Fluid and Electrolyte REVIEWER

Basics (7)
- Processes
- Assessment
- Dx test
Fluid Volume Problems (3)
Electrolyte imbalances (7)
Acid-Base Imbalance (12)

BASICS
-​
- Body is composed of: WATER AND ELECTROLYTES
Homeostasis: Normal volume, composition, distribution, and
pH of body fluids
FUNCTIONS OF WATER IN BODY
1. Hydrates brain cells
2. Lubricate skin and tissues
3. Helps digestion and metabolic functions
4. Eliminates toxins
5. Provides elasticity to muscles and joints
6. Reduces water retention
7. Generates energy
8. Oxygenates blood and lungs
9. Fluidifies blood and reduce arterial pressure
10. Regulates body temperature
11. Prevents loss of calcium
ACCORDING TO LEMONE
1. Provides a medium for the transport and exchange of nutrients
and other substances 

2. Provides a medium for metabolic reactions 

3. Regulation of body temperature 

4. Provides form for body structure; acts as a shock absorber 


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 5. Provides insulation 

6. Acts as a lubricant 

TOTAL BODY FLUID
60% - total body weight
100% - fetus
80% - baby at birth
70% - Normal adult
50% - elderly person

FACTORS INFLUENCING AMOUNT OF BODY WATER

1. Age
2. Gender
3. Body fat

ELECTROLYTES
Cations: (+)
Anions: (-)
FUNCTIONS
1. Assist in water regulation
2. Regulate/maintain acid-base
3. balance
4. Contribute to enzyme reactions
5. Essential for neuromuscular activity

*Intracellular Fluid/Compartment
- K is the most abundant cation
- PO4 is the most abundant anion
*Extracellular Fluid/Compartment
- Na is the most abundant cation
- Cl is the most abundant anion
*Electrolytes are expressed in terms of mEq/L – a measure of
the ions chemical activity or its power.

-Men has more water

-Body composition: Water, electrolytes, molecules

-study about osmolarity and osmolality

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 -Normal levels sodium, potassium, calcium EVERYTHING and
units
-Osmosis, Diffusion

Hypertonic: shrink
Hypotonic: swell
Isotonic:

What process does not increase water?

Specific gravity?
Fluid volume deficit: weak and fray, dry, poor skin turgor, dry
mucus, cold clammy, flat, CVP: low
Fluid volume excess: High BP, pulse, temp could be high, moist
skin, distended neck vein, tout/ edematous, CVP: high.

Possible cause fluid volume excess: drinking too much water,

increase sodium intake, liver cirrhosis, nephrotic syndrome,
heart failure
Possible cause fluid volume deficit: diarrhea, diabetes insipidus,
DM,

-Edema grading
Fluid accumulation: electrolytes go down, dilution of
electrolytes, water intoxication

-Hyponatremia: results in brain swell so give hypertonic

-Hypernatremia: HYPOTONIC

If pseudohyperkalemia : RETEST
What is medical management: Kayexillate, insulin with glucose,
insulin dextrose (brings back K back to the cell)

Hypocalcemia: CAUSED BY: hypoparathyroidism, surgical

removal or damage of the parathyroid, MANIFESTATION:
everything is sensitive, spasm, tachycardia, tetany, chvostek,
diarrhea, breathing problems TREATMEANT: calcium
gluconate, vit D, calcium rich food, green leafy vegetables

Hypercalcemia: everything is slow CAUSED by:

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 hyperparathyroidism, immobility, cancer of the bones
MANIFESTATIONS: constipation, depression of breathing,
behavioral changes Tx: Calcitonin, diuretics, phosphate

NO MAGNESIUM NO CHLORIDE

CHVOSTEK - CHEEK TRASSEU - HAND

ABG Analysis: Allen’s test. Normal values pH, CO2, HCO2,

Oxygen

Respiratory Acidosis: asthma, copd, shallow breathing

ACCUMULATION OF CO2, Kidney will reabsorb carbonate
MANIFESTATIONS: Hyperventilation, tachycardia, warm
flushed feeling, lethargic, coma, death Tx: Oxygen
supplementation, bronchodilators, semi-fowlers, narcotics
antagonist, Sodium bicarbonate

Respiratory alkalosis: Caused by: hyperventilation. Anxiety,

aspirin overdose MANIFESTATIONS: decreased cerebral blood
flow, numbness tingling sensation, hypocalcemia (Spasm), less
hydrogen more protein bound, Tx: SHALLOW BREATHING,
breathe slowly, salt,

