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Fluids and Electrolytes
Fluids and Electrolytes
Avenues
by which
water
enters
and
leaves
the body
Fluid Movements
Factors affecting Fluids and Electrolytes
Fluids and solutes constantly move within Balance
the body, which allows the body to maintain
Age
homeostasis
Climate
Fluids along with nutrients and waste
products constantly shift within the body’s Diet
compartments from the cell to the interstitial Stress
spaces, to the blood vessels and back again Illness
Types of Transport Medical treatments
A. Active transport Medications
B. Passive transport Surgery
Diffusion
Osmosis ANTIDIURETIC HORMONE REGULATION
Filtration MECHANISMS
solution until the two solutions had equal
concentrations
Ex. Half normal or 0.45%SS
Hypertonic:
Has a higher solute concentration than
another solution
Fluid from the second solution would shift
into the hypertonic solution until the two
solutions had equal concentrations
Ex. D5NSS
Assessment
CLINICAL MEASUREMENT
• Daily weights
• Each kg = 1 L of fluid
• To gain accuracy:
• Balance the scale
before each use and
weigh the client;
• At same time
each day before
breakfast after
the first void
• Wear the same
or similar
clothing
• On the same
Fluid types scale
Fluids in the body generally aren’t found in • Vital signs
pure forms • Tachycardia – first sign of
Isotonic, hypotonic, and hypertonic types hypovolemia
Defined in terms of the amount of solute or • Fluid I & O
dissolve substances in the solution • Oral fluids
Balancing these fluids involves the shifting • Ice chips
of fluid not the solute involved • Foods that tend to become
Isotonic: fluid at room temperature
No net fluid • Tube feedings
shifts occur • Parenteral fluids
between • IV meds
isotonic • Catheter or tube irrigant
solutions • Urinary output – if with diaper,
because the 1 g = 1 mL
solution are • Vomitus or liquid feces
equally • Diaphoresis
• Tube drainage
• Wound dressing or wound
fistula
concentrated
Ex. NSS or 0.9SS LABORATORY TESTS FOR EVALUATING FLUID
STATUS
Hypotonic: Osmolality – measures the solute
Has a lower concentration per kilogram in blood and
solute urine.
concentration Osmolarity – concentration of solution per
than another liter.
solution BUN – (10-20 mg/dL)made up of urea, an
Fluid from the end product of protein metabolism by the
hypotonic liver.
solution Creatinine (0.7 to 1.5 mg/dL)- end product
would shift of muscle metabolism
into the Serum electrolytes
second
CBC
Diagnosis
Fluid volume deficit
High risk for Fluid volume deficit
Fluid volume excess
Altered oral mucous membrane
• Turn the patient at least every 2
Fluid balance hours to prevent skin breakdown
The desirable amount of fluid intake and loss • Encourage oral fluids
in adults ranges from 1500 to 3500 mL each
24 hours. Ave= 2500 mL Warning Signs
Normally INTAKE = OUTPUT • Cool pale skin over the arms and legs
• Decreased central venous pressure
Fluid Imbalance • Delayed capillary refill
• Changes in ECF volume = alterations in • Deterioration in mental status flat
sodium balance jugular veins
• Change in sodium/water ratio = either • Orthostatic hypotension
hypoosmolarity or hyperosmolarity • Tachycardia
• Fluid excess or deficit = loss of fluid balance • Urine output initially more than
• As with all clinical problems, the same 30ml/min, then dropping below
pathophysiologic change is not of equal 10ml/hour
significance to all people • Weak or absent peripheral pulses
• Weight loss
FLUID DEFICIT/HYPOVOLEMIA
May occur as a result of:
• Reduced fluid intake FLUID REPLACEMENT THERAPY
• Loss of body fluids Aimed at restoring and maintaining
• Sequestration (compartmentalizing) homeostasis
of body fluids Methods:
• Oral and gastric feeding
Pathophysiology and Clinical Manifestations • Parenteral therapy
Choice of therapy affected by several factors
• Type and severity of imbalance
• Patient’s overall health status, age,
renal and cardiovascular status
• Usual maintenance requirements
Advantages
Dextrose Na Cl K Lactate
IVF
(g/L) (meq/L) (meq/L) (meq/L) (meq/L)
D5
0.9
50 154 154
%
NaCl
D5
0.15
50 25 25
%
NaCl
D5
0.3
50 51 51
%
NaCl
D5
0.45
50 77 77
%
NaCl
HYPOVOLEMIA
Nursing Intervention D5
50 25 22 20 23
• Monitor fluid intake and output IMB
• Checked daily weight (a 1lb(0.45kg) LRS 0 130 109 4 28
weight loss equals a 500 ml fluid loss)
• Monitor hemodynamic values such as NSS 0 154 154
CVP
• Monitor results of laboratory studies D5L
50 130 109 4 28
• Assess level of consciousness RS
• Administer and monitor I.V. fluids • Provides the patient with life-
• Apply and adjust oxygen therapy as sustaining fluids, electrolytes, and drugs
ordered • Immediate and predictable
• If patient is bleeding, apply direct therapeutic effects
continuous pressure to the area and • Preferred for administering fluids,
elevate it if possible electrolytes, and drugs in emergency
• Assess skin turgor situations
• Assess oral mucous membranes
• Allows fluid intake when a patient has
GI malabsorption
• Permits accurate dosage titration for
