Chapter 12

Fluid Volume and Electrolytes

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 Homeostasis
 Fluid occupies almost 60% of the weight of
an adult. Body fluid is located in two fluid
compartments: the intracellular space and
the extracellular space. Electrolytes in body
fluids are active chemicals or cations that
carry positive charges and anions that carry
negative charges.
 Maintenance of proper equilibrium -
Maintaining fluid and electrolyte
homeostasis is essential for normal
functioning of the body.
 Intracellular fluid
 Extracellular fluid - surrounds the cell
 Interstitial compartment
2

 Intravascular compartment 2
Fluid Volume
and Electrolyte
Replacement
 Osmolality of body
fluids
 Isoosmolar
 Hypoosmolar
 Hyperosmolar

 Tonicity
 Measurement of
concentration of IV
solutions compared
with osmolality of
body fluids

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  Homeostasis
Fluid Volume  Anions and cations balanced

and  Fluid compartments in osmotic

equilibrium

Electrolyte  Fluid and particle movement

Replacement
 Osmosis
 Diffusion

(Cont.) 


Hydrostatic pressure
Active transport

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  Fluid replacement considerations
Fluid Volume  All routes of fluid intake and loss

and 


Daily water requirements
Water, electrolyte, and protein
Electrolyte requirements
Patient’s weight, caloric needs
Replacement


 Body surface area

(Cont.)  Illness
 Surgery

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Fluid Volume
 Types of IV solutions
 Crystalloids

and  Isotonic

Electrolyte
 Hypotonic
 Hypertonic

Replacement  Colloids
Blood and blood products
(Cont.)


 Lipid emulsion

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  Crystalloids uses
 Short-term maintenance therapy

Fluid Volume
 Treat dehydration and electrolyte
imbalance

and  May be isotonic, hypotonic,

hypertonic

Electrolyte  Examples

Replacement
 Dextrose5 in water (D5W)
 Isotonic (unless continuous or

(Cont.)
rapid)

 Normal saline solution (0.9% NSS)

 Isotonic solution

 Lactated Ringers

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Fluid Volume
and  Colloids volume expanders

Electrolyte
 Dextran solutions
 Albumin

Replacement  Hetastarch

(Cont.)

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 Fluid Volume and
Electrolyte
Replacement (Cont.)

 Blood and blood

products
 Whole blood
 Packed red blood cells
 Plasma
 Platelets
 Lipid emulsion

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 Nursing Process: Fluid Imbalance

Assessment Nursing diagnoses

Identify patients at risk for fluid volume deficit and excess Fluid volume, deficient related to fluid loss, and/or inadequate fluid intake
Assess patient’s vital signs, lab values, and note baseline values Fluid volume, deficient related to altered regulatory mechanisms, and excess fluid or sodium intake

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Nursing Process: Fluid Imbalance
(Cont.)
The patient will exhibit
balanced fluid volume.
Planning The patient will have
balanced intake and output
over 24-hour period.

Ensure prescribed amount of

Nursing IV fluid infuses hourly.
Monitor for signs and
interventions symptoms of fluid volume
deficit.

Evaluation

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Fluid Volume
and Electrolyte
Replacement
 Electrolytes
 Potassium
 Major intracellular
cation
 Sodium
 Major ECF cation
 Calcium
 Magnesium
 Chloride
 Phosphorus
(phosphate)

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  Electrolyte functions
Transmission and conduction of
Fluid Volume

nerve impulses

and  Contraction of cardiac, skeletal,

and smooth muscles

Electrolyte  Normal kidney function

Change carbohydrates to energy
Replacement


 Change amino acids to protein

(Cont.)  Role in acid–base balance

 Regulates osmolality of cellular
fluids

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Fluid Volume and Electrolyte
Replacement (Cont.)
Potassium normal
serum range
3.5 to 5.0 mEq/L

Functions

Less than 3.5 mEq/L

Hypokalemia
Signs and symptoms

More than 5.0 mEq/L

Hyperkalemia
Signs and symptoms

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  Correction of potassium
Fluid Volume deficit and excess

and  Administration
Oral, IV (must be diluted)
Electrolyte


 Foods high in potassium

Replacement  Fruits, fruit juice, vegetables

(Cont.)  Drug effect on potassium

balance

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  Assessment
 Assess patient for signs and symptoms of

