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Fluid and Electrolytes
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Fluid and Electrolytes

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  • State of equilibrium of the internal environment of the body that is maintained by dynamic processes of feedback and regulation. Homeostasis is a dynamic equilibrium Homeostasis is maintained by fluid and electrolyte shifts Water moves between spaces and compartments depending on the types and amounts of solutes within the body Homeostasis is maintained by fluid and electrolyte shifts Water moves between spaces and compartments depending on the types and amounts of solutes within the body Homeostasis is maintained by several organs Kidneys Lungs Heart and blood vessels Pituitary, parathyroid and adrenal glands Skin GI tract Water Primary component within the human body 50-60% of adult body weight
  • Percentage of water decreases with age. Makes infants and the elderly high risk
  • Water is vital to the body to: Transport chemicals and nutrients to cells and tissues Excrete wastes Be a medium for biochemical reactions Regulate body temperature Cushion organs and joints Preserve homeostasis by intake and output of water
  • Combine 5 and 6 and scan in picture page 4
  • Cell membrane separates these compartments Constant state of interaction with each other Intracellular Fluid (ICF) Fluid within the cells 2/3 of body fluid Approximately 25 liters of fluid in the adult Primary cation in the ICF is K + Anions in the ICF: Cl-, phos-, bicarb Extracellular Fluid (ECF) Spaces outside the cells 1/3 of the total body fluid Approximately 15 liters of fluid in the ECF with 12 liters in the interstitial space and 3 liters of plasma Primary ECF cation is Na+ Primary ECF anion is Cl- Functions Maintain cell membrane permeability Vehicle for movement of components to various areas of the body Intravascular fluid (IVF) Interstitial fluid (ISF) IVF ==plasma Plasma contains serum, protein, and chemical products ISF== Solutions in the small spaces and gaps between body structures, cells, and tissues Lymph and water Transcellular fluid Mucous, ocular fluids, sweat, secretions of GU tract, cerebrospinal fluid, pleural, pericardial, and peritoneal secretions. Usually not significant gains and losses in a day.
  • Fluids in the body are not found in pure forms. Usually in three types of solutions. Isotonic fluids have the same solute concentration as another solution so they are in balance and no fluid shift occurs. It can cause increased extracellular fluid volume, which can result in circulatory overload. Hypotonic fluids have a lower solute concentration than another solution so fluid would move from a lower concentration to a higher concentration until they are equal. It can lower the osmotic pressure, causing fluid to invade the cell. Hypertonic fluids have a higher concentration of solute than another solution so fluid would shift from the second to the first Higher solutions to make them equal in concentration. It can increase the osmotic pressure of the blood plasma, drawing fluid from the cells.
  • Movement of particles or ions (solute) Diffusion : movement of ions or particles in random motion across a semi permeable membrane from an area of higher concentration of particles to an area of lower concentration of particles Example: O2 diffuses from an alveolus in a lung where the concentration greater, across the blood capillary membrane, into a red blood cell where it is in lesser concentration Do lump of sugar in the water Movement of fluid Osmosis : the movement of fluid through a semi permeable membrane from an area of low particle concentration to an area of high particle concentration Example: Dehydration leads to a greater concentration of electrolytes (particles) in the ECF, so water flows from the ICF into the ECF to dilute the particles.
  • Active Transport -solutes move from an area of lower concentration to an area of higher concentration. Like swimming upstream ATP- Adenosine triphosphate—stored in all cells, supplies the energy for solute movement in and out of cells. Sodium-Potassium pump—specialized physiologic pump Sodium-potassium pump: sodium moves from outside the cell in and potassium from inside the cell out. The pump moves larger volumes of the electrolyte than diffusion which requires no energy. Keeps Na and KCl from becoming equal in all fluids Needed for transmission of electrical impulses Other solutes that require ATP are Calcium, hydrogen, amino acids, and certain sugars. Filtration : movement of particles and water through a semi permeable membrane from an area of higher pressure to an area of lower pressure Capillary filtration- movement of fluid and solutes through the capillaries results from blood pushing against the walls of the capillary. That pressure is called hydrostatic pressure and is greater the the pressure in the surrounding interstitial space, when it is less, fluids and solutes move back into the capillary.
