Ati: Fluid & Electrolyte Imbalances

Front 1

body fluids are distributed

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between Intracellular & Extracellular compartments

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Fluid can move between compartments through

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Selective permeable membranes

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varieties of methods of moving fluid through compartments

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diffusion, active transport, filtration, osmosis

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minerals sometimes called salts that are present in all body fluids?

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electrolytes

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They help regulate fluid balance and hormone production, strengthen skeletal structures, and act as catalysts in nerve response, muscle contraction, and the metabolism of nutrients

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ELECTROLYTES

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When electrolytes dissolved in water or another solvent what happen?

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It separate into ions: conduct either POSITIVE OR NEGATIVE electrical current

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Examples of Electrolytes that are cation or positive?

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magnesium, potassium, sodium, and calcium

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Examples of Electrolytes that are anions or negative?

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phosphate, sulfate, chloride, bicarbonate

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The lab test can reflect the electrolyte concentrations in?

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Plasma not within the cell

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two fluid imbalances

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Fluid Volume deficit and Fluid volume excess

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loss of water, no loss of electrolytes

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dehydration

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loss of water and electrolytes

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hypovolemia

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Compensatory mechanisms include sympathetic nervous system responses that also arise? 3 ans

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Increased thirst, antidiuretic horme (ADH) release, and aldosterone release

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Why is it that older adults have an increased risk of dehydration ?

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due to a decrease in TOTAL BODY MASS, w/c includes total body water content

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Assessment: Causes of HYPOVOLEMIA?

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1. ABNORMAL GI LOSES ( vomiting, diarrhea, nasogastric suctioning.
2. ABNORMAL SKIN LOSSES (Diaphoresis-excessive sweating)
3. ABNORMAL RENAL LOSSES ( diuretic therapy, diabetes insipidus, renal disease, adrenal insufficiency, osmotic diuresis)
4. THIRD SPACING- Peritonitis, Intestinal obstruction, ascites, burns
5. HEMORRHAGE
6. ALTERED INTAKE (NPO)

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does hct (hematocrit) increase or decrease in hypovolemia?

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increase

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What happens to the H2O and Na when Hypervolemic

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Water and sodium are abnormally high

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gain of more water than electrolytes

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overhydration/hypoosmolar fluid imbalance

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severe hypovolemia can lead to

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pulmonary edema and heart failure

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causes of hypervolemia? 5 ans

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1. Chronic stimulus to the kidney to conserve sodium and water(heart failure, cirrhosis, increased glucocorticosteroids)
2. Abnormal renal function with reduced excretion of sodium and water (renal failure)
3. Interstitial to plasma fluid shifts (hypertonic fluids, burns)
4. Age-related changes in cardiovascular and renal function
5. Excessive sodium intake

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subjective/objective data of hypervolemia

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tachycardia, bounding pulse, hyprtension, tachypnea, confusion, muscle weakness, weight gain, edema

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decreased hct occurs in

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hypervolemia

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in hypervolemia, respiratory alkalosis occurs

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decreased CO2, increased pH

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nursing interventions for hypervolemia

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assess respiratory rate, symmetry & effort, monitor dyspnea and shortness of breath, monitor I&O, implement prescription restrictions for fluid & Na intake, monitor & document edema and weight daily

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major electrolytes in the body

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Na, K, Cl, Mg, P, and Ca

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major electrolyte found in ECF

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Na+

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subjective/objective data of hyponatremia

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hypothermia, tachycardia, rapid thready pulse, orthostatic hypotension, headache, confusion, lethargy, muscle weakness

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nursing interventions for hyponatremia

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monitor I&O, weight daily, vital signs, consciousness, ECF, restrict fluid intake

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hypernatremia subjective/objective data

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hyperthermia, tachycardia, orthostatic hypotension, irritability, muscle twitching, edema, warm/flushed skin

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nursing interventions for hypernatremia

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encourage h2o intake/discourage Na intake, administer diuretics, monitor consciousness, monitor I&O

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subjective/objective data for hypokalemia

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hyperthermia, hypotension, muscle cramping, bradycardia, polyuria

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nursing interventions for hypokalemia

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provide K via IV or po, monitor I&O, cardiac rhythm, respirations

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subjective/objective data for hyperkalemia

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explosive diarrhea, hypotension,

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nursing interventions for hyperkalemia

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administer kayexalate (excrete K), monitor cardiac rhythm, withhold K

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subjective/objective data for hypocalcemia

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check chvostek's sign (excitability/facial twitching), decreased heart rate, hypotension, diarrhea, cramping

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nursing interventions for hypocalcemia

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administer Ca via IV or PO, encourage foods high in Ca

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subjective/objective data for hypercalcemia

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check for Trousseau's sign (depression via cuff), anorexia, nausea, constipation, vomiting, confusion

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pt with hypovolemia m/b vomiting & diarrhea; also expected to find

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tachycardia, syncope, decreased skin turgor

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pt at risk for hypervolemia

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is a pt who has heart failure