Nursing 
potassium imbalance
Assess potassium level
Process:  Nursing diagnoses

Potassium  Knowledge, deficient related to drugs and

foods affecting potassium level
 Cardiac output, decreased related to
excess serum potassium

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  Planning
 The patient’s serum
potassium level will be WNL.
 Nursing interventions
Nursing  Give oral K with at least 8

Process:
oz water or juice.
 Administer K-containing IV

Potassium solutions via a calibrated

infusion pump.
 Monitor K levels frequently.
 Monitor ECG.
 Evaluation

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Fluid Volume and Electrolyte
Replacement
Sodium normal serum range 135 to 145 mEq/L

Function

Hyponatremia: less than 135 Signs and symptoms

mEq/L Correction of a sodium deficit

Hypernatremia: more than 145

mEq/L Signs and symptoms

Foods high in sodium

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 Nursing Process: Sodium

Assessment Nursing diagnoses

Check patient’s serum sodium imbalance. Fluid volume, imbalance (excess) related to water retention
Assess the patient for signs and symptoms of sodium imbalance. Fluid volume, imbalance (deficit) related to nasogastric suctioning

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Nursing Process: Sodium (Cont.)

The patient’s serum

Planning sodium level will be
WNL.

Instruct patient on signs and

Nursing symptoms of hyponatremia
and hypernatremia.
interventions Monitor serum sodium levels
and report abnormal levels.

Evaluation

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  Calcium normal serum range
 8.6 to 10.2 mg/dL
 Function

Fluid Volume  Hypocalcemia

 Less than 8.6 mg/dL
and  Signs and symptoms

Electrolyte
 Bone fractures, anxiety, irritability,
tetany

Replacement  Hypercalcemia
 More than 10.2 mg/dL
 Signs and symptoms
 Clinical management of calcium
imbalance

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 Nursing Process: Calcium

Assessment Nursing diagnoses

Check serum calcium levels. Nutrition, imbalance: less than body requirements related to GI discomfort
Assess for signs and symptoms of calcium imbalance Tissue integrity, impaired related to numbness and tingling of hands
Obtain baseline vital signs and ECG readings

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Nursing Process: Calcium (Cont.)

The patient’s serum

calcium level will be WNL.
Planning The patient’s tetany
symptoms will cease.

Monitor serum total calcium

Nursing and ionized calcium levels.
Monitor vital signs and report
interventions abnormal findings.
Monitor ECG.

Evaluation

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Fluid Volume and Electrolyte
Replacement
Magnesium normal
serum range
1.5 to 2.5 mEq/L

Function

Less than 1.5 mEq/L

Hypomagnesemia Signs and symptoms
Foods high in magnesium

More than 2.5 mEq/L

Hypermagnesemia
Signs and symptoms

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  Assessment
 Check serum magnesium level
 Assess the patient for signs and
symptoms of magnesium
Nursing imbalance
Nursing diagnoses
Process:


 Nutrition, imbalance: less than

Magnesium body requirements related to

insufficient intake of magnesium-
rich foods
 Cardiac output, decreased related
to hypomagnesemia or
hypermagnesemia

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  Planning
 The patient’s serum magnesium

Nursing 
level will be WNL.
Nursing interventions
Process:  Monitor serum magnesium results.

Magnesium 


Monitor vital signs.
Monitor urine output.
(Cont.)  Check for Trousseau and Chvostek
signs of severe hypomagnesemia.
 Evaluation

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  Chloride
 Principal anion in ECF
Fluid Volume  Normal serum range

and 
 96 to 106 mEq/L
Functions
Electrolyte  Hypochloremia

Replacement  Signs and symptoms

 Hyperchloremia
 Signs and symptoms

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  Phosphorous
 Major anion in ICF
Fluid Volume  Normal serum range

and  2.4 to 4.4 mEq/L

Functions
Electrolyte


 Hypophosphatemia
Replacement  Signs and symptoms

(Cont.) 


Foods high in phosphorous
Hyperphosphatemia
 Signs and symptoms

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 Which are manifestations of
hypocalcemia? (Select all that apply.)

Practice A. Twitching of the mouth

Question #1 B. Seizures
C. Urinary retention
D. Carpopedal spasms

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