Fluids and Electrolytes Outline A PDF

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Fluids and Electrolytes Outline The balance of fluids in the body is called homeostasis and is influenced by many factors. Fluids mainly consist of water, electrolytes and minerals, constantly moving in and out of cells in the body. Fluid inside the cells is called intracellular fluid, or ICF. Fluid outside the cells is extracellular fluid (ECF). Fluid Intake and Output Fluid and Electrolyte Regulation 

Osmosis - passive movement of fluid across a membrane from an area of lower solute concentration to an area of higher solute concentration

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Diffusion - form of passive transport that moves solutes from higher to lower concentration

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Filtration - movement of fluid through capillary walls through hydrostatic pressure

Organs in regulating fluid volume and electrolyte balance to maintain homeostasis. - brain, adrenal glands, and the kidneys Indicators of Fluid Status - VS, hydration, weight change, skin turgor Age-Related Changes - impaired thirst perception; decreased glomerular filtration rate; alterations in hormone levels, including antidiuretic hormone, atrial natriuretic peptide, and aldosterone; decreased urinary concentrating ability; and limitations in excretion of water, sodium, potassium, and acid Infants – Up to 6 months old have mothers’ immunity that is why vaccinations are start directly after birth. Infant needs to gain their own immunity as soon as possible. Infants are at higher risk for dehydration because they have immature kidneys an can’t drink fluid own their own. Osmolality - # of millimoles per kg Osmolarity – Millimoles found in 1L of solution Range = 270-300 mOsm / Mid-range = 290 mOsm BUN (Blood Urea Nitrogen)- measure nitrogen portion in the urea and serves as measure of glomerular function. Normal level = 8-21 mg/dL. Decreased BUN can be seen in SIADH, liver failure, & malnutrition Creatinine- kidney output; breakdown of muscle. Normal range 0.5-1.2 md/dL. Normal ratio Bun to creatinine is 10:1 to 20:1. Specific Gravity – measure od dissolved chemicals in urine and reflects the ability of kidneys to concentrate urine and is affected by # and size of particles (minerals and salts) in urine. Normal range is 1.005-1.030. Higher can be seen in SIADH pt. Lower can be seen with diuretic use, Diabetes Insipidus, and increased fluid intake. Fluid Volume Status – Decreased Plasma Volume = Dehydration / Increased Lab Concentration = Hct, Na+, BUN, Serum Osmolality, Urine Specific Gravity

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“Mary had a little lamb and everywhere Mary went, the lamb was sure to go.” Mary is salt (NaCl) and the lamb is water. Everywhere salt goes, water follows. Fluid Volume Deficit (FVD): Hypovolemia = Dehydration

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Causes - poor fluid intake, excessive fluid loss (vomiting, diarrhea, hemorrhage or excessive diuretic therapy) and third space loss of fluid (where fluid remains within the body but has shifted from the intravascular space to another compartment within the body Lab values - increased hct, serum osmolarity, urine-specific gravity, serum sodium Clinical manifestations - tachycardia, thready pulse, orthostatic hypotension, tachypnea, hypoxia, dizziness, syncope, confusion, weakness, fatigue, increased R, thirst, dry tongue, N/V, anorexia, and acute weight loss, oliguria, diminished capillary refill, dry skin, poor skin turgor, flattened neck veins Medical management - IV fluids and possibly blood transfusions may be necessary Complications - Hypovolemic Shock Nursing management - monitor daily weight and VS, assess skin turgor, monitor I&O's, lab values, level of consciousness, maintain client safety, and administer oral and IV fluids as ordered, provide frequent mouth care, prevent skin breakdown, change positions slowly, avoid alcohol and caffeine

Signs and Symptoms: Weight loss Loss of skin turgor Concentrated urine output Oliguria (low urine output) Thirst Dry mucous membranes Weak, rapid peripheral pulses Flattened neck veins Hypotension Anxiety Restlessness Cool, clammy, pale Skin **Severe rapid fluid loss may be seen in hemorrhage, burns, or extensive losses from GI tract

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Fluid Volume Excess (FVE): Hypervolemia = Overhydration

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Causes - compromised regulatory system (HF, kidney disease, cirrhosis), overload of fluids (oral, enteral, IV), fluid shifts that occur following burns, prolonged use of corticosteroids, severe stress, hyperaldosteronism Lab values - decreased Hct and Hgb, decreased blood osmolarity with water/fluid excess, decreased urine sodium and specific gravity, decreased BUN due to plasma dilution Clinical manifestations - tachycardia, bounding pulse, hypertension, tachypnea, weakness, visual changes, paresthesia’s, altered level of consciousness, seizures (if severe), ascites, increased motility, crackles, cough, dyspnea, peripheral edema Medical management - Chest x-ray to reveal possible pulmonary congestion, respiratory services and pulmonology can be consulted Complications - Pulmonary edema Nursing management - Monitor I&O's, daily weight, peripheral edema, blood sodium and potassium levels, assess breath sounds, maintain sodium restricted diet as prescribed, encourage rest, position in semi-fowler's

Signs and Symptoms: Hypertension Tachycardia Elevated Central Venous Pressure Development of S2 Heart Sounds Juglar vein distention Weakness

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Sodium: Hyponatremia

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“No Na+”: < 135 mEq/L

Causes - excessive sweating, diuretics, wound drainage, NG tube suction of isotonic gastric contents, decreased secretion of aldosterone, hyperlipidemia, kidney disease, inadequate sodium intake, hyperglycemia N = Na+ excretion increase with frenal problems, NG suction, vomiting, diuretics, sweating, diabetic insipidus, aldosterone secretion O = Overload of fluids (CHF, Hypotonic Fluids, Liver failure) N = Na+ intake is low thru low salt diet or NOP status A = Antidiuretic hormone over secreted (SIADH) adrenal insufficiency

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Lab values - blood sodium 2.6 mg/dL Clinical manifestations - lethargy, ECG changes; prolonged PR and QT interval and QRS complex wide, diminished DTR's, hypotension, arrhythmias, respiratory arrest, N/V, impaired breathing, cardiac arrest Medical management - IV administration of calcium gluconate and possibly furosemide Complications - severe hypermagnesemia can lead to cardiovascular complications Nursing management - monitor cardiac, respiratory, GI, neuro, and renal status, place patient on cardiac monitor, ensure safety, discourage foods high in magnesium (avocado, green leafy vegetables, oatmeal, fish, cauliflower, legumes, milk)

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Calcium: Hypocalcemia – Low: Serum Ca++ < 8.2 mg/dL

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Causes - inadequate intake of calcium, diarrhea or steatorrhea, inadequate vitamin D intake, end-stage kidney disease, wound drainage Lab Values - calcium level 4.5 mg/dL Clinical manifestations - hypocalcemia, confused, hyperactive DTR's, anorexia, muscle spasms, seizures, positive Trousseau's and Chvostek's sign Medical management - administration of phosphate binders Complications - acute hypocalcemia with possible tetany and, more rarely, acute deposition of calcium/phosphate complexes into joints Nursing management - administer PhosLo with food; works on the GI system, do not give phosphate laxatives or enemas, restrict foods high in phosphorus (fish, nuts, chicken, beef, whole grains), prepare for dialysis

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