  • Renal — Excrete or retain water and wastes Cardio - - Need adequate BP for kidneys to work Pumps blood and nutrients throughout the body and organs Lymph – Removes excess fluid from intravascular system into the lymph and returns it again. Edema Nervous – Baroreceptors in aortic arch, veins, atria, respond to volume change and stimulate the pituitary to secrete ADH Respiratory – Removes water from the body with respirations and controls oxygen and carbon dioxide exchange ADH acts directly on the collecting ducts and tubules of the kidneys to reabsorb water Aldosterone maintains water balance by regulating sodium metabolism in the kidneys With decreased blood flow, aldosterone causes sodium retention and in turn water retention
  • GI – absorbs water and nutrients from the gut. Or can lose large amount in illness Skin – perspiration Endocrine – Antidiuretic hormone (ADH) or vasopressin –secreted by the pituitary and regulates water retention and excretion Responds to increase in Na levels, reduced blood volume, hypertonicity, or diminished circulation. If hypotonic situation , then ADH is inhibited and diuresis can occur Aldosterone – secreted by the adrenal glands, regulates distal tubular reabsorption of Na by the kidneys thus increasing blood volume Stimulates K secretion into the tubules and ducts of the kidneys Thyroid – influences metabolic rate and blood flow Also stores and releases calitonin, which assists in regulating calcium levels Parathyroid – regulates calcium and phosphate level by acting on the bones, to move Ca from bone to blood 2) acts on kidneys and gut to reabsorb Ca if bones are deficit 3) Phosphate is stimulated to be reabsorb in the kidneys or be excreted in urine
  • Acid - any substance that releases hydrogen ions when placed in solution Base - alkali, any substance that releases hydroxyl ion in a solution and can combine with hydrogen ions Alkalinity or acidity of a solution depends upon the degree of hydrogen ion concentration pH of 7.0 is considered neutral ECF(blood) pH ranges from 7.35 to 7.45 As hydrogen increases, the pH decreases As hydrogen decreases, the pH increases Byproducts of metabolism are acidic Acids and bases leave the body by several routes……lungs and kidneys
  • PHOSPHATE - High concentration in the cells. Maintains acid base balance within the cell PROTEIN - proteins are mainly negative charges which balance positively charged Hydrogen ions Hemoglobin is a protein buffer -- RBC releases bicarb and allows chloride ions to move into cells Known as the “chloride shift” LUNGS As carbon dioxide rises, signals the lungs to increase respiratory rate and “blow off” co2 As carbon dioxide decreases, respiratory rate decreases and co2 is retained KIDNEYS Excrete H and retain bicarb Also manufacture bicarb from carbon dioxide and water if needed
  • Causes: Pneumonia, Asthma, COPD, Emphysema, CHF, acute alcoholism, drug overdose, Guillian-Barre, MS, MG Symptoms: Disorientation, depressed breathing, weakness and coma Treatment: Increase respiratory rate, antibiotics, bronchodilators, bicarbonate
  • Causes: Hyperventilation, fever, gram negative septicemia, anxiety attacks, salicylate poisoning, CVA, CNS malignancies, severe anemia, cyanotic heart conditions, pneumonia, pulmonary edema Symptoms: Light headedness, sweating, palpitations, muscle cramping, parasthesias, unconsciousness Treatment: Correct pulmonary problem, rebreathe CO2, fluids to maintain electrolytes
  • Causes: Fever, diarrhea, starvation, renal insufficiency, diabetes mellitus, loss of base through the GI tract or urine or an increase in metabolic acid production Symptoms: Weakness, malaise, n/v, stupor, SOB, unconsciousness Treatment: Restore bicarbonate
  • Causes: Vomiting, gastric suctioning, prolonged use of electrolyte-free solutions, excessive ingestion of sodium bicarbonate, diuretic therapy, corticosteroid therapy, severe hypocalcemia Symptoms: Muscular hyperactivity, tetany Treatment: Fluid and electrolyte solutions
  • Daily requirement is 0.5 to 2.7 grams. Usual American diet is about 6grams a day. Levels stay constant because the more you eat, the more the kidneys excrete. Sodium goes up(water deficit), you feel thirsty, and the pituitary releases ADH and your kidneys retain water OR Serum sodium goes down(water excess), thirst diminishes, ADH is suppressed, renal excretion of water increases and serum osmolality and sodium levels become normal
  • Signs and symptoms: Postural hypotension—hypovolemia, weak rapid pulse If hypervolemia then may have edema, hypertension,weight gain, rapid bounding pulse Fatigue Headache Muscle weakness Altered mental status Starts to deteriorate at 110mEq/L Coma and death Causes: Excessive water intake Excessive sodium loss Renal or nonrenal Urine, perspiration, vomiting, diarrhea, gastric suction, diuretics Adrenal malfunction - Low aldosterone impairs reabsorption Heart failure, liver failure, over administration of hypotonic IV fluids SIADH
  • Hypertonic sodium chloride. Sometimes up to 3-5% NS in severe cases. Na <110 mEq/L
  • Signs and symptoms Common signs and symptoms =SALT S kin flushed, A gitation, L ow grade fever, T hirst Thirst, dry mucous membranes, body temperature rises, urine output < 30 ml/hr, restlessness, agitation, coma, death. Causes: Loss of water Excessive ingestion of salt IV administration of large volumes of isotonic or hypertonic saline solutions Can be a hyper or hypovolemia with sodium levels elevated.
