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Fluid and Electrolytes

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Fluid and Electrolytes

  1. 1. Fluids & Electrolytes
  2. 2. Fluid & Electrolytes• Homeostasis• Water
  3. 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. 4. Water• Transport• Excrete• Medium• Regulation• Cushion• Preserve homeostasis
  5. 5. Fluid & Electrolytes• Water Intake • Water in food 1000ml • Water from oxidation 300ml • Water as liquid 1200ml • Total water intake QD 2500ml
  6. 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. 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. 8. Water Distribution • Intracellular • Extracellular • Transcellular
  9. 9. Water Distribution
  10. 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. 11. Tonicity• Isotonic• Hypotonic• Hypertonic
  12. 12. Movement of BodyFluids & Electrolytes • Passive transport • Diffusion • Osmosis
  13. 13. Movement of BodyFluids and Electrolytes • Active Transport • ATP • Sodium-Potassium pump • Capillary Filtration
  14. 14. Body Systems in Fluid & Electrolyte Regulation • Renal system • Cardiovascular system • Lymphatic system • Nervous System • Respiratory system
  15. 15. Body Systems in Fluid & Electrolyte Regulation• Gastrointestinal system• Integumentary system• Endocrine system • ADH (antidiuretic hormone) • Aldosterone • Thyroid • Parathyroid
  16. 16. Disease ProcessesThat Alter Body Water• Renal failure• Congestive heart failure• Gastrointestinal dysfunction• Pregnancy• Neurological conditions• Burns• Hepatic failure
  17. 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. 18. Acid - Base Balance• Equalization must exist between the acidity and alkalinity of body fluids• pH - potential of hydrogen
  19. 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. 20. Acid - Base Balance• Phosphate Buffer System• Protein Buffer System• Carbonic Acid-Bicarbonate Buffer System • Respiratory system • Kidneys
  21. 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. 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. 23. Respiratory Acidosis • pH ↓7.35 • CO2 retention • Causes • Symptoms • Treatment
  24. 24. Respiratory Acidosis • pH 7.20 • O2 sat 75 • PaO2 62 • PaCO2 55 • HCO3 24
  25. 25. Respiratory Alkalosis • pH > 7.45 • CO2 deficit • Causes • Symptoms • Treatment
  26. 26. Respiratory Alkalosis • pH 7.55 • O2 sat 75 • PaO2 62 • PaCO2 26 • HCO3 24
  27. 27. Metabolic Acidosis • pH < 7.35 • HCO3 < 22 • Causes • Symptoms • Treatment
  28. 28. Metabolic Acidosis • pH 7.26 • O2 sat 85 • PaO2 90 • PaCO2 30 • HCO3 18
  29. 29. Metabolic Alkalosis • pH > 7.45 • Bicarb > 26 • Causes • Symptoms • Treatment
  30. 30. Metabolic Alkalosis• pH 7.56• O2 sat 85• PaO2 90• PaCO2 48• HCO3 28
  31. 31. Functions of Electrolytes• Water distribution in the ICF and ECF• Neuromuscular irritability• Acid-base balance• Maintenance of osmotic pressure
  32. 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. 33. Hyponatremia• Serum sodium < 135 mEq/L• Signs and Symptoms• Causes
  34. 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. 35. Hypernatremia• Serum sodium > 145 mEq/L• Signs and Symptoms• Causes
  36. 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. 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. 38. Hypokalemia• Serum K+ < 3.5 mEq/L• Signs and symptoms• Causes
  39. 39. Hypokalemia• Nursing interventions: • Potassium replacement • Potassium sparing diuretics • Monitor serum electrolytes
  40. 40. Hyperkalemia• Serum K+ > 5 mEq/L• Signs and symptoms• Causes