analgesics and other drugs
Administration routes
• Oral route : oral ingestion of fluids
and electrolytes as liquids or solids
administered directly into the GI tract
• Nasogastric route: instillation of fluids
and electrolytes through feeding tubes, such
as NG, gastrostomy and jejunostomy tubes
• I.V. route: administration of fluids and
electrolytes directly into the bloodstream
using continuous infusion, bolus, or I.V. push
injection through peripheral or central
venous site
Composition of Different Intravenous Solution
IV FLUIDS
Diagnostic Findings:
• Decreased hematocrit resulting from
hemodilution
• Normal serum Na level
• Low serum K and BUN levels
• either due to hemodilution or
higher levels may indicate
renal failure
• Low oxygen level
• Abnormal chest x-ray
• Indicates fluid accumulation
• May reveal pulmonary edema
or pleural effusions
Treatment
• Na and fluid intake restriction
• Diuretics to promote excess fluid
excretion
• Morphine and nitroglycerin (Nitro-
Dur) for pulmonary edema
• Dilate blood vessels
• Reduce pulmonary congestion
and amount of blood returning
to the heart
• Digoxin for heart failure
• Strengthens cardiac
contractions
Treatment
• Supportive measures
• Oxygen administration
• Bed rest
• Hemodialysis or continuous renal
replacement therapy for renal
dysfunction
• diuretics • Participates in the generation and
transmission of nerve impulses
Nursing Interventions • Is an essential electrolyte in the sodium-
• Monitor fluid intake and output potassium pump
• Monitor daily weight • RDA: not known precisely. 500 mg
• Monitor cardiopulmonary status • Eliminated primarily by the kidneys, smaller
• Auscultate breathe sounds in feces and perspiration
• Assess for complaints of dyspnea • Salt intake affects sodium concentrations
• Monitor chest x-ray results • Sodium is conserved through reabsorption
• Monitor arterial blood gas values in the kidneys, a process stimulated by
• Assess for peripheral edema aldosterone
• Inspect the patient for sacral edema • Normal value: 135-145 mEq/L
• Monitor infusion of I.V. solutions
• Monitor the effects of prescribed Potassium (K+)
medications • Major cation of the ICF. Chief regulator of
cellular enzyme activity and cellular water
ELECTROLYTES content
• The more K, the less Na. The less K, the
more Na
• Plays a vital role in such processes such as
transmission of electrical impulses,
particularly in nerve, heart, skeletal,
intestinal and lung tissue; CHON and CHO
metabolism; and cellular building; and
maintenance of cellular metabolism and
excitation
• Assists in regulation of acid-base balance by
cellular exchange with H
• RDA: not known precisely. 50-100 mEq
• Sources: bananas, peaches, kiwi, figs,
dates, apricots, oranges, prunes, melons,
raisins, broccoli, and potatoes, meat, dairy
products
• Excreted primarily by the kidneys. No
effective conserving mechanism
• Conserved by sodium pump and kidneys
when levels are low
• Aldosterone triggers K excretion in urine
• Normal value: 3.5 – 5 mEq/L
Calcium (Ca2+)
• Most abundant electrolyte in the body. 99%
in bones and teeth
• Close link between calcium and phosphorus.
High PO4, Low Ca
• Necessary for nerve impulse transmission
and blood clotting and is also a catalyst for
muscle contraction and other cellular
activities
• Needed for Vitamin B12 absorption and use
• Necessary for strong bones and teeth and
thickness and strength of cell membranes
• RDA: 1g for adults. Higher for children and
pregnant and lactating women according to
body weight, older people, esp. post-
menopausal
• Found in milk, cheese, and dried beans;
some in meat and vegetables
• Use is stimulated by Vitamin D. Excreted in
urine, feces, bile, digestive secretions, and
perspiration
• Normal value 8.5 – 10.5 mg/dl
Magnesium (Mg2+)
• Mostly found within body cells: heart, bone,
Sodium (Na+) nerve, and muscle tissues
• Controls and regulates volume of body fluids • Second most important cation in the ICF, 2nd
• Its concentration is the major determinant to K+
of ECF volume • Functions: Metabolism of CHO and CHON,
• Is the chief electrolyte of ECF protein and DNA synthesis, DNA and RNA
• Influence ICF Volume transcription, and translation of RNA,
maintains normal intracellular levels of
potassium, helps maintain electric activity in
nervous tissue membranes and muscle Diagnostic Title Possible Etiologic
membranes Factors
• RDA: about 18-30 mEq; children require Deficient fluid volume Active fluid volume loss
larger amounts (hemorrhage,
• Sources: vegetables, nuts, fish, whole diarrhea, gastric
grains, peas, and beans intubation, wounds, diaphoresis),
• Absorbed in the intestines and excreted by inadequate fluid intake, failure of
the kidneys regulatory mechanisms,
• Plasma concentrations of magnesium range sequestration of body
from 1.5 – 2.5 mEq/L, with about one third of fluids
that amount bound to plasma proteins
Excess Fluid Volume Excess fluid intake,
NURSING MANAGEMENT OF PATIENT WITH excess sodium intake,
FLUID AND ELECTROLYTE IMBALANCES compromised regulatory
processes