Fluid and electrolyte


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  • Homeostasis – a tendency of biological systems to maintain stability while continually adjusting to conditions that are optimal for survival.
  • Osmosisis diffusion of water caused by fluid gradient.Diffusionis movement of a substance from area of higher concentration to one of lower concentration.Active Transport is movement of substance across permeable membrane and gradient; requires energy and pump. E.g. Sodium/potassium pump
  • Sodium-Potassium PumpSodium concentration is higher in ECF than ICFSodium enters cell by diffusionPotassium exits cell into ECF
  • Filtration- the movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressureOsmolality - reflects the concentration of fluid that affects the movement of water between fluid compartments by osmosisOsmotic pressure - the amount of hydrostatic pressure required to stop the flow of water by osmosis
  • Isotonic– same solute concentration, equal, no movement across membraneHypertonic/hyper-osmotic– greater concentration osmotic pressure water pulled intofluid to equalizeHypotonic/hypo-osmotic– lesser concentration osmotic pressure water pulled outof fluid to equalize
  • Gain - solid foods, Drinks, thirst centerLoss - water and electrolytesmove in a variety ofWays - sensible andInsensible.KidneysSkinLungsGI tract
  • Fluid DeficitIsotonic – fluid and electrolytes loss equally; decline in circulating blood volumeHypertonic – fluid loss exceeds loss of electrolytesHypotonic – electrolytes loss exceeds loss of waterFluid ExcessIsotonic – Only ECF is expandedHypertonic – excessive Na+ intake; fluid shifts from ICF to ECFHypotonic – water intoxication; life threatening; fluid moves in ICF and all compartment expands
  • Skin – elasticity; Renal – decrease filtration; increase water loss; poor excretion of waste products;Muscle mass – lean – greater risk of dehydration and decrease fluid intake;Neuro – diminished reflexes such as the thirst center; decrease fluid, risk of dehydration;Endocrine – atrophy of muscle and adrenal; regulation of Na and K poor; prone to hyponatraemia and hyperkalaemia
  • Nursing AssessmentSkin elasticity, oedema, skin dryness, mucous membraneVital Signs -Increase respiratory rate in response to hypoxia, hypotensionAltered Mental status – confusion, lethargicNeuromuscular - assessment of muscle tone and strength, movement, coordination, and tremorsRenal - weight loss, fluid balance recordLab data –elevated haemoglobins, haematocrits, glucose, protein, blood urea
  • Intervention for Fluid ImbalanceDehydrationOral Fluid ReplacementWater, Oral ElectrolytesIV TherapyCheck closely for FluidOverload - Input and OutputCheck vital signsDrug TherapyDepending on cause:Antiemetic, Antidiarrhoea,Antibiotic, DysrhythmiasOral care, artificial tears, saliva
  • Over-HydrationFluidImbalanceIsotonic Over-HydrationHypotonic Over-Hydration Water intoxication; fluid moves into ICFHypertonic Over-Hydration Fluid pulled from ICSInterventionsDrug therapyOsmotic diuretics, then Loop diuretic (Lasix)Vital Signs Check IV fluids hourly – Input and OutputDaily weight, serum and electrolytes level, ECGDiet TherapyRestrict fluid and sodium intakeNotify MO
  • Hypo and Hypermagnesaemia (Mg+)Hypo and Hyperphosphataemia (Phos+)Hypo and Hyperchloraemia (Cl-)
  • Excessive – Hyper electrolytes; Antagonist – medication to block absorption, or binders to electrolytes that excrete the excess electrolytes via renal or GI system; last resort is dialysis.Complications – heart rate, dysrhythmias, ECG, Vital Signs
  • Assess mental status, cardiovascular, Neuromuscular, GI; Vital signs, weights, I &O if fluid excess or loss and needs monitoring.GI distress – increase motility, nausea, diarrhea, and abdominal cramping; bowel sounds hyperactive; bowels watery and frequent; Hyponatraemia with hypovolaemia – rapid weak, thready pulse, neck veins flat, severe hypotension (diastolic down); Hypervolaemia – Blood pressure normal or high; pulses difficult to palpate if edema.In hypernatraemia – irritability – overexcited tissues; mental status – seizures, memory impaired and possible attention span delay, lethargic, drowsy. Cardiovascular – If hypovolaemia – faint peripheral pulses, hypotension, orthostatic hypertension, pulse pressure is reduced.Diuretics if excess fluids,
  • K+ - cause major cell excitability, in particular nerve and muscle, and cellular processes; increase cell uptake of K+(hypo K+) in metabolic alkalosis and insulin use. GI – decreased peristalsis, constipation, abdominal distention- paralytic ileus;Mental status – loss problem solving ability;EKG – ST- segment depressed, T wave flat or inverted and increase U wave; dysrhythmias can be fatal.IV K+ - severely irritating to tissues – never given SQ or IM, and given in 1 liter; Oral potassium – liquid, unpleasant taste. But with protocol and frequent lab monitoring, it does well to raise K+ levels.In treatment – for constipation – fiber, fluids; asses for respiratory distress – hypoxemia ( decrease blood oxygen levels or hypercapnia – increase CO2 levels)K sparing diuretics, foods high in K+; Older adults at risk due to meds, mental status, physiological changes.Hyperkalaemia – Tall, peak T waves, prolong PR intervals, flat or absent P waves and wide QRS’ high K+ levels – complete heart block, asystole and ventricular fibrillation; paresthesia – tingling numbness in hands and feet and around mouth; treat with sodium polystyrene sulfonate
  • Hypocalcaemia - seizuresHypocalcaemia – excitable tissues – heart, muscles, nerves, and intestinal smooth muscles. Blood-clotting requires calcium in excessive calcium may have increase clotting especially if viscosity of blood.EKG – changes in T wave and QT intervalsCalcium binders – to lower serum calcium levels – drugs that interfere with calcium uptake – NSAID, ( calcium inhibitor - reabsorption to bones).
