Fluids and Electrolytes Review

Philippine Integrated Nurse Licensure Examination

Sample Question

The nurse is caring for a client with Congestive Heart Failure. On assessment, the nurse finds the client complaining of dyspnea and that rales are heard on auscultation. The nurse suspects fluid volume excess. Which additional sign would the nurse expect if fluid volume excess is present? A. B. C. D. Flat neck and hand veins Weight loss Increased central venous pressure Hypotension

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Fluids and Electrolytes Outline 3 concepts Fluids y Electrolytes y Acids and Bases y .

Important Concepts Remember the ABC y Safety of the patient y Maslow s Hierarchy of needs y Utilize the NURSING PROCESS A-D-P-I-E y .

renal. endocrine & GIT Balance Imbalances Application of the Nursing Process in the discussion .Summary of Subtopics y y y y y y y y Basic Definition Body Proportions and Distributions Sources Dynamics Regulation by 3 systems.

THE BODY FLUIDS y y y y y y A solution of solvent and solutes Our body is made up of fluids and solids About 50-60% of the body weight is WATER In a 70 Kg adult male: 60% X 70= 40-42 Liters Note that 1 kg body weight= 1 liter of water The body has two major compartments: 1 Intracellular 2. Extracellular .

The Proportion of Body Fluids Interstitial 15% Intracellular fluid 40% Intravascular 5% Transcellular 1-2% .

.The Intracellular Fluid y y Found inside the cell surrounded by a membrane. This is compartment with the highest percentage of water in adults.

The Extracellular Fluid y Fluid found outside the cells 1. TRANSCELLULAR FLUID Found inside body cavities like pleura. INTRAVASCULAR FLUID Found inside the blood vessels and lymphatic vessels 3. INTERSTITIAL FLUID Found in between the cells 2. peritoneum. CSF .

5 . The nurse estimates that client has gained how many liters of fluid? A. 0.5 pounds. Upon reviewing the chart.Sample question 1. 3 B. A client with CHF is assessed by the nurse. it is determined that his weight increased by 4. 2 D. 1 C.

water from foodstuffs y IVF y Medications y Blood products 2.Sources of Fluids: Fluid Input 1. Exogenous sources y Fluid intake. Endogenous sources y By products of metabolism y secretions .

Fluid Losses Routes of Fluid output y Urine Sensible losses y Fecal losses y Sweat y Insensible losses though the skin and lungs as water vapor .

The nurse understands that this fluid loss may occur through: A.Sample question 2. A nurse reads a doctor s progress notes in the client s chart which states insensible fluid loss approximately 800 ml. Urinary output C. The Gastrointestinal tract B. Wound drainage D. The skin .

Blood pressure B.Sample question A nurse is administering IVF as ordered to a patient who sustained second-degree burns. Mental status C. Peripheral pulses . Urine output D. the nurse understands that the most reliable indicator for fluid adequacy is the: A. In evaluating the adequacy of fluid resuscitation.

.Sample question The nurse receives the following endorsements. D. The client with AIDS taking corticosteroids. C. The client who has Renal failure undergoing dialysis. She is certain that which patient is at most risk for the development of fluid volume deficit? A. B. The client who came from the OR after a hemorroidectomy. The client with Rheumatic fever taking diuretics.

Fluid Dynamics The movement of fluids (solutes and solvents) in the body compartment y Diffusion y Osmosis y Filtration y Active transport .

y A solution having the same tonicity as that of body fluid or plasma is considered ISOTONIC. y A solution with high solute concentration is considered as HYPERTONIC. y .The Concept of TONICITY This is the concentration of solutes in a solution. y A solution with low solute concentration is considered as HYPOTONIC.

Helpful Hints In a HYPERTONIC solution. the cell will shrink. the cell will swell. y . y In an ISOTONIC solution. fluid will go out from the cell. fluid will enter the cell. y In a HYPOTONIC solution. there will be no movement of fluid.

y If a sugar is placed in plain water. the glucose molecules will dissolve and diffuse distribute in the solution.DIFFUSION The movement of SOLUTES or particles in a solution from a higher concentration to a lower concentration. y .

OSMOSIS The force that draws water or solvent from a less concentrated solution into a more concentrated solution through a semi-permeable membrane. y The pressure that draws water inside the vessel which is more concentrated is called Osmotic pressure. It is called ONCOTIC PRESSSURE. y . y A special type of osmotic pressure is exerted by the proteins in the plasma.

Decreased muscle tone . Chovstek s Sign C. Dry skin and sticky mucous membrane D. Hyperactive deep tendon reflex B. She suspects hypernatremia in this patient and expect to note: A.Sample question y The nurse is caring for a psychiatric patient who ingested high-sodium containing foods.

ie. y Increased hydrostatic pressure is one mechanism producing edema. y An example of this process is urine formation. y .FILTRATION The movement of both solute and solvent by hydrostatic pressure. from an area of a higher pressure to an area of a lower pressure.

y .Active transport This is the movement of solutes across a membrane from a lower concentration to a higher concentration with utilization of energy.a primarily active transport process. y Example is the Sodium-Potassium pump.

