fluid and electrolyte balance.pptx
•Download as PPTX, PDF•
0 likes•20 views
This document discusses fluid, electrolyte, and acid-base imbalances. It begins by defining these balances and how the body maintains them. It then describes various fluid volume imbalances including deficits and excesses. It also discusses osmolar imbalances like dehydration. Electrolyte imbalances covered include sodium, potassium, calcium, magnesium, phosphorus, and chloride. Finally, it examines metabolic and respiratory acid-base imbalances and their nursing management. The goal is for learners to understand factors affecting fluid and electrolyte balances and how to describe related imbalances.
More Related Content
Similar to fluid and electrolyte balance.pptx
Similar to fluid and electrolyte balance.pptx (20)
More from Renuga Suresh
Recently uploaded
Recently uploaded (20)
fluid and electrolyte balance.pptx
- 1. Course : B.Sc Nursing Subject : Fundamentals of Nursing Unit : X Topic : Fluid and Electrolyte Imbalance
- 2. OBJECTIVES • At the end of the session the learner will be able to • discuss about the factors affecting fluid and electrolyte and acid base balances. • describe about the fluid electrolyte and acid base imbalances.
- 3. INTRODUCTION Fluid, electrolyte and acid base balance within the body maintain health and function in all body systems. These balances are maintained by the intake and output of water and electrolytes, their distribution in the body and regulated by the renal and pulmonary system.
- 4. FLUID VOLUME IMBALANCE FLUID VOLUME DEFICIT HYPEROSMOLAR FLUID VOLUME EXCESS HYPOOSMOLAR ISOTONIC IMBALANCE OSMOLAR IMBALANCE
- 5. ISOTONIC FLUID VOLUME DEFICIT Water and solutes lost in equal proportion. CAUSES Diarrhea,vomitting,fistulas,drains Bleeding, burns Fever, excessive perspiration Inadequate fluid intake Diuretics GI suctioning
- 6. SIGNS AND SYMPTOMS • Postural hypotension • Tachycardia • Dry mucus membranes • Poor skin turgor • Thirst • Confusion • Rapid weight loss • Slow vein filling • Oliguria • Weak pulse
- 7. NURSING INTERVENTIONS • Ensure patent airway, adjust O2 levels as ordered • Direct pressure to bleeding, if present • Administer meds, blood, albumin, & IV fluids • Weigh patients daily • Provide skin care • Maintain strict I&O • Monitor vital signs • Monitor lab work
- 8. FLUID VOLUME EXCESS Water and solutes gained in excess of normal body levels Causes: • Isotonic fluid overload • Excess sodium intake • CHF, renal failure, • Cirrhosis • Increase in steroids or serum aldosterone
- 10. LABORATORY FINDINGS • Decreased hematocrit • Decreased BUN • Low O2 levels
- 11. NURSING INTERVENTIONS • Restrict Na+ & fluid intake • Watch for edema • Provide measures to facilitate breathing • Provide skin care for weeping & edema • Monitor response to medications • Monitor accurate I/O, Consistent daily weight, Vital Signs • Monitor laboratory values • Hemodialysis may be needed
- 12. OSMOLAR Hyperosmolar: Dehydration Loss of water = increased serum osmolality
- 13. CAUSES OF DEHYDRATION • Diabetes insipidus, • Prolonged fever, • Watery diarrhea, • Hyperglycemia, • Failed thirst drive • Latrogenic: hypertonic solutions (IV & tube feeding) • Diuresis of water alone
- 14. SIGNS & SYMPTOMS • Irritability, • Confusion, • Weakness, • Dizziness • Decreased urine output, • Darkened urine • Extreme thirst !!! • Fever (insensible – continuous) • Coma • Tachycardia, • Weak, thready pulse, • Hypotension LABORATORY FINDINGS Elevated serum osmolarity Elevated serum sodium Urine specific gravity > 1.030
- 16. NURSING INTERVENTIONS • Replace fluids by PO route first • SLOW admin. of salt-free IV solutions • Monitor S/S cerebral & pulmonary edema • Monitor accurate I/O, Consistent daily weight, Vital Signs • Monitor laboratory values • Provide skin and mouth care
- 17. HYPO OSMOLAR Causes Syndrome of inappropriate of antidiuretic hormone/ Excess water intake. Signs/Symptoms Decreased LOC, Convulsions, Coma