  • Diseases, injuries, medications, and therapies can all disturb K levels. Small alterations can seriously affect neuromuscular and cardiac function A change in pH may affect serum K Hydrogen and K ions freely exchange across plasma cell membrane. In acidosis, excess H ions move into cells and push K into the extracellular fluid. Thus,acidosis an cause hyperkalemia. Likewise, alkalosis can cause hypokalemia, as K moves into the cell to maintain balance
  • Signs and symptoms: Ectopic cardiac activity Weak pulses, distant heart sounds Depression Muscle weakness,  DTRs Polyuria and polydipsia S keletal muscle weakness U wave C onstipation, ileus T oxic effects of dig I rregular weak pulse O rthostatic hypotension N umbness (paresthesia) Causes: Decreased dietary intake Diuretic use Vomiting, diarrhea, suctioning, fistulas Tissue destruction as burns Malnutrition Diabetes insipidus
  • Nursing interventions: Potassium replacement Oral Intravenous Never give IV push. Can cause cardiac arrest Potassium sparing diuretics Monitor serum electrolytes
  • Serum K+ > 5 mEq/L Signs and symptoms: Cardiac dysrhythmias Diarrhea, abdominal pain Painful muscle cramps Cardiac failure Hyperkalemia continued... Causes: Renal disease Increased intake Tissue trauma Metabolic acidosis Adrenal cortical insufficiency (Addison’s Disease)
  • Two forms Free, ionized which is circulating Bound to albumin
  • Serum Ca++ < 8.5 mg/dL Signs and symptoms: Neuromuscular irritability, such as numbness and tingling, hyperactive reflexes, tetany, and seizures Dry skin and hair, brittle nails Bone pain Causes: Reduced intestinal absorption Vitamin D deficiency Excessive loss--renal disease, loop diuretics, fistulas, burns Damaged or surgery to parathyroid glands Albumin, phosphorus, or magnesium imbalances
  • Nursing interventions Oral calcium supplements IV administration of calcium gluconate or calcium chloride Administer slowly and observe for bradycardia Extravasation precautions Monitor serum electrolytes Monitor for neuromuscular complications
  • Trousseau’s sign Apply blood pressure cuff to patient's upper arm and inflate to 20mm Hg above the systolic pressure. May appear after 1 – 4 minutes. Will experience an adducted thumb, flexed wrist and metacarpophalangeal joints, and extended interphalangeal joints with fingers together—carpopedal spasm—indicating tetany, a major sign of hypocalcemia. Chvostek’s sign You can induce by tapping the patient’s facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates chvostek’s sign.
