Fluid, Electrolyte, & Acid-Base Balance

  1. Some factors affecting fluid and electrolyte balance.
    • 1. Fever
    • 2. decrease in activity
    • 3. meds like diuretics
    • 4. edema
    • 5. diarrhea
  2. What is the primary fluid in the body?
  3. List the different functions of water in the body.
    • 1. Transporting
    • 2. Facilitates metabolism
    • 3. Solvent
    • 4. Temp. maintenance
    • 5. Role in Digestion and elimination
    • 6. Tissue Libricant
  4. What's an example of temperature maintenance in the body?
    Dehydrated pts are at risk for being febrile.
  5. What's an example of the role digestion and elimination play in the function of water in the body?
    If pt is experiencing constipation then they need to drink water, increase intake, increase fruits/veggies (more fiber and more water).
  6. What are the two major fluid compartments?
    • 1. Intracellular Fluid (ICF)
    • 2. Extracellular Fluid (ECF)
  7. This fluid is found within the cells, also known as cytosol.
    Intracellular Fluid
  8. This fluid is found outside the cells.
    Extracellular Fluid
  9. What are the two kinds of extracellular fluid?
    • 1. Interstitial fluid
    • 2. Plasma
  10. Fluid surrounding the cells.
    Interstitial fluid
  11. The fluid component of blood.
  12. __Liter of fluid = __lbs
    1 Liter of fluid = 2.2 lbs
  13. What is the body fluid percentage usually of an elderly person?
  14. What is the body fluid percentage of usually of a baby?
  15. What is the body fluid percentage usually of a woman?
  16. What is the body fluid percentage usually of a male?
  17. What are some of the reasons elders have such a decrease in body fluid percentage?
    • 1. decrease in body mass (despite increase in adipose tissue)
    • 2. decrease in efficiency of the body
    • 3. decrease in thirst for water
  18. What are the two kinds of passive transport?
    • Diffusion
    • Osmosis
  19. What is Active Transport called in the body known as?
    Sodium-potassium pump
  20. The movement of particles across semi-permeable membrane.
  21. Higher concentration moves to lower concentration until equilibrium is maintained.
  22. Movement of water across semi-permeable membrane.
  23. Lower concentration of water moves to higher concentration.
  24. This draws the water, what is this pressure known as?
    Osmotic Pressure
  25. The concentration of particles in solution.
  26. This has greater concentration than serum, or higher osmolarity. It pulls fluid from the intravascular and interstitial compartment of the cells.
  27. This has less concentration than serum so the osmolarity is lower, it allows fluid to move into cells.
  28. How much is normal daily fluid intake?
  29. How much is normal fluid output?
  30. Besides intake and output what else regulates our body fluids?
    Hormonal Regulation
  31. How much are normal PO fluids?
  32. How much water is found in normal solids?
  33. How much intake is metabolized?
  34. How much output do the kidneys make?
  35. How much output does the skin make?
  36. How much fluid output comes from the lungs?
  37. How much fluid output comes from GI?
  38. How much output in total do we normally put out?
  39. How much urine do we put out usually in one hour?
  40. What is the specific gravity urine?
  41. What is the normal pH of urine?
  42. What do we lose through our urine?
  43. What does fluid imbalances mean for the body?
    Unable to maintain homeostasis
  44. What do we look at when there's a fluid imbalance?
    Volume or distribution of water or electrolytes.
  45. What are deficits in the body known as?
  46. What are excesses in the body known as?
  47. What are some reasons pts have low fluid intake?
    • Feeling sick
    • Nausea
    • Unconcious
    • Elderly don't want to get up to go to BR so less intake
    • dysphagia
  48. What is the body composed of ?
    • Water
    • Electrolytes
  49. What's the solvent in your body?
  50. What are the solutes in our body?
  51. Electrolytes are made of...
  52. What are the two types of ions?
    • Cations
    • Anions
  53. What's a positive charge ion known as?
  54. What's a negative charge ion known as?
  55. milliequivalents/Liter
  56. How would you define what electrolytes are?
    Charged particles or ions that are dissolved in body.