- 18. NURSING INTERVENTIONS • Restrict Na+ & fluid intake • Watch for edema • Provide measures to facilitate breathing • Provide skin care for weeping & edema • Monitor response to medications • Monitor accurate I/O, Consistent daily weight, Vital Signs • Monitor laboratory values • Hemodialysis may be needed
- 19. NORMAL VALUES OF ELECTROLYTES
- 20. HYPONATREMIA Serum sodium less than 135 mEq/L Causes: adrenal insufficiency water intoxication SIADH or losses by vomiting diarrhea sweating diuretics
- 21. MANIFESTATIONS • poor skin turgor • dry mucosa • headache • decreased salivation • decreased BP • nausea • abdominal cramping • neurologic changes
- 22. LABORATORY FINDINGS: Serum Osmolality below 280 mOsm/kg Urine specific gravity below 1.010 TREATMENT: Restrict water Sodium replacement
- 23. Hypernatremia • MANIFESTATIONS • Thirst • Elevated temperature • Dry • Swollen tongue • Sticky mucosa • Neurologic symptoms • Restlessness • Weakness Serum sodium greater than 145mEq/L CAUSES
- 24. LABORATORY FINDINGS: Serum Na+ above 145 mEq/L Serum Osmolality above 295 mOsm/kg Urine specific gravity above 1.030 TREATMENT: Hypotonic IV solution or D5W
- 25. HYPOKALEMIA CAUSES: GI losses Medications Alterations of acid-base balance Hyperaldosteronism Poor dietary intake
- 27. LABORATORY FINDINGS: • K+ below 3.5 mEq/L • ECG abnormalities TREATMENT • Oral K+ or IV solution w/K+ • Increased dietary K+
- 28. HYPERKALEMIA Serum potassium greater than 5.0 mEq/L
- 29. Manifestations: • Cardiac changes and dysrhythmias • Muscle weakness with potential respiratory impairment • Paresthesias • Anxiety • GI manifestations
- 30. NURSING MANAGEMENT Assessment of serum potassium levels, Mix ivs containing K+ well, Monitor medication affects, Dietary potassium restriction/dietary teaching for patients at risk Hemolysis of blood specimen Salt substitutes, medications may contain potassium potassium-sparing diuretics may cause elevation of potassium Should not be used in patients with renal dysfunction
- 31. HYPOCALCEMIA • Serum level less than 8.5 mg/dL, Causes: • Hypoparathyroidism, • Malabsorption, • Pancreatitis, • Alkalosis, • Massive transfusion of citrated blood, • Renal failure, • Medications,
- 33. Nursing management: Assessment, • Severe hypocalcemia is life-threatening, • Weight-bearing exercises to decrease bone calcium loss, • Patient teaching related to diet and medications, • And nursing care related to IV calcium administration
- 34. HYPERCALCEMIA Serum level above 10.5 mg/dL
- 35. • Manifestations: • Muscle weakness, • Incoordination, • Anorexia, • Constipation, • Nausea and vomiting, • Abdominal and bone pain, • Polyuria, • Thirst, • Nursing management • Assessment, • Hypercalcemic crisis has high mortality, • Encourage ambulation, • Fluids of 3 to 4 L/d, • Fiber for constipation, • Ensure safety
- 36. HYPOMAGNESEMIA Serum level less than 1.8 mg/dl, evaluate in conjunction with serum albumin Causes: • Alcoholism, • GI losses, • Enteral or parenteral feeding • Deficient in magnesium, • Medications, • Rapid administration of citrated blood; • Contributing causes include diabetic ketoacidosis, sepsis, burns, hypothermia
- 37. Manifestations • Neuromuscular irritability • Muscle weakness • Tremors • Athetoid movements • ECG changes and dysrhythmias • Alterations in mood and level of consciousness
- 38. NURSING MANAGEMENT • Assessment • Ensure safety • Patient teaching related to diet • Medications • Alcohol use • Need to monitor, treat potential hypocalcemia • Dysphasia common in magnesium-depleted patients • Assess ability to swallow with water before administering food or medications
- 40. Hypomagnesemia • Manifestations • Flushing, • Lowered BP, • Nausea, • Vomiting, • Hypoactive reflexes, • Drowsiness, • Depressed respirations, • ECG changes, • Nursing management Assessment, Do not administer medications containing magnesium Patient teaching regarding magnesium containing OTC medications
