Fluid And Electrolyte Balance Chapter 026

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Fluid And Electrolyte Balance Chapter 026

  1. 1. Maintaining Fluid and Electrolyte Balance Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  2. 2. Concepts of Fluid Balance <ul><li>Functions of body fluids </li></ul><ul><li>Fluid compartments </li></ul><ul><li>Electrolytes </li></ul><ul><li>Movement of fluids and electrolytes </li></ul><ul><li>Regulation of fluid balance </li></ul><ul><li>Problems of fluid balance </li></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  3. 3. Functions of Body Fluids <ul><li>Body needs: </li></ul><ul><ul><li>1500 mL daily </li></ul></ul><ul><ul><li>700 mL from food we eat </li></ul></ul><ul><ul><li>300 mL from oxidation of food </li></ul></ul><ul><li>Functions </li></ul><ul><ul><li>Makes half the body weight </li></ul></ul><ul><ul><li>Transports nutrients and wastes to and from cells </li></ul></ul><ul><ul><li>Acts as solvent for electrolytes and nonelectrolytes </li></ul></ul><ul><ul><li>Facilitates digestion and elimination </li></ul></ul><ul><ul><li>Maintains acid-base balance </li></ul></ul><ul><ul><li>Lubricates joints and other body tissues </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  4. 4. Fluid Compartments <ul><li>Intracellular fluid compartment </li></ul><ul><ul><li>Contain 70% of body fluids </li></ul></ul><ul><ul><li>Fluid loss at cellular level affects entire body </li></ul></ul><ul><li>Extracellular fluid compartment </li></ul><ul><ul><li>Contain 30% of body fluids </li></ul></ul><ul><ul><li>Intravascular fluids </li></ul></ul><ul><ul><li>Interstitial fluids </li></ul></ul><ul><ul><li>Transcellular fluids </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  5. 5. Electrolytes Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Electrolyte Normal Plasma Value Sodium 135 to 145 mEq/L Potassium 3.5 to 5.0 mEq/L Calcium 4.5 to 5.5 mg/dL Magnesium 1.5 to 2.5 mg/dL Chloride 98 to 106 mEq/L Phosphorus 1.2 to 3.0 mg/dL
  6. 6. Movement of Fluids and Electrolytes <ul><li>Osmosis </li></ul><ul><ul><li>Hypotonic </li></ul></ul><ul><ul><li>Hypertonic </li></ul></ul><ul><li>Diffusion </li></ul><ul><li>Active transport </li></ul><ul><li>Filtration </li></ul><ul><ul><li>Colloid osmotic pressure </li></ul></ul><ul><ul><li>Hydrostatic pressure </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  7. 7. Regulation of Fluid Balance <ul><li>Thirst </li></ul><ul><ul><li>Intake of fluids </li></ul></ul><ul><li>Lymphatic system </li></ul><ul><ul><li>“ Sponging up” </li></ul></ul><ul><li>Neuroendocrine system </li></ul><ul><ul><li>Hormones </li></ul></ul><ul><li>Gastrointestinal system </li></ul><ul><ul><li>Absorbs — secretes — reabsorbs </li></ul></ul><ul><li>Renal system </li></ul><ul><ul><li>Works with neuroendocrine system to regulate volume </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  8. 8. Problems of Fluid Balance <ul><li>Deficient fluid volume </li></ul><ul><ul><li>Hypovolemia </li></ul></ul><ul><ul><li>Dehydration </li></ul></ul><ul><li>Excess fluid volume </li></ul><ul><ul><li>Hypervolemia </li></ul></ul><ul><ul><li>Water intoxication </li></ul></ul><ul><li>Electrolyte imbalance </li></ul><ul><ul><li>Deficit or excess of one or more electrolytes </li></ul></ul><ul><li>Acid-base imbalance </li></ul><ul><ul><li>Respiratory acidosis and respiratory alkalosis </li></ul></ul><ul><ul><li>Metabolic acidosis and metabolic alkalosis </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  9. 9. Factors Affecting Fluid Balance <ul><li>Lifestyle factors </li></ul><ul><ul><li>Nutrition </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Stress </li></ul></ul><ul><li>Physiological factors </li></ul><ul><ul><li>Cardiovascular </li></ul></ul><ul><ul><li>Respiratory </li></ul></ul><ul><ul><li>Gastrointestinal </li></ul></ul><ul><ul><li>Renal </li></ul></ul><ul><ul><li>Integumentary </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><li>Developmental factors </li></ul><ul><ul><li>Infants and children </li></ul></ul><ul><ul><li>Adolescents and middle-aged adults </li></ul></ul><ul><ul><li>Older adults </li></ul></ul><ul><li>Clinical factors </li></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Chemotherapy </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Gastrointestinal intubation </li></ul></ul><ul><ul><li>Intravenous therapy </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  10. 10. Assessment of Fluid Balance <ul><li>General </li></ul><ul><li>Focused assessment for deficient fluid volume </li></ul><ul><li>Focused assessment for excess fluid volume </li></ul><ul><li>Focused assessment for associated problems </li></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  11. 11. General Assessment <ul><li>Health history </li></ul><ul><ul><li>Chief complaint </li></ul></ul><ul><ul><li>Past history of illnesses </li></ul></ul><ul><li>Physical examination </li></ul><ul><ul><li>Standard clinical measurements </li></ul></ul><ul><ul><li>Weighing the client </li></ul></ul><ul><ul><li>Input and output </li></ul></ul><ul><ul><li>Assessing edema </li></ul></ul><ul><li>Diagnostic tests </li></ul><ul><ul><li>Plasma sodium </li></ul></ul><ul><ul><li>Plasma osmolality </li></ul></ul><ul><ul><li>Urine osmolality </li></ul></ul><ul><ul><li>Hematocrit </li></ul></ul><ul><ul><li>Blood urea nitrogen (BUN) </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  12. 