Professional Documents
Culture Documents
Fluid Electrolytes and Acid Base Balance
Fluid Electrolytes and Acid Base Balance
imbalance
-Objectives:
Homeostasis:
The ability of the body to maintain internal balance. All organs and structure of the body are involved in the
maintenance of homeostasis
1. Kidneys
2. Lungs
3. Heart
4. Adrenal glands
5. Parathyroid glands
6. Pituitary gland.
Balance :
1
Composition of Body Fluids and Major Electrolyte Content in Body Fluid
A. Water
B. Solutes ( dissolved particles)
1. Disturbances in water, electrolyte and acid-base balance occur in a wide variety of diseases and can be
associated with a high mortality and require urgent assessment and treatment.
2. The kidneys play an important part in maintaining normal water, electrolyte and acid-base balance .
3. When fluid balance is critical, all routes of gain and all routes of loss must be recorded and all volumes
compared.
4. Organs of fluid loss include the kidneys, skin, lungs, and gastrointestinal (GI) tract.
Cations Anions
Cations Anions
2
Average Daily Intake and Output in an Adult
INTAKE OUTPUT
Skin 600 mL
Total gain* 2,600 mL Total loss* 2,600 mL
1. Excess Na intake
2. Rapid administration of hypertonic/isotonic fluids
3. Increased release of ADH
4. Decreased plasma proteins
5. Chronic Kidney Diseases
6. Acute Renal Failure
7. Heart failure
5. Auscultate lungs and heart sounds & assess breath sounds at regular intervals, particularly when
parenteral fluids are being administered.
6. Measure intake and output at regular intervals to identify excessive fluid retention. note urine
output and fluid balance on 24 hour.
7. Weigh the patient daily and acute weight gain is noted. An acute weight gain of 0.9 kg represents a
gain of approximately 1 L of fluid.
1. PREVENTING FVE
a. Sodium restricted diets, and adherence to the prescribed diet is encouraged.
b. The patient is instructed to avoid over the-counter medications without first checking with a
health care provider because these substances may contain sodium
2. II-DETECTING AND CONTROLLING FVE
a. Promoting rest
b. Restricting sodium intake
c. Monitoring parenteral fluid therapy, and administering appropriate medications (diuretics).
d. If dyspnea or orthopnea is present, the patient is placed in a semi-Fowler’s position to promote
lung expansion.
e. The patient is turned and positioned at regular intervals because edematous tissue is more
prone to skin breakdown than normal tissue.
3. Give oral fluids with caution
4. Monitor infusion of fluids
5. Encourage deep breathing exercise
6. Provide safety precautions
7. Assist with identification and treatment of underlying cause
8. Monitor lab studies
Causes:
1. Decreased BP and postural hypotension (ie, a drop in systolic pressure exceeding 15 mm Hg when
the patient moves from a lying to a sitting position).
4
2. Weak , rapid pulse
3. Flattened neck veins
4. Decreased urine volume of less than 30 mL/h in an adult
5. Tingling of extremities
6. Increased RR, rapid shallow breathing
7. Weight loss:
a. One liter of fluid weighs approximately 1 kg
b. i.e. an acute loss of 0.5 kg represents a fluid loss of approximately 500 mL.
I-PREVENTING FVD
2. For example, if the patient has diarrhea, diarrhea control measures should be implemented and
replacement fluids administered.
3. These measures may include administering antidiarrheal medications and small volumes of oral
fluids at frequent intervals.
II-CORRECTING FVD
1. Oral fluids are administered to help correct FVD, and select fluids most likely to replace the lost
electrolytes
2. If the patient is reluctant to drink because of oral discomfort, the nurse assists with frequent mouth
care and provides nonirritating fluids.
5
3. If the patient cannot eat and drink, the nurse may need to administer fluid by an alternative route
(enteral or parenteral) prescribed to prevent renal damage related to prolonged FVD.
4. Assist with identification & treatment of cause
5. Monitor laboratory studies
6. Administer IV solutions as indicated
7. Administer sodium bicarbonate, if indicated
8. Provide tube feedings, including free water
9. Turn frequently, massage skin and protect bony prominences
10. Provide skin and mouth care
11. Apply lotion as indicated
12. Provide safety precautions
Sodium
1. NV = 135-145 mEq/L
2. Is the major cation of ECF
3. Important for Neuromuscular conduction/transmission of impulses
4. Maintains acid-base balance
Hyponatremia
Causes:
1. Neurological:
a. Lethargy, headache, confusion, apprehension, depressed reflexes, seizures and coma
2. Muscle:
a. Cramps, weakness, fatigue
3. Gastrointestinal:
a. Nausea, vomiting, abdominal cramps, and diarrhea
Hypernatremia
Causes of Hypernatremia:
1. Hypertonic IV soln.
2. Oversecretion of aldosterone
3. Loss of pure water:
a. Long term sweating with chronic fever
6
b. Respiratory infection → water vapor loss
c. Diabetes – polyuria
4. Insufficient intake of water (hypodipsia)
1. Thirst
2. Lethargy
3. Neurological dysfunction due to dehydration of brain cells
4. Decreased vascular volume
Hypokalemia
Causes :
1. Decreased intake of K+
2. Increased K+ loss
a. Chronic diuretics
b. Acid/base imbalance
c. Trauma and stress
d. Increased aldosterone
e. Redistribution between ICF
and ECF
Hyperkalemia
Causes:
1. Renal disease
2. Massive cellular trauma
3. Insulin deficiency
4. Addison’s disease
5. Potassium sparing diuretics
6. Decreased blood pH
7
7. Exercise causes K+ to move out of cells
Calcium
2.1 – 2.6 mEq/L (ionized calcium)
Essential for:
1. Bone formation/reabsorption
2. Neural transmission/muscle contraction
3. Coenzyme in blood coagulation
4. Ionized Ca is the active form
Hypocalcemia
Caused by:
1. Renal failure
2. Lack of vitamin D
3. Suppression of parathyroid function ( PTH)
4. Hypersecretion of calcitonin
5. Malabsorption states
6. Abnormal intestinal acidity and acid/ base bal.
7. Widespread infection or peritoneal inflammation
Manifestations:
Hypercalcemia
Causes:
1. Hyperparathyroidism ( PTH )
2. Hypothyroid states
3. Renal disease
4. Excessive intake of vitamin D
5. Milk-alkali syndrome
8
6. Certain drugs
7. Hypercalcemia of malignancy
Clinical manifestations:
9
Acid-Base Balances
Normal PH = 7.35 - 7.45 (slightly alkaline)
10
11
Nursing Assessment & intervention for acid-base imbalance:
Good luck
12