- 42. Manifestations: • neurologic symptoms • confusion • muscle weakness • tissue hypoxia • muscle and bone pain Nursing management: • Assessment • Encourage foods high in phosphorus • Gradually introduce calories for malnourished patients receiving parenteral nutrition
- 44. Manifestations: • Few symptoms • Soft-tissue calcifications, • Symptoms occur due to associated hypocalcemia Nursing management: • Assessment, • Avoid high- phosphorus foods; • Patient teaching related to diet, • Phosphate-containing substances, • Signs of hypocalcemia
- 45. HYPOCHLOREMIA Serum level less than 96 mEq/L Causes: • Addison’s disease • Reduced chloride intake • GI loss • Diabetic ketoacidosis • Excessive sweating • Fever • Burns • Medications • Metabolic alkalosis • Loss of chloride occurs with loss of other electrolytes, potassium, sodium
- 46. Manifestations: • Agitation, • Irritability, • Weakness, • Hyperexcitability of muscles, • Dysrhythmias • Seizures, Nursing management: • Assessment, • Avoid free water, • Encourage high-chloride foods, • Patient teaching related to high-chloride foods
- 47. HYPERCHLOREMIA Serum level more than 108 mEq/L Causes: • Excess Sodium Chloride Infusions With Water Loss • Head Injury • Hypernatremia • Dehydration • Severe Diarrhea • Respiratory Alkalosis • Metabolic Acidosis • Hyperparathyroidism • Medications
- 48. Manifestations: • Tachypnea • Lethargy • Weakness • Rapid • Deep respirations • Hypertension • Cognitive changes Nursing management: • Assessment • Patient teaching related to diet and hydration
- 50. METABOLIC ACIDOSIS Metabolic acidosis is acid accumulation due to Increased acid production or acid ingestion Decreased acid excretion GI or renal HCO3 − loss Metabolic acidosis is either due to increased generation of acid or an inability to generate sufficient bicarbonate.
- 52. Management • Treat the underlying cause • Provide hydration • Monitor arterial blood gases • Monitor I&O and weight • Assess vital signs • Assess respiratory rate and depth • Assess level of consciousness • Monitor GI function • May need to administer alkalotic IV solution ◦ NaHCO3 ◦ Must be administered cautiously due to possibility of metabolic alkalosis and hypokalemia
- 54. MANAGEMENT Correct underlying disorder, supply chloride to allow excretion of excess bicarbonate, restore fluid volume with sodium chloride solutions
- 55. RESPIRATORY ACIDOSIS • Respiratory system cannot eliminate all CO2 made by peripheral tissues • Accumulates in ECF & lowers its pH • Primary symptom of hypercapnia-respiratory acidosis • Hypoventilation-low respiratory rate
- 57. MANAGEMENT • Goal focuses on improving ventilation and ↓ PaCO2 • Pulmonary Hygiene – CPT, coughing, deep breathing, repositioning—semi-fowler’s, suctioning, hyperventilating pt. before and after treatments • Auscultate lungs for CPT effectiveness • Oxygen - Use caution with COPD patient • Monitor resp. rate; may use mechanical ventilation • IVF for hydration & PO fluids--up to 3000ml/24 hours • Medications • Pursed-lip breathing
- 58. Respiratory Alkalosis High pH >7.45PaCO2 <35 mm Hg Always due to hyperventilation Manifestations: lightheadedness inability to concentrate numbness and tingling sometimes loss of consciousness
- 60. MANAGEMENT • Identify cause, then treat • If Anxiety, teach slow deep breathing or breathing into paper bag, sedative may be needed • If Pain, administer pain meds. • If needs emotionally upset, provide support • Safety measures • Seizure precautions • Administer oxygen if cause is acute
- 61. CONCLUSION Dehydration may result from lack of water. Positive water balance is an excess accumulation of water in the body. Acid base balance is the regulation of hydrogen ions in the body. Healthy people have intricate maintenance systems for fluid, electroltye and acid base balance.
- 62. REFERENCES • Potter and Perry's Fundamentals of Nursing (2017) 2nd Edition, Elsevier Publication, page No.970-981. • Kozier & Erb's Fundamentals of Nursing (10th Edition), Pearson publication. • Sr Nancy, Principles & Practice Of Nursing, Nursing Arts Procedures (2006), NR Brothers Publication.