  41. 41. Hyperkalemia• Nursing interventions: • IV administration of calcium gluconate, sodium bicarbonate, glucose with insulin, Kayexalate • Restrict intake of potassium
  42. 42. Calcium• Normal serum level 8.5 to 10.5 mEq/L• Most abundant electrolyte in the body• Stored primarily in bones & teeth
  43. 43. Calcium• Effects neuromuscular function• Cardiac status• Bone formation• Blood coagulation
  44. 44. Hypocalcemia• Serum Ca++ < 8.5 mg/dL• Signs and symptoms• Causes
  45. 45. Hypocalcemia• Nursing interventions • Oral calcium supplements • IV administration of calcium gluconate or calcium chloride • Monitor serum electrolytes • Monitor for neuromuscular complications
  46. 46. Trousseau Chvostek
  47. 47. Hypercalcemia• Serum Ca++ > 10.5 mg/dL• Signs and symptoms• Causes
  48. 48. Hypercalcemia• Nursing interventions • Fluid infusion • IV calcitonin and aredia • Dialysis • Encourage mobilization • Increase fluid intake • Monitor serum electrolyte levels • EKG • I&O
  49. 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. 50. Magnesium• Purpose • Enzymatic cellular activation for protein & carbohydrate metabolism • Activates the sodium-potassium pump • Needed to maintain calcium levels within cells
  51. 51. Hypomagnesemia• Signs & Symptoms• Causes
  52. 52. Hypomagnesemia• Nursing interventions • Oral, IM and IV magnesium salts
  53. 53. Hypermagnesemia • Signs & symptoms • Causes
  54. 54. Hypermagnesemia• Nursing Interventions • Avoid magnesium compounds • Assess vital signs • IV administration of calcium gluconate
  55. 55. Chloride• Normal range --100 - 106 mEq/liter• Helpful in diagnosing disorders of acid- base balance and water balance
  56. 56. Chloride• Hyperchloremia • Cushing’s syndrome • Hyperventilation • Some kidney disorders• Hypochloremia • Diabetic acidosis • Heat exhaustion • Vomiting & diarrhea
  57. 57. Characteristics of Solutions • Osmolality • Osmolarity • Normal serum osmolality is 280-300 mOsm/kg
  58. 58. Dextrose in Water (D5W) • 5% dextrose in water = 5 gm dextrose in 100ml = 50 gm dextrose in 1000ml • Isotonic • Indications
  59. 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. 60. Dextrose 5% &0.45% Sodium Chloride• Hypertonic• Osmolarity: 405 mOsm/liter• Contains electrolytes Na+ & Cl-• Indications• Contains 170 calories per liter
  61. 61. 0.45% Sodium Chloride• Hypotonic• Osmolarity: 155 mOsm/liter• Contains electrolytes Na+ & Cl-• Does not supply calories• Indications
  62. 62. 0.9 % Sodium Chloride• Isotonic• Osmolarity: 308 mOsm/liter• Contains Na+ & CL-• Indications
  63. 63. 3% Sodium Chloride• Hypertonic• Osmolarity: 1030 mOsm/liter• Contains concentrated sodium & chloride• Indications
  64. 64. 50% Dextrose• Hypertonic• Osmolarity: 2526 mOsm/liter• Indications• Supplies 1700 calories/liter
  65. 65. Ringer’s Lactate• Isotonic• Osmolarity: 275 mOsm/liter• Contains sodium, potassium, calcium, chloride• Indications
  66. 66. Fluid Volume Deficit • Definition • Causes • Signs & symptoms
  67. 67. Fluid Volume Deficit• Nursing interventions: • Isotonic solution • Monitor for fluid overload with rapid rehydration • Monitor I & O • Draw serum electrolytes
  68. 68. Fluid Volume Excess • Definition • Causes • Signs & symptoms
  69. 69. Fluid Volume Excess • Nursing interventions • Correct the cause • Sodium restriction • Fluid restriction • Diuretics • I&O • Draw serum electrolytes
  70. 70. Fluids & Electrolytes T hank You Questions?

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