Metabolic acidosis: Caused by: diarrhea, diuretics, fistula,

aspirin overdose, ketoacidosis from DM, Tx: Sodium
bicarbonate, increase fluid, insulin

Metabolic alkalosis: caused by: vomiting MANIFESTATIONS:

same as respiratory alkalosis Tx: ACIDIC stuff, cranberry,
sodium bicarbonate

KIDNEY: Size: 10cm length 5cm in width 2.5 thickness

Reddish brown. Layers: renal cortex, medulla, hilus

Renal cortex has: nephrons

Medulla: tubules

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 Pelvis: calluses

Protective layers: outer renal fascia, adipose tissue, capsules

ASSESSMENT: Urine: Amber, 4.5-8 (pH), aromatic, no

glucose, no ketones, 2-3 RBS, <5 WBC, clear

Urinalysis: delay: fridge, or cool box

History taking: Pain in flank, dull : KIDNEYS STUDY PAINS

UTI
Cause: E.Coli
Risk: shorter urethra MANIFESTATIONS: backpain, Dysuria,
pyuria, fever and chills, dehydration, frequency, urgency,
hesitancy Tx: increase fluid 2-3L, acid ash diet, Management:
Pyridium (DISCOLORATION ORANGE COLOR, if skin and
sclera becomes orange: discontinue), Hot compress,

RENAL Carcinoma: STUDY THE STAGES, Tx: Nephrectomy,

radiation, chemotherapy NEPHRECTOMY: NORMAL
OUTPUT, radical. TOTAL Nephrectomy: less output but after 1
day: normal output

Glomerulonephritis: Acute: BY GABS: BUN and Creatinine

increase in blood decrease in urine. Mx: increase fluid intake,
antibiotic, corticosteroids, low sodium, low protein (azotemia),
low potassium

Nephrotic syndrome: hypoproteinuria, hyperlipidemia, WHAT

IS THE OTHER TRIAD?? Normal to hypotension. DIET:
Moderate protein, low fat, low sodium (because of anasarca)
care with anasarca? No adhesive, turning, positioning

SIGNS OF SHOCK: Increase raas, hypotension, tachycardia,

tachypnea, fast then eventually slow, cold clammy skin,

Chronic renal failure: GRADE?

CAUSE: agn, nephrotic syndrome, pre-renal, intra-renal, post-

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 renal (STUDY THIS TOO BITCH)

STAGE 4: ENDSTAGE --- HEMODIALYSIS: weigh client,

V/S, care for fistula: listen for bruit and feel for thrill, fistula has
to mature 1-6 weeks, no jewelry, watch, no constrictive clothes,
no cuff

What is hemodialysis indicated to? Uncontrolled acidosis,

hyperkalemia, excessive edema
Hemodialysis can correct hyperkalemia, acidosis, increased
BUN and creatinine, NOT ANEMIA, NOT IMMUNE
SUPPRESSION,
COMPLICATIONS: loss of water, disequilibrium,
hypoelectrolytes TX: RRT (criteria for recipient: should live
longer after transplant, should not have immune problem or
cancer, should not be too old or young… FOR DONOR:
compatibility, no cancer, no diseases, psychosocial should be
intact. DEAD: continuous kidney circulation, not old, no
infection, no cancer, no diseases)

Bladder cancer: MANIFESTATION: Painless hematuria XRAY,

CT SCAN, MRI CYSTOSCOPHY
Right after cystoscophy: pinkish urine 1-2 days. If chills,
infection. Watch out for infection.
Bladder cancer can affect psychosocial status: anxiety, change in
role, presence of stoma. STOMA:When younger 40, use body
image disturbance. If 50: situational low self-esteem.

CALCULI: CAUSES OF EACH TYPES! MANIFESTATIONS:

Pain – first concern. XRAY, With dye, check for allergies,
WITH IVP: ENEMA, NPO FOR 8 HOURS, CHECK FOR
IODINE. POST: increase fluid,

Peritoneal dialysis: introduce – 10-15mins of 2L and stay for

20mins taken out in 10mins. WEIGH, V/S. During outflow:
dialesate should be clear yellow. If cloudy, infection. If
brownish, poop perforation. Board like abdomen: peritonitis.
During outflow, if not 2L and stops, turn client from side to side.

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