Sodium of 140 mEq/L D. Hematocrit of 58% .000 B. Which of the following laboratory findings will support this condition? A.Sample question y The nurse reviews the laboratory report of a patient with fluid volume deficit. WBC count of 9. Creatinine of 1 mg/dl C.

Obtain a serial serum Sodium level . To determine the progress of the therapy. Check the temperature periodically C.Sample question y The client is taking a high dose of Furosemide. the nurse performs which of the following important action? A. Weight the patient daily D. Monitor urinary pH B.

The Kidney y Regulates primarily fluid output by urine formation y Releases RENIN y Regulates sodium and water balance .Regulation of Body fluid balance 1.

Endocrine regulation y Regulates primarily fluid intake by thirst mechanism y ADH increase water reabsorption on collecting duct y Aldosterone increases Sodium retention in the distal nephron y ANF Promotes Sodium excretion and inhibits thirst mechanism .Regulation of Body fluid balance 2.

Regulation of Body fluid balance 3. Gastro-intestinal regulation y The GIT digests food and absorbs water y Only about 200 ml of water is excreted in the fecal material per day .

chloride.The ELECTROLYTES Electrolytes are charged ions capable of conducting electricity and are solutes in all compartment. PO4y CATIONS are positively charged ions: Sodium. magnesium. y . y ANIONS are Negatively charged ions: Bicarbonate. Potassium. calcium.

Helpful mnemonics y y y y y PI-SO Potassium is inside Phosphate is inside Sodium is outside Chloride is outside .

y Urine formation If there is little water in the body. If there is water excess. Renal regulation y Occurs by the process of glomerular filtration. . it will be eliminated.Regulation of Electrolyte Balance 1. tubular reabsorption and tubular secretion. it is conserved.

Endocrinal regulation y Hormones play a role in electrolyte regulation y Aldosterone promotes Sodium retention and Potassium excretion y ANF promotes Sodium excretion y Parathormone promotes Calcium retention and Phosphate excretion y Calcitonin promotes Calcium excretion and Phosphate excretion .Regulation of Electrolyte Balance 2.


assists in maintaining blood volume y 3.SODIUM The MOST ABUNDANT cation in the ECF Normal range is 135-145 mEq/L y Major contributor of plasma osmolarity FUNCTIONS y 1. participates in the Na-K pump y 2. assists in nerve transmission and muscle contraction y Aldosterone increases sodium retention y ANF increases sodium excretion y y .

fats and proteins y Aldosterone promotes renal excretion of K+ y Acidosis promotes exchange of K+ for H+ in the cell y y y . maintains ICF Osmolality y 2.POTASSIUM MOST ABUNDANT cation in the ICF Normal range is 3. metabolism of carbohydrates. nerve conduction and muscle contraction y 3.0 mEq/L Major electrolyte maintaining ICVF balance FUNCTIONS y 1.5-5.

cardiac function y 4. formation and mineralization of bones/teeth y 2. blood clotting y 5.5-10 mg/dL FUNCTIONS y 1. muscular contraction and relaxation y 3. enzyme activation y .CALCIUM Majority of calcium is in the bones and teeth y Normal serum range 8.

Ca+ retention and activation of Vitamin D y Calcitonin released when Ca+ is high.CALCIUM Regulation: y GIT absorbs Ca+ in the intestine with the help of Vit. it decreases Ca+ by excretion in the kidney . D y Kidney Ca+ is filtered in the glomerulus and reabsorbed in the tubules y PTH increases Ca+ by bone resorption.

MAGNESIUM Second to K+ in the ICF Normal range is 1. protein and DNA synthesis y 3. neuromuscular irritability y y .1 mEq/L FUNCTIONS y 1. intracellular production and utilization of ATP y 2.3-2.


regulates plasma osmolality y 3. acts as chemical buffer y y . together with Na+. participates in the chloride shift y 4.CHLORIDE The MAJOR Anion in the ECF Normal range is 95-108 mEq/L FUNCTIONS y 1. major component of gastric juice aside from H+ y 2.

component of bones y 2.PHOSPHATES The MAJOR Anion in the ICF y Normal range is 2.5-4.5 mg/L FUNCTIONS y 1. components of DNA and RNA y PTH decreases PO4 in blood by renal excretion y Calcitonin increases renal excretion of PO4 y . needed to generate ATP y 3.

regulates acid-base balance y 2.22-26 mEq/L FUNCTION y 1.BICARBONATES Present both in ICF and ECF y Normal range. component of the bicarbonate-carbonic acid buffer system y .

sticky tongue.IMBALANCE: EXCESS 1. thirst . IVF. diarrhea y S/SX: dry. water loss in excess of water. HYPERNATREMIA y More than 145 mEq/L y Fluid moves out of cell crenation y Etiology: sodium intake.