  • Serum Ca++ > 10.5 mg/dL Signs and symptoms: Decreased mental alertness Reduced muscle tone and fatigue Abdominal pain, nausea, vomiting Polydipsia, polyuria Causes: Malignancy Hyperparathyroidism Thiazide diuretics or renal failure Prolonged immobilization Excessive intake from milk and antacids Acidosis (increase ionized Ca)
  • Nursing interventions: Fluid infusion to provide hemodilution followed by Lasix to enhance the body’s excretion of calcium and excess fluid IV calcitonin and aredia given to enhance bone reabsorption of calcium Dialysis Encourage mobilization Increase fluid intake Monitor serum electrolyte levels EKG I & O
  • Signs and Symptoms: Increased neuromuscular activity Confusion, agitation Nystagmus Tetany Seizures Causes: Reduced dietary intake Impaired absorption Nausea, vomiting, intestinal surgeries Cirrhosis, pancreatitis Chronic renal disease
  • With seizures or dysrhythmias, give high doses by IV
  • Signs and symptoms: CNS depression Decrease in respirations Hypotension Bradycardia Very rare imbalance Occurs with: Renal failure Diabetic acidosis Hyperparathyroidism
  • Helpful in diagnosing disorders of acid- base balance and water balance The reciprocal of other anions and increases and decreases in response i.e.. In metabolic acidosis there is a reciprocal rise in chloride when bicarbonate drops
  • A solution of higher osmolality has a higher particle concentration and a lower water concentration Osmolality: the characteristic of a solution determined by the ionic concentration of the dissolved substances per unit of solvent; measured in mOsm/kg Osmolarity: concentration of osmotically active particles in solution usually measured in mOsm/liter 1.Measures are relatively interchangeable for our purposes 2.Both are measures of the potential to draw water into a space Normal serum osmolality is 280-300 mOsm/kg Serum osmolality is effected by: drugs kidney or other organ function electrolytes/lab values other The vascular space holds onto or shifts water and/or particles in an attempt to stay within 280-300mOsm/kg (homeostasis)
  • 5% dextrose in water = 5 gm dextrose in 100ml = 50 gm dextrose in 1000ml 50 gm x 3.4kcal = 170 calories per liter Provides calories for essential energy Does not contain electrolytes Isotonic @ 253mOsm/liter Indications Dehydration: dextrose is quickly metabolized leaving water. Water decreases osmotic pressure of the plasma and invades the cells Hypernatremia: 5% dextrose will decrease the concentration of Na+
  • Used to treat hypovolemia Maintain fluid intake Maintenance of choice if no electrolyte imbalances
  • Indications Used to expand plasma volume and to replace sodium losses Contraindicated in CHF, pulmonary edema, renal impairment, and sodium retention
  • Indications Correction of severe sodium depletion
  • Indications Supplies 1700 calories/liter Should be given through a central line Hyperkalemia: high concentrations of dextrose with insulin moves potassium into the cells (active transport)
  • Indications Used primarily for fluid resuscitation and rapid expansion of ECF D5LR is the same with 50 grams of dextrose
  • Definition: Equal fluid and electrolyte depletion in the ECF (Hypovolemia) Causes: Vomiting, diarrhea, suctioning, fever, wounds, blood loss, polyuria, etc. Signs and symptoms: Dry mucous membranes; poor skin turgor; weak, thready pulse; hypotension, orthostatic hypotension, weight loss, decreased urine output
  • Definition: increase in the extracellular fluid volume (Hypervolemia) Causes: excessive sodium intake, CHF, steroid therapy, renal failure, excessive IV fluids Signs and Symptoms: edema, weight gain, increased urine output, hypertension, bounding pulse, rales, frothy sputum
  • Transcript

    • 1. Fluids & Electrolytes
    • 2. Fluid & Electrolytes• Homeostasis• Water
    • 3. Body Water• Newborn 79%• 2-8yr 62%• Men 36-69yr 55%• Women 36-69yr 48%• Men 70+yr 51%• Women 60+yr 43%
    • 4. Water• Transport• Excrete• Medium• Regulation• Cushion• Preserve homeostasis
    • 5. Fluid & Electrolytes• Water Intake • Water in food 1000ml • Water from oxidation 300ml • Water as liquid 1200ml • Total water intake QD 2500ml