  • Trousseau’s sign – Carpal spasm can be extracted by compressing the upper arm causing ischaemia to the nerves distallyHoman’s sign – Pain obtained in the calf when the foot is dorsiflexed, symptomatic of venous thrombosisChvosteck’s sign – a spasm of the facial muscles which occurs in tetany.
  • Isotonic - Lactated Ringers Solution or Normal SalineHypotonic - .45% NaClHypertonic – 5 or 10% Dextrose ( concentration)Common complication or problem with IV fluids – infectionLocal complications – Infiltration and extravasations – escape of fluid from its normal course into surrounding tissues. Phlebitis inflammation of vein; Thrombophlebitis – inflammation with blood clot. HaematomaAir embolism – another complication – dyspnoea, cyanosis, weak, hypotension, unresponsiveness. Omit starting IV and peripheral and central and midline catheters
  • Thank you for your time any questions??????
  • Fluid and electrolyte

    1. 1. Fluid and Electrolyte Imbalances
    2. 2. ObjectivesDefine Key Terms associated with Fluids andElectrolytesDescribe the Assessment for Fluid andElectrolytes ImbalancesDiscuss the Nursing Interventions inMaintaining Fluid and Electrolyte Homeostasis
    3. 3. Homeostasis60% of body consistsof fluidIntracellular spaceExtracellular spaceElectrolytes -active ions:Cation positiveAnion negative
    4. 4. Regulation of Body Fluid CompartmentsOsmosis is diffusion of water caused by fluid gradient.Diffusion is movement of a substance from area of higherconcentration to one of lower concentration.Active Transport is movement of substance acrosspermeable membrane and gradient; requires energy and pump.E.g. Sodium/potassium pump
    5. 5. Active Transport Osmosis
    6. 6. Regulation of Body Fluid Compartments (cont’d)Filtration - the movement of water and solutes from an areaof high hydrostatic pressure to an area of low hydrostaticpressureOsmolality - reflects the concentration of fluid that affectsthe movement of water between fluid compartments by osmosisOsmotic pressure - the amount of hydrostatic pressurerequired to stop the flow of water by osmosis
    7. 7. Homeostatic pressure
    8. 8. OsmolarityIsotonic – same solute concentration, equal, no movementacross membraneHypertonic/hyper-osmotic – greater concentrationosmotic pressure water pulled into fluid to equalizeHypotonic/hypo-osmotic – lesser concentrationosmotic pressure water pulled out of fluid to equalize
    9. 9. Dehydration Fluid Overload
    10. 10. Gains and Losses of fluid Gain LossSolid foods water and electrolytesDrinks move in a variety ofThirst center Ways - sensible and Insensible. Kidneys Skin Lungs GI tract
    11. 11. Fluid Imbalances Fluid Deficit Fluid ExcessIsotonic – fluid and Isotonic – Only ECF iselectrolytes loss equally; expandeddecline in circulating blood Hypertonic – excessivevolume Na+ intake; fluid shifts fromHypertonic – fluid loss ICF to ECFexceeds loss of electrolytes Hypotonic – waterHypotonic – electrolytes intoxication; life threatening;loss exceeds loss of water fluid moves in ICF and all compartment expands
    12. 12. Developmental Considerations ElderlySkin - elasticity impaired45% to 50% of body weight in older adults is water, loss of muscle mass and reduced ratio of lean to total body weightSites for skin turgor: Forehead, Sternum, AbdomenRenal - decrease filtration, water loss, poor excretionMuscular – higher risk of dehydration, decrease fluid intakeNeuro - diminished reflexes such as thirst centre decreased fluid, leading to dehydrationEndocrine - atrophy of muscle adrenal, poor Na, K regulation, prone to hyponatraemia and hyperkalaemia
    13. 13. Nursing AssessmentSkin elasticity, oedema, skindryness, mucous membraneVital Signs -Increase respiratoryrate in response tohypoxia, hypotensionAltered Mental status –confusion, lethargicNeuromuscular - assessment ofmuscle tone andstrength, movement, coordination, and tremorsRenal - weight loss, fluid balancerecordLab data –elevatedhaemoglobins, haematocrits, glucose, protein, blood urea