12. Focused Assessment for Deficient fluid volume <ul><li>Defining characteristics </li></ul><ul><ul><li>Extracellular </li></ul></ul><ul><ul><li>Intracellular </li></ul></ul><ul><li>Related factors </li></ul><ul><ul><li>The acuteness of the loss </li></ul></ul><ul><ul><li>The severity of the loss </li></ul></ul><ul><ul><li>The client’s age and state of health </li></ul></ul><ul><ul><li>The degree to which the client combats the deficit </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  13. 13. Focused Assessment for Excess fluid volume <ul><li>Defining characteristics </li></ul><ul><ul><li>Extracellular </li></ul></ul><ul><ul><li>Intracellular </li></ul></ul><ul><li>Related factors </li></ul><ul><ul><li>Any increase in fluid intake </li></ul></ul><ul><ul><li>Any increase in sodium intake </li></ul></ul><ul><ul><li>Increase in capillary permeability </li></ul></ul><ul><ul><li>Protein loss </li></ul></ul><ul><ul><li>The client’s response to fluid excess </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  14. 14. Focused Assessment for Associated Problems <ul><li>Electrolyte imbalances </li></ul><ul><ul><li>Fluid imbalances rarely exists without electrolyte imbalance </li></ul></ul><ul><ul><li>Anticipate the risk for imbalance </li></ul></ul><ul><li>Metabolic acidosis </li></ul><ul><ul><li>End-stage renal disease </li></ul></ul><ul><ul><li>Severe diarrhea </li></ul></ul><ul><ul><li>Hypoxia </li></ul></ul><ul><ul><li>Hyperglycemia </li></ul></ul><ul><li>Metabolic alkalosis </li></ul><ul><ul><li>Consumption of excessive bicarbonate products </li></ul></ul><ul><ul><li>Loss of excessive potassium and hydrochloric acid </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  15. 15. Diagnosis <ul><li>Deficient fluid volume or Risk for deficient fluid volume </li></ul><ul><li>Excess fluid volume or Risk for excess fluid volume </li></ul><ul><li>Related nursing diagnoses </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Ineffective health maintenance </li></ul></ul><ul><ul><li>Imbalanced nutrition </li></ul></ul><ul><ul><li>Impaired skin integrity </li></ul></ul><ul><ul><li>Impaired tissue perfusion </li></ul></ul><ul><ul><li>Impaired gas exchange </li></ul></ul><ul><ul><li>Constipation </li></ul></ul><ul><ul><li>Impaired oral mucous membranes </li></ul></ul><ul><ul><li>Disturbed sleep pattern </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  16. 16. Planning (Expected Outcomes) <ul><li>Deficient fluid volume </li></ul><ul><ul><li>Increase in fluid intake </li></ul></ul><ul><ul><li>Moist mucous membranes </li></ul></ul><ul><ul><li>Absence of tongue furrows </li></ul></ul><ul><li>Excess fluid volume </li></ul><ul><ul><li>Decrease in peripheral edema </li></ul></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Decrease in fatigue and weakness </li></ul></ul><ul><li>Associated problems </li></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  17. 17. Interventions <ul><li>To reduce the risk of deficient fluid volume </li></ul><ul><ul><li>Teaching client about fluid needs </li></ul></ul><ul><ul><li>Preventing excessive fluid deficits </li></ul></ul><ul><ul><li>Restoring lost fluids </li></ul></ul><ul><li>To increase fluid volume </li></ul><ul><ul><li>Restoring fluid balance </li></ul></ul><ul><ul><li>Preventing further loss </li></ul></ul><ul><ul><li>Instituting rehabilitative care </li></ul></ul><ul><ul><li>Administering intravenous therapy </li></ul></ul><ul><li>To decrease fluid volume </li></ul><ul><ul><li>Restoring fluid balance </li></ul></ul><ul><ul><li>Preventing complications </li></ul></ul><ul><ul><li>Instituting rehabilitative care </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  18. 18. Interventions <ul><li>To balance electrolyte levels </li></ul><ul><ul><li>General interventions </li></ul></ul><ul><ul><ul><li>Nutrition is the key </li></ul></ul></ul><ul><ul><li>Sodium imbalance: hyponatremia or hypernatremia </li></ul></ul><ul><ul><li>Potassium imbalance: hypokalemia or hyperkalemia </li></ul></ul><ul><ul><li>Calcium imbalance: hypocalcemia or hypercalcemia </li></ul></ul><ul><ul><li>Magnesium imbalance </li></ul></ul><ul><ul><li>Phosphate imbalance </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  19. 19. Intravenous Therapy <ul><li>Types of intravenous (IV) solutions </li></ul><ul><li>Categorized by osmolality: how solution affects other fluids </li></ul><ul><ul><li>Isotonic </li></ul></ul><ul><ul><li>Hypotonic </li></ul></ul><ul><ul><li>Hypertonic </li></ul></ul><ul><li>Sites for IV therapy </li></ul><ul><li>Potential complications </li></ul><ul><ul><li>Infiltration </li></ul></ul><ul><ul><li>Phlebitis </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Air embolism </li></ul></ul><ul><ul><li>Allergic reaction </li></ul></ul><ul><ul><li>Circulatory overload </li></ul></ul><ul><li>Care of IV site </li></ul><ul><ul><li>Peripheral </li></ul></ul><ul><ul><li>Central </li></ul></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
  20. 20. Evaluation <ul><li>The time frame for </li></ul><ul><li>evaluating fluid or electrolyte imbalance varies with the urgency of the imbalance. </li></ul>Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.

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