  57. List the major positive ions or cations.
    • Na
    • K
    • Ca
    • Mg
  58. List major negative ions or Anions.
    • Cl
    • Bicarbonate ion HCO₃
  59. The 6 major electrolytes in the body are:
    • 1. Sodium
    • 2. Potassium
    • 3. Calcium
    • 4. Chloride
    • 5. Phosphorus
    • 6. Magnesium
  60. What test results indicate fluid deficit?
    • Increased hematocrit
    • Increased serum electrolyte levels
    • Increased blood urea nitrogen (BUN) levels
    • Increased serum osmolarity
  61. What test results indicate fluid excess?
    • ↓hematocrit
    • ↓serum electrolyte levels
    • ↓BUN levels
    • Reduced serum osmolarity
  62. What are signs/symptoms of fluid deficit?
    • wt. loss
    • increased thready pulse rate
    • orthostatic BP, or diminished BP
    • ↓central venous pressure
    • sunken eyes, dry conjunctivae, ↓tearing
    • poor skin turgor (not reliable for elderly)
    • pale, cool skin
    • poor capillary refill ( >2 sec)
    • lack of moisture in groin & axillae
    • thirst
    • ↓salivation
    • dry mouth
    • dry, cracked lips
    • furrows in tongue
    • difficulty forming words (needs moisture on mouth)
    • mental status changes
    • weakness
    • diminished urine output
  63. What are s/s of fluid excess?
    • wt gain
    • ↑BP
    • bounding pulse that isn't obliterated
    • jugular vein distention
    • ↑RR
    • Dyspnea
    • Moist crackles or rhonchi on auscultation
    • Edema of dependent body parts (sacral edema=bedrest,
    • edema in feet and ankles=ambulatory pts)
    • Generalized edema
    • Puffy eyelids
    • Periorbital edema
    • Slow emptying of hand veins when the are is raised
  64. What is the normal level of Potassim K?
    3.5-5.0 mEq/L
  65. When there's an increase in urine output what happens to K?
    decreased K, not stored well and excreted by kidneys
  66. This ion is a major ICF cation, and is only 2% in ECF.
  67. This is essential for the sodium potassium pump to work.
  68. This electrolyte helps with the transmission of nerve impulses, metabolism, muscle contraction, and cardiac rhythm.
  69. What electrolyte is regulated by intake, but not stored well?
  70. This ion is eliminated by the kidneys.
  71. This ion has little tolerance for fluctuations.
  72. When Potassium levels are abnormal what happens? What's affected?
    Become symptomatic quickly and affects the cardiac muscle function
  73. This ion plays a major role in acid-base balance of the body.
  74. What are some foods high in Potassium?
    • Bananas
    • Fat free or skim milk
    • OJ
    • Prune juice
  75. Potassium Imbalance can lead to what...
    • 1. Hypokalemia
    • 2. Hyperkalemia
  76. What is the #1 cause of hypokalemia?
  77. What kinds of s/s do diuretics cause?
    • ↑urine,
    • GI loss
    • polyuria
    • extreme sweating
    • weak
    • cardiac dysrhythmias, irreg. pulse
  78. This potassium imbalance of low K can lead to...
    • Renal Failure
    • ↑intake
    • Fluid Volume deficit
  79. What are the s/s and of Hyperkalemia?
    • Anxiety
    • parethesia (tingling, numbness)
    • dysrhythmia
    • abdominal cramps
    • diarrhea
  80. Someone who has a dysrhythmia due to irregular pulse, what ion levels should we check?
    Potassium level
  81. How much Mg is found in the ICF?
  82. How much Mg is found in bone?
  83. This ion is needed for metabolism, cardiac & skeletal muscle excitability, and neurochemical activity.
  84. This ion is regulated by dietary intake, kidney, and PTH.
  85. About 1/3 of this ion is found in our cells, and 2/3 found in our bones.
  86. List some foods high in Mg.
    • Pumpkin seeds
    • Spinach boiled
    • Chard boiled
    • Soybeans cooked
  87. ↓Mg can lead to... due to...
    Hypomagnesemia due to malnutrition or alcoholism.
  88. What are s/s of hypomagnesemia?
    • tremors
    • confusion
    • hyper deep tendon reflexes
  89. ↑Mg can lead to... due to...