    • 6. Fluid & Electrolytes• Water Loss • Loss through skin 500ml • Loss through lungs 350ml • Feces 150ml • Loss through kidneys 1500ml • Total water loss per day 2500ml
    • 7. Water Regulation• Water intake is regulated through thirst• Water and electrolytes are continuously lost and replaced• Water balance is maintained primarily by the kidneys
    • 8. Water Distribution • Intracellular • Extracellular • Transcellular
    • 9. Water Distribution
    • 10. Water Distribution• PERCENTAGE OF TOTAL BODY WEIGHT Adult Male Adult FemaleTotal Body Water 60% 50%Intracellular Fluid 45% 35%Extracellular Fluid 15% 15%Interstitial Fluid 11% 10%Intravascular Fluid 4.5% 4.3%
    • 11. Tonicity• Isotonic• Hypotonic• Hypertonic
    • 12. Movement of BodyFluids & Electrolytes • Passive transport • Diffusion • Osmosis
    • 13. Movement of BodyFluids and Electrolytes • Active Transport • ATP • Sodium-Potassium pump • Capillary Filtration
    • 14. Body Systems in Fluid & Electrolyte Regulation • Renal system • Cardiovascular system • Lymphatic system • Nervous System • Respiratory system
    • 15. Body Systems in Fluid & Electrolyte Regulation• Gastrointestinal system• Integumentary system• Endocrine system • ADH (antidiuretic hormone) • Aldosterone • Thyroid • Parathyroid
    • 16. Disease ProcessesThat Alter Body Water• Renal failure• Congestive heart failure• Gastrointestinal dysfunction• Pregnancy• Neurological conditions• Burns• Hepatic failure
    • 17. Nursing Responsibilities• Monitor vital signs• Monitor daily weights• Monitor I & O • Weight change of 1 kg represents a gain or loss of 1 liter of body wt. • Average daily water intake and output is approximately 2500ml
    • 18. Acid - Base Balance• Equalization must exist between the acidity and alkalinity of body fluids• pH - potential of hydrogen
    • 19. Acid - Base Balance• Acidosis • Excess acids (H+ ions) or a deficiency of base (bicarbonate ions) • pH less than 7.35• Alkalosis • Reduction of acids and an increase in bicarbonate ions • pH greater than 7.45
    • 20. Acid - Base Balance• Phosphate Buffer System• Protein Buffer System• Carbonic Acid-Bicarbonate Buffer System • Respiratory system • Kidneys
    • 21. Normal Arterial Blood Gases • pH 7.35 - 7.45 • O2 Sat > 95% • PaO2 80 - 100 • PaCO2 35 - 45 • HCO3 22 - 26 • BE -2 to +2
    • 22. Aid to Interpreting ABGs • Steps • check pH • check Co2 • check bicarb • Respiratory alterations: • pH ↑ PCO2 ↓ • pH ↓ PCO2 ↑ • Metabolic alterations: • pH ↑ PCO2 ↑ • pH ↓ PCO2 ↓
    • 23. Respiratory Acidosis • pH ↓7.35 • CO2 retention • Causes • Symptoms • Treatment
    • 24. Respiratory Acidosis • pH 7.20 • O2 sat 75 • PaO2 62 • PaCO2 55 • HCO3 24
    • 25. Respiratory Alkalosis • pH > 7.45 • CO2 deficit • Causes • Symptoms • Treatment
    • 26. Respiratory Alkalosis • pH 7.55 • O2 sat 75 • PaO2 62 • PaCO2 26 • HCO3 24
    • 27. Metabolic Acidosis • pH < 7.35 • HCO3 < 22 • Causes • Symptoms • Treatment
    • 28. Metabolic Acidosis • pH 7.26 • O2 sat 85 • PaO2 90 • PaCO2 30 • HCO3 18
    • 29. Metabolic Alkalosis • pH > 7.45 • Bicarb > 26 • Causes • Symptoms • Treatment
    • 30. Metabolic Alkalosis• pH 7.56• O2 sat 85• PaO2 90• PaCO2 48• HCO3 28
    • 31. Functions of Electrolytes• Water distribution in the ICF and ECF• Neuromuscular irritability• Acid-base balance• Maintenance of osmotic pressure
    • 32. Sodium• Major cation (Na+) in the ECF• Influences distribution of body water• Maintains extracellular fluid volume• Excreted mainly by the kidneys• Regulates osmotic pressure• Necessary for neuromuscular impulse transmission• Normal serum sodium 135 to 145 mEq/L
    • 33. Hyponatremia• Serum sodium < 135 mEq/L• Signs and Symptoms• Causes
    • 34. Hyponatremia• Nursing Interventions: • Restricted fluids, oral sodium supplements • Isotonic sodium chloride • Follow with diuretics that will result in loss of more water than sodium • Monitor neurological and cardiovascular status, I & O, monitor lab values
    • 35. Hypernatremia• Serum sodium > 145 mEq/L• Signs and Symptoms• Causes
    • 36. Hypernatremia• Nursing Interventions: • Limit dietary and IV intake • Administer IV fluids to lower the sodium concentration • Dialysis • Monitor neuro signs and symptoms, I&O, serum electrolytes
