The document discusses fluid and electrolyte imbalances, including types, causes, clinical manifestations, and treatment interventions for conditions such as fluid volume deficit and excess, as well as various electrolyte imbalances like hypokalemia, hyperkalemia, hyponatremia, and hypernatremia. It provides specific assessment findings and treatment options, including dietary changes, fluid management, drug therapy, and monitoring techniques. The information is structured to aid in the understanding of clinical signs, causes, and appropriate nursing interventions.

1. Fluid & Electrolyte ImbalanceFluid & Electrolyte Imbalance

2. Fluid ImbalanceFluid Imbalance

3. Fluid Volume DeficitFluid Volume Deficit
(Hypovolemia, Isotonic Dehydration)(Hypovolemia, Isotonic Dehydration)
Common Causes
– Hemorrhage
– Vomiting
– Diarrhea
– Burns
– Diuretic therapy
– Fever
– Impaired thirst

4. Clinical ManifestationsClinical Manifestations
Signs/Symptoms
– Weight loss
– Thirst
– Orthostatic changes in pulse rate and bp
– Weak, rapid pulse
– Decreased urine output
– Dry mucous membranes
– Poor skin turgor

5. Treatment/Interventions (FVD)Treatment/Interventions (FVD)
Fluid Management
– Diet therapy – Mild to moderate dehydration.
Correct with oral fluid replacement.
– Oral rehydration therapy – Solutions containing
glucose and electrolytes. E.g., Pedialyte,
Rehydralyte.
– IV therapy – Type of fluid ordered depends on
the type of dehydration and the clients
cardiovascular status.

7. Nursing ImplicationsNursing Implications
Monitor postural heart rate and bp
when getting patients out of bed

8. Fluid Volume ExcessFluid Volume Excess
Common Causes:
– Congestive Heart Failure
– Early renal failure
– IV therapy
– Excessive sodium ingestion

9. Clinical ManifestationsClinical Manifestations
Signs/Symptoms
– Increased BP
– Bounding pulse
– Venous distention
– Pulmonary edema
 Dyspnea
 Orthopnea (diff. breathing when supine)
 crackles

10. Treatment/InterventionsTreatment/Interventions
Drug therapy
– Diuretics may be ordered if renal failure is not
the cause.
Restriction of sodium and saline intake

11. Electrolyte ImbalanceElectrolyte Imbalance

12. Hypokalemia (<3.5mEq/L)Hypokalemia (<3.5mEq/L)
Pathophysiology –
– Decrease in K+ causes decreased excitability of
cells, therefore cells are less responsive to
normal stimuli

13. Hypokalemia (<3.5mEq/L)Hypokalemia (<3.5mEq/L)
Contributing factors:
– Diuretics
– Shift into cells
– Digitalis
– Water intoxication
– Corticosteroids
– Diarrhea
– Vomiting

15. Hypokalemia (<3.5mEq/L)Hypokalemia (<3.5mEq/L)
Interventions
– Assess and identify those at risk
– Encourage potassium-rich foods
– K+ replacement (IV or PO)
– Monitor lab values
– D/c potassium-wasting diuretics
– Treat underlying cause

16. Hyperkalemia (>5.0mEq/L)Hyperkalemia (>5.0mEq/L)
Pathophysiology – An inc. in K+ causes
increased excitability of cells.

17. Hyperkalemia (>5.0mEq/L)Hyperkalemia (>5.0mEq/L)
Contributing factors:
– Increase in K+ intake
– Renal failure
– K+ sparing diuretics
– Shift of K+ out of the cells

19. Hyperkalemia (>5.0mEq/L)Hyperkalemia (>5.0mEq/L)
Interventions
– Need to restore normal K+ balance:
– Eliminate K+ administration
– Inc. K+ excretion
 Lasix
 Kayexalate (Polystyrene sulfonate)
– Infuse glucose and insulin
– Cardiac Monitoring

20. Hyponatremia (<135mEq/L)Hyponatremia (<135mEq/L)
Contributing Factors
– Excessive diaphoresis
– Wound Drainage
– NPO
– CHF
– Low salt diet
– Renal Disease
– Diuretics

21. Hyponatremia (<135mEq/L)Hyponatremia (<135mEq/L)
Assessment findings:
– Neuro - Generalized skeletal muscle weakness.
Headache / personality changes.
– Resp.- Shallow respirations
– CV - Cardiac changes depend on fluid volume
– GI – Increased GI motility, Nausea, Diarrhea
(explosive)
– GU - Increased urine output

22. Hyponatremia (<135mEq/L)Hyponatremia (<135mEq/L)
Interventions/Treatment
– Restore Na levels to normal and prevent further
decreases in Na.
– Drug Therapy –
 - IV therapy to restore both fluid and Na. If severe
may see 2-3% saline.
 – Administer osmotic diuretic (Mannitol) to excrete
the water rather than the sodium.
– Increase oral sodium intake and restrict oral
fluid intake.

23. Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Contributing Factors
– Hyperaldosteronism
– Renal failure
– Corticosteroids
– Increase in oral Na intake
– Na containing IV fluids
– Decreased urine output with increased urine
concentration

24. Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Contributing factors (cont’d):
– Diarrhea
– Dehydration
– Fever
– Hyperventilation

25. Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Assessment findings:
– Neuro - Spontaneous muscle twitches.
Irregular contractions. Skeletal muscle wkness.
Diminished deep tendon reflexes
– Resp. – Pulmonary edema
– CV – Diminished CO. HR and BP depend on
vascular volume.

26. Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
GU – Dec. urine output. Inc. specific
gravity
Skin – Dry, flaky skin. Edema r/t fluid
volume changes.

27. Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Interventions/Treatment
– Drug therapy
 .45% NSS. If caused by both Na and fluid loss,
will administer NaCL. If inadequate renal excretion
of sodium, will administer diuretics.
– Diet therapy
 Mild – Ensure water intake

28. Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)
Contributing factors:
– Dec. oral intake
– Lactose intolerance
– Dec. Vitamin D intake
– End stage renal disease
– Diarrhea

29. Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)
Contributing factors (cont’d):
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid
gland

30. Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)
Assessment findings:
– Neuro –Irritable muscle twitches.
 Positive Trousseau’s sign.
 Positive Chvostek’s sign.
– Resp. – Resp. failure d/t muscle tetany.
– CV – Dec. HR., dec. BP, diminished
peripheral pulses
– GI – Inc. motility. Inc. BS. Diarrhea

31. Positive Trousseau’s SignPositive Trousseau’s Sign

32. Positive Chvostek’s SignPositive Chvostek’s Sign

33. Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)
Interventions/Treatment
– Drug Therapy
 Calcium supplements
 Vitamin D
– Diet Therapy
 High calcium diet
– Prevention of Injury
 Seizure precautions

34. Hypercalcemia (>10.5mg/dL)Hypercalcemia (>10.5mg/dL)
Contributing factors:
– Excessive calcium intake
– Excessive vitamin D intake
– Renal failure
– Hyperparathyroidism
– Malignancy
– Hyperthyroidism

35. Hypercalcemia (>10.5mg/dL)Hypercalcemia (>10.5mg/dL)
Assessment findings:
– Neuro – Disorientation, lethargy, coma, profound
muscle weakness
– Resp. – Ineffective resp. movement
– CV - Inc. HR, Inc. BP. , Bounding peripheral pulses,
Positive Homan’s sign.
Late Phase – Bradycardia, Cardiac arrest
– GI – Dec. motility. Dec. BS. Constipation
– GU – Inc. urine output. Formation of renal calculi

36. Hypercalcemia (>10.5mg/dL)Hypercalcemia (>10.5mg/dL)
Interventions/Treatment
– Eliminate calcium administration
– Drug Therapy
– Isotonic NaCL (Inc. the excretion of Ca)
– Diuretics
– Calcium reabsorption inhibitors (Phosphorus)
– Cardiac Monitoring

37. Hypomagnesemia (<1.4mEq/L)Hypomagnesemia (<1.4mEq/L)
Contributing factors:
– Malnutrition
– Starvation
– Diuretics
– Aminoglycoside antibiotics
– Hyperglycemia
– Insulin administration

38. Hypomagnesemia (<1.4mEq/L)Hypomagnesemia (<1.4mEq/L)
Assessment findings:
*Neuro - Positive Trousseau’s sign.
Positive Chvostek’s sign. Hyperreflexia.
Seizures
*CV – ECG changes. Dysrhythmias. HTN
*Resp. – Shallow resp.
*GI – Dec. motility. Anorexia. Nausea

39. Hypomagnesemia (<1.4mEq/L)Hypomagnesemia (<1.4mEq/L)
Interventions:
– Eliminate contributing drugs
– IV MgSO4
– Assess DTR’s hourly with MgSO4
– Diet Therapy

40. Hypermagnesemia (>2.0mEq/L)Hypermagnesemia (>2.0mEq/L)
Contributing factors:
– Increased Mag intake
– Decreased renal excretion

41. Hypermagnesemia (>2.0mEq/L)Hypermagnesemia (>2.0mEq/L)
Assessment findings:
Neuro – Reduced or weak DTR’s. Weak
voluntary muscle contractions. Drowsy to
the point of lethargy
CV – Bradycardia, peripheral
vasodilatation, hypotension. ECG changes.

42. Hypermagnesemia (>2.0mg/dL)Hypermagnesemia (>2.0mg/dL)
Interventions
– Eliminate contributing drugs
– Administer diuretic
– Calcium gluconate reverses cardiac effects
– Diet restrictions