    Hypermagnesemia due to renal failure, excess intake
  90. What are s/s of hypermagnesemia?
    • N/V
    • lethargy
    • decrease in deep tendon reflexes
    • decrease in RR
    • hypotension
  91. This is the main ICF anion.
  92. 85% exists with Ca in bone and teeth
  93. This ion is regulated by dietary intake, kidneys, GI absorptions & PTH
  94. This ion maintains acid-base balance, metabolism, maintains bones and teeth, and neuromuscular action.
  95. This electrolyte is essential for bone formation.
  96. This ion helps with transmission of nerve impulses.
  97. List some foods high in Phosphorus.
    • Cottage cheese
    • Cereal 100% bran
    • Wheat Bran
    • Beef Sirloin
    • Yogurt fruit flavored
  98. What is the normal level for Sodium?
    135 - 145 mEq/L
  99. This ion controls and regulates volume of body fluids.
  100. This is the main ECF cation.
  101. This ion maintains water balance in ECF, transmission of nerve impulses, and acid-base balance.
  102. This ion is regulated by dietary intake and aldosterone.
  103. We lose this electrolyte through the GI tract, skin loss, and diuretics.
  104. ↓Na can lead to... due to...
    Hyponatremia due to GI loss, adrenal insufficiency, increased sweating, use of diuretics
  105. ↑Na can lead to... due to...
    Hypernatremia due to increase in water loss, water deprivation, increased ingestion of salt.
  106. What are the s/s of hyponatremia?
    • confusion
    • wt loss
    • postural hypotension
    • convulsions
    • tachycardia
  107. What are the s/s of hypernatremia?
    • thirst
    • fever
    • convulsions
    • dry-flushed skin
  108. This ion maintains osmotic pressure in the blood.
  109. This ion produces hydrochloric acid maintaining the acidity of gastric fluids.
  110. This ion is the main ECF anion.
  111. This electrolyte is regulated by dietary intake and by the kidneys.
  112. This ion is excreted with diuresis or vomiting.
  113. This ion is a major cation in teeth and bone, found equally in ICF and ECF.
  114. Calcium balance depends on...
    • Vitamin D
    • Parathyroid hormone
    • Calcitonin
  115. Premenopausal women need how much calcium daily?
  116. Menopausal women who have hip fractures need how much Calcium/day?
  117. This ion helps with the transmission of nerve impulses, muscle contractions, coagulation, and cardiac contraction.
  118. Women who are at risk for osteoporosis have ↓vitamin D, how can they increase vit D?
    • Sun
    • Milk
  119. What some sources high in Calcium?
    • Sun
    • Milk
    • Soy Milk
    • Viactive
    • Yogurt
  120. ↓Ca leads to... due to...
    Hypocalcemia due to Vit D deficiency, pancreatitis
  121. What are s/s of hypocalcemia?
    • numbness
    • tingling
    • tetany (contracted/spasm)
    • muscle cramps
    • Trousseau's sign
    • Chvostek's sign
  122. Trosseau's sign
    Image Upload 2
  123. Chvostek's sign
    Image Upload 4
  124. ↑Ca leads to... due to...
    Hypercalcemia due to malignancy.
  125. What are the s/s of hypercalcemia?
    • N/V
    • weakness
    • decreased LOC
    • cardiac arrest
    • anorexic
  126. A pt is admitted to hospital for hypocalcemia. Nursing interventions related to which system would have highest priority?

    D. neuromuscular
  127. This ion is regulated by the kidneys, present in both ECF and ICF, and regulates acid-base balance, and has very tight control.
  128. This is necessary for cell function and metabolism.
    Acid-Base Balance
  129. Acid Base Balance includes:
    • CO₂
    • HCO₃
    • Bicarbonate (buffer)
  130. CO₂ role in acid-base balance is...
    acid regulated by lungs (respiratory)
  131. HCO₃ role in acid-base balance is...
    base regulated by kidneys (metabolic)
  132. This substance can absorb or release H⁺ to correct acid-base imbalance.
    Buffer like bicarbonate
  133. ABG's are...
    Arterial Blood Gases are the best evaluator of acid-base balance.
  134. This measures the hydrogen concentration in body fluids
  135. ↑H⁺
    more acidic
  136. ↓H⁺
    more alkaline (basic)
  137. Arterial blood should be kept at
    7.35 - 7.45 pH
  138. Anything below 7.35 pH can lead to...
  139. Anything above 7.45 pH can lead to...
  140. To become more basic...
    an acid releases hydrogen.
