessment
  • Labs
  • BUN 7-18 mg/dl
  • Increased indicates- renal failure
  • Decreased indicates - malnutrition, over
    hydration, liver damage
  • Creatinine 0.6 1.5 mg/dl
  • Increased indicates renal failure, CHF, shock
  • Decreased indicates fluid status, dehydration

43
Lets do a care plan! CHF Patient See pg 98-100
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