0 mEq/L y Etiology: IVF with K+.IMBALANCE: EXCESS 2. HYPERKALEMIA y K+ more than 5. Hyper-alimentation and K+ replacement y ECG: peaked T waves and wide QRS . acidosis.

malignancy. D.IMBALANCE: EXCESS 3. thiazide diuretic y ECG: Shortened QT interval . HYPERCALCEMIA y Serum calcium more than 10. excessive Vit. prolonged immobilization.5 mg/dL y Etiology: Overuse of calcium supplements.

Renal failure. Mg medications y S/SX: depressed tendon reflexes. RR . HYPERMAGNESEMIA y Serum magnesium more than 2.IMBALANCE: EXCESS 4.1 mEq/L y Etiology: use of Mg antacids. oliguria.

HYPERCHLOREMIA y Serum chloride more than 108 mEq/L y Etiology: sodium chloride excess .IMBALANCE: EXCESS 5.

PO4 containing medications.5 mg/dL y Etiology: Tissue trauma. osteoporosis y .IMBALANCE: EXCESS HYPERPHOSPHATEMIA y Serum PO4 more than 4. chemotherapy.

1. HYPONATREMIA y Na level is less than 135 mEq/L y Water is drawn into the cell cell swelling y Etiology: prolonged diuretic therapy, excessive burns, excessive sweating, SIADH, plain water consumption y S/SX: nausea, vomiting, seizures

2. HYPOKALEMIA y K+ level less than 3.5 mEq/L y Etiology: use of diuretic, vomiting and diarrhea y ECG: flattened , depressed T waves, presence of U waves

3. HYPOCALCEMIA y Calcium level of less than 8.5 mg/dL y Etiology: removal of parathyroid gland during thyroid surgery, vit. D deficiency, Furosemide, infusion of citrated blood y s/sx: Tetany, (+) Chovstek s (+) Trousseaus s y ECG: prolonged QT interval

Hydrochloric acid .substance that can donate or release hydrogen ions Carbonic acid.ACIDACID-BASE CONCEPTS y Acid.

ACIDACID-BASE CONCEPTS Base.substance that can accept hydrogen ions Bicarbonate y .

ACIDACID-BASE CONCEPTS y Buffer.substance that can accept or donate hydrogen Hemoglobin buffer Bicarbonate : carbonic acid buffer Phosphate buffer .

ACIDACID-BASE CONCEPTS Acid. Hydrochloric acid y Base.substance that can accept or donate hydrogen Hemoglobin buffer Bicarbonate : carbonic acid buffer Phosphate buffer y .substance that can donate or release hydrogen ions Carbonic acid.substance that can accept hydrogen ions Bicarbonate y Buffer.

Normal ph 7.Helpful Hints Carbon dioxide is considered to be ACID because of its relationship with carbonic acid y pH measures the degree of acidity and alkalinity. It is inversely related to Hydrogen.35 y Increased pH.ALKALOSIS-decreased hydrogen pH above 7.45 y .ACIDIC-increased Hydrogen pH below 7.45 y Decreased pH.35-7.

Remember a high hydrogen acidic pH is low y a low hydrogen alkalosis pH is high y a high CO2 may mean acidic y a low CO2 may mean alkalosis y .

CO2 and HCO3 are crucial in the balance. They must be constantly regulated.Dynamics of Acid and bases y y y y y Acids and bases are constantly produced in the body. . A ratio of 20:1 is maintained (HCO3:H2CO3) Respiratory and renal system are active in regulation.

. y Bicarbonate can be excreted in ALKALOTIC condition.Ways to balance the acids and bases Excretion y Acid can be excreted. and Hydrogen can be excreted in ACIDOTIC condition.

y Hydrogen can be produced in ALKALOTIC condition. .Ways to balance the acids and bases Production y Bicarbonate can be produced in ACIDOTIC condition.

.Ways to balance the acids and bases The respiratory system compensates for metabolic problems y CO2 (acid) can be exhaled from the body to normalize the pH in ACIDOSIS. y CO2 (acid) can be retained in the body to normalize the pH in ALKALOSIS.

y The Kidney can excrete H+ excess (Acidosis) to normalize the pH in ACIDOSIS.Ways to balance the acids and bases The kidney can compensate for problems in the respiratory system y The Kidney reabsorbs and generates Bicarbonate (alkaline) in ACIDOSIS. .

y The kidney can retain H+ (acid) in conditions of ALKALOSIS. y .Ways to balance the acids and bases The kidney can excrete bicarbonate (alkali) in conditions of ALKALOSIS.

Ways to balance the acids and bases Chemical buffers can also participate in the balance of acid-base y 1.bicarbonate buffer y 2. Carbonic acid.ICF and hemoglobin The action is immediate but very limited . protein buffer. Phosphate buffer y 3.

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