  141. To become more acidic...
    a base traps hydrogen.
  142. This does not eliminate enough CO₂ , ↑CO₂ and ↑H
    Respiratory acidosis
  143. This eliminates too much CO₂ , ↓CO₂ , ↓H
    Respiratory alkalosis
  144. Respiratory acidosis occurs in pts with what Dx...
    • CHF - post-op pt taking opiates
    • COPD - hypoventilation
    • pneumonia - chronic asthmatic
  145. Respiratory alkalosis occurs in pts with Dx...
    • hyperventilation
    • anxious pt
  146. This acid base imbalance has a loss of bicarb from ECF, ↑H and ↓bicarb, ↓pH
    Metabolic Acidosis
  147. This eliminates too much CO₂, ↓H , ↑bicarb , ↑pH, and vomiting is the most common cause.
    Metabolic alkalosis
  148. To prevent excessive changes in pH we need what major buffers in ECF...
    • HCO₃
    • H₂CO₃
  149. Other buffers include:
    • Plasma proteins
    • Hemoglobin
    • Phosphates
  150. We can regulate the acid-base balance by eliminating or retaining CO₂ through the lungs so
    a faster rate/more depth =
    get rid of more CO₂ and pH rises
  151. We can regulate the acid-base balance by eliminating or retaining CO₂ through the lungs so
    a slower rate/less depth =
    retain CO₂ and pH lowers
  152. How do the kidneys regulate our acid-base balance of our body?
    regulate by selectively excreting or conserving bicarb and hydrogen ions
  153. Which organs are slower to respond to change?
  154. List factors affecting Fluid, Electrolyte, and Acid-Base balance.
    • age, gender, size
    • chronic diseases and conditions (ex. Renal Failure, CHF, asthma)
    • acute conditions (asthma, surgery, diarrhea, vomiting, NG suctioning)
    • meds (diuretics)
    • Tx (suctioning, IV)
    • other factors: lifestyle, alcoholism
  155. pts who vigorously exercise need...
  156. Nursing History we would need include:
    • current and past medical history
    • meds & Tx
    • Food/Fluid Intake
    • Fluid Output
    • Fluid, Electrolyte, Acid-Base Imbalances
  157. We watch diuretics for
  158. We watch steroids for
  159. These are meds to watch:
    • Diuretics- K
    • Steroids
    • Electrolyte supplements
    • Antibiotics (meds affect kidneys) - nephrotoxicity
    • Respiratory depressants- opioids- long term use
    • NSAID's
    • TPN
  160. Our physical assessment includes:
    • I&O -IV, meds, TPN, emesis, diarrhea
    • Urine concentration
    • Daily wt
    • Skin turgor
    • Thirst
    • Facial and neck appearance - distended vein
    • Neuromuscular irritability -Chvestok's
    • VS
    • Behavior
  161. What labs do we look at?
    • CBC- hematocrit (↑means less diluted, more concentrated)
    • Electrolytes
    • ABG's
    • Kidney function (BUN and creatinine)
    • Urinalysis (U/A) pH and specific gravity(↑=dehydration)
  162. How do we find the hematocrit?
    Find out hemoglobin level and x3 to find hematocrit
  163. List some possible nursing Dx:
    • Fluid Volume (excess, deficit)
    • Impaired skin integrity
    • Ineffective breathing pattern
    • Impaired oral mucosa
    • Decreased cardiac output
    • Activity Intolerance
    • Acute Confusion
  164. What are some desired outcomes?
    • Maintain or restore normal fluid balance
    • Maintain or restore normal balance of electrolytes
    • Maintain or restore pulmonary ventilation and O₂
    • Prevent associated risks (tissue breakdown, decreased cardiac output, confusion, other neurologic signs)
  165. For the nursing Dx: Deficient Fluid Volume, what interventions would we do?
    • increase intake
    • strict I&O
    • daily wt
    • VS Q4
    • oral care
    • assess urine/skin
    • medicate as ordered for antiemetic/antidiarreals
    • monitor electrolytes/IV intake
    • monitor for worsening s/s hypovolemia
Card Set
Fluid, Electrolyte, & Acid-Base Balance
How the body maintains fluid and electrolyte balance