    • 37. Potassium• Major cation (K+) of the ICF• Normal serum value 3.5 to 5.0 mEq/L• Maintains osmotic balance and cell membrane electrical potential
    • 38. Hypokalemia• Serum K+ < 3.5 mEq/L• Signs and symptoms• Causes
    • 39. Hypokalemia• Nursing interventions: • Potassium replacement • Potassium sparing diuretics • Monitor serum electrolytes
    • 40. Hyperkalemia• Serum K+ > 5 mEq/L• Signs and symptoms• Causes
    • 41. Hyperkalemia• Nursing interventions: • IV administration of calcium gluconate, sodium bicarbonate, glucose with insulin, Kayexalate • Restrict intake of potassium
    • 42. Calcium• Normal serum level 8.5 to 10.5 mEq/L• Most abundant electrolyte in the body• Stored primarily in bones & teeth
    • 43. Calcium• Effects neuromuscular function• Cardiac status• Bone formation• Blood coagulation
    • 44. Hypocalcemia• Serum Ca++ < 8.5 mg/dL• Signs and symptoms• Causes
    • 45. Hypocalcemia• Nursing interventions • Oral calcium supplements • IV administration of calcium gluconate or calcium chloride • Monitor serum electrolytes • Monitor for neuromuscular complications
    • 46. Trousseau Chvostek
    • 47. Hypercalcemia• Serum Ca++ > 10.5 mg/dL• Signs and symptoms• Causes
    • 48. Hypercalcemia• Nursing interventions • Fluid infusion • IV calcitonin and aredia • Dialysis • Encourage mobilization • Increase fluid intake • Monitor serum electrolyte levels • EKG • I&O
    • 49. Magnesium• Abundant in the intracellular compartment• Regulated by parathyroids• Ionized form• 30% bound to albumin• Normal blood magnesium level is 1.5 - 2.3 mEq/L
    • 50. Magnesium• Purpose • Enzymatic cellular activation for protein & carbohydrate metabolism • Activates the sodium-potassium pump • Needed to maintain calcium levels within cells
    • 51. Hypomagnesemia• Signs & Symptoms• Causes
    • 52. Hypomagnesemia• Nursing interventions • Oral, IM and IV magnesium salts
    • 53. Hypermagnesemia • Signs & symptoms • Causes
    • 54. Hypermagnesemia• Nursing Interventions • Avoid magnesium compounds • Assess vital signs • IV administration of calcium gluconate
    • 55. Chloride• Normal range --100 - 106 mEq/liter• Helpful in diagnosing disorders of acid- base balance and water balance
    • 56. Chloride• Hyperchloremia • Cushing’s syndrome • Hyperventilation • Some kidney disorders• Hypochloremia • Diabetic acidosis • Heat exhaustion • Vomiting & diarrhea
    • 57. Characteristics of Solutions • Osmolality • Osmolarity • Normal serum osmolality is 280-300 mOsm/kg
    • 58. Dextrose in Water (D5W) • 5% dextrose in water = 5 gm dextrose in 100ml = 50 gm dextrose in 1000ml • Isotonic • Indications
    • 59. Dextrose 5% &0.2% Sodium Chloride• Isotonic• Osmolarity: 320 mOsm/liter• Contains 34 mEq/liter of NaCl• Supplies 170 calories per liter• Indications
    • 60. Dextrose 5% &0.45% Sodium Chloride• Hypertonic• Osmolarity: 405 mOsm/liter• Contains electrolytes Na+ & Cl-• Indications• Contains 170 calories per liter
    • 61. 0.45% Sodium Chloride• Hypotonic• Osmolarity: 155 mOsm/liter• Contains electrolytes Na+ & Cl-• Does not supply calories• Indications
    • 62. 0.9 % Sodium Chloride• Isotonic• Osmolarity: 308 mOsm/liter• Contains Na+ & CL-• Indications
    • 63. 3% Sodium Chloride• Hypertonic• Osmolarity: 1030 mOsm/liter• Contains concentrated sodium & chloride• Indications
    • 64. 50% Dextrose• Hypertonic• Osmolarity: 2526 mOsm/liter• Indications• Supplies 1700 calories/liter
    • 65. Ringer’s Lactate• Isotonic• Osmolarity: 275 mOsm/liter• Contains sodium, potassium, calcium, chloride• Indications
    • 66. Fluid Volume Deficit • Definition • Causes • Signs & symptoms
    • 67. Fluid Volume Deficit• Nursing interventions: • Isotonic solution • Monitor for fluid overload with rapid rehydration • Monitor I & O • Draw serum electrolytes
    • 68. Fluid Volume Excess • Definition • Causes • Signs & symptoms
    • 69. Fluid Volume Excess • Nursing interventions • Correct the cause • Sodium restriction • Fluid restriction • Diuretics • I&O • Draw serum electrolytes
    • 70. Fluids & Electrolytes T hank You Questions?

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