    14. 14. Intervention for Fluid Imbalance DehydrationOral Fluid ReplacementWater, Oral ElectrolytesIV TherapyCheck closely for FluidOverload - Input and OutputCheck vital signsDrug TherapyDepending on cause:Antiemetic, Antidiarrhoea,Antibiotic, DysrhythmiasOral care, artificial tears, saliva
    15. 15. Over-Hydration Fluid Imbalance InterventionsIsotonic Over-Hydration Drug therapy Osmotic diuretics, then LoopHypotonic Over-Hydration diuretic (Lasix)Water intoxication; fluid moves Vital Signsinto ICF Check IV fluids hourly – Input and OutputHypertonic Over-Hydration Daily weight, serum andFluid pulled from ICS electrolytes level, ECG Diet Therapy Restrict fluid and sodium intake
    16. 16. Electrolyte Imbalances Hypo and Hypernatraemia (Na+) 135-146 mmol/L Hypo and Hyperkalaemia (K+) 3.5 - 5.0 mmol/L Hypo and Hypercalcaemia (Ca+) 2.2 – 2.67mmol/L
    17. 17. Electrolytes Basic Principles in TreatmentElectrolyte Deficits Electrolyte Excess Drug Supplements Antagonist – block Foods absorption Hydration Assess – Vital signs, Cease foods or ECG changes medications high in Remove the cause electrolytes Assess – Vital signs, ECG changes Remove the cause
    18. 18. Sodium Electrolyte Imbalances Hyponatraemia N+ HypernatraemiaClinical Manifestation Clinical ManifestationIrritability, confusion, dizziness, tremors, Restlessness, intense thirst, dry swollenseizures, coma, dry mucous tongue, twitching, weightmembrane, cold, clammy skin, weight loss, lethargy, seizures, coma, flushedgain, muscle spasms, nausea, vomiting skin, peripheral/pulmonary oedemaAssess mental, muscle weakness, GI Assess mental status, muscle twitchingdistress, hypovolaemia, fluid and irregular muscle contractions, Vitalinput/output, Vital Signs Signs, BP in hypovolaemia, BP with bounding pulses in hypervolaemia, fluidNotify MO input/outputReplace Na+ slowly, Saline IV infusions Notify MOCheck ADH levels If fluid loss - hypotonic IV fluidsMonitor electrolytes if Na+ K+ If fluid and Na+ loss - isotonic IV fluidDiet therapy Restrict Na+
    19. 19. Potassium Electrolyte Imbalances Hypokalaemia K+ HyperkalaemiaClinical Manifestation Clinical ManifestationHand grasp weak, hyporeflexia, paresthesia, GI upset, irritability,muscle weakness, shallow irregular pulserespirations, pulse thready andweak, dysrhythmia, lethargic, Assess ECG changes, Vital Signs,confusion, coma, GI upset, hypo Fibre/Fluid intakeactivity Notify MOAssess Vital Signs, ECG changes; Stop K+ - oral or IVFibre and Fluid intake Administer K+ excreting diuretics (lasix) and KayexlateNotify MO Dialysis if severeAdminister K+ oral or IVMonitor lab results
    20. 20. ECG Changes
    21. 21. Calcium Electrolyte Imbalances Hypocalcaemia Ca+ HypercalcaemiaClinical Manifestations - Vitamin D Clinical Manifestations - osteoporosis,deficiency, numb and tingling prolonged immobilization, decreasedfingers, muscle muscle tone, weakness, lethargy, kidneycramps, weak/thready stones, bradycardia, dysrhythmias, deep tendon reflexes without paresthesiapulse, tachycardia/bradycardia, seizures Assess - Vital Signs, ECG – T wave, QT intervalAssess - Vital Signs, bowel Homan’s sign, mental status, musclesounds, Trousseau’s and Chvosteck’s weakness, bowels sounds Renal calculi - strain urine, Input/outputsigns Discontinue calcium oral or IV drugsNotify MO (antacids), Notify MO - Saline IV, LasixAdminister Calcium gluconate, foods diuretics, calcium binders, NSAID,high in calcium, assess for injury dialysisSeizure precautions
    22. 22. Trousseau’s signHoman’s sign Chvosteck’s sign
    23. 23. Complications of Intravenous TherapySystemic Complications Local ComplicationsFluid overload Infiltration and ExtravasationsAir embolism –Dyspnoea, Cyanosis Phlebitis ThrombophlebitisSepticemia and other infection Hematoma Clotting and ObstructionCease IV FluidsNotify MO Stop infusion at once Warm or cold compresses Notify MO
    24. 24. Thank you