-
Some factors affecting fluid and electrolyte balance.
- 1. Fever
- 2. decrease in activity
- 3. meds like diuretics
- 4. edema
- 5. diarrhea
-
What is the primary fluid in the body?
Water!
-
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
-
What's an example of temperature maintenance in the body?
Dehydrated pts are at risk for being febrile.
-
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).
-
What are the two major fluid compartments?
- 1. Intracellular Fluid (ICF)
- 2. Extracellular Fluid (ECF)
-
This fluid is found within the cells, also known as cytosol.
Intracellular Fluid
-
This fluid is found outside the cells.
Extracellular Fluid
-
What are the two kinds of extracellular fluid?
- 1. Interstitial fluid
- 2. Plasma
-
Fluid surrounding the cells.
Interstitial fluid
-
The fluid component of blood.
Plasma
-
__Liter of fluid = __lbs
1 Liter of fluid = 2.2 lbs
-
What is the body fluid percentage usually of an elderly person?
45%
-
What is the body fluid percentage of usually of a baby?
70-80%
-
What is the body fluid percentage usually of a woman?
50%
-
What is the body fluid percentage usually of a male?
60%
-
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
-
What are the two kinds of passive transport?
-
What is Active Transport called in the body known as?
Sodium-potassium pump
-
The movement of particles across semi-permeable membrane.
Diffusion
-
Higher concentration moves to lower concentration until equilibrium is maintained.
Diffusion
-
Movement of water across semi-permeable membrane.
Osmosis
-
Lower concentration of water moves to higher concentration.
Osmosis
-
This draws the water, what is this pressure known as?
Osmotic Pressure
-
The concentration of particles in solution.
Osmolarity
-
This has greater concentration than serum, or higher osmolarity. It pulls fluid from the intravascular and interstitial compartment of the cells.
Hypertonic
-
This has less concentration than serum so the osmolarity is lower, it allows fluid to move into cells.
Hypotonic
-
How much is normal daily fluid intake?
2200-2700mL
-
How much is normal fluid output?
2200-2700mL
-
Besides intake and output what else regulates our body fluids?
Hormonal Regulation
-
How much are normal PO fluids?
1100-1400mL
-
How much water is found in normal solids?
800-1000mL
-
How much intake is metabolized?
300mL
-
How much output do the kidneys make?
1200-1500mL
-
How much output does the skin make?
500-600mL
-
How much fluid output comes from the lungs?
400mL
-
How much fluid output comes from GI?
100-200mL
-
How much output in total do we normally put out?
2000-2700mL
-
How much urine do we put out usually in one hour?
30mL
-
What is the specific gravity urine?
1.01-1.03
-
What is the normal pH of urine?
4.6-8
-
What do we lose through our urine?
electrolytes
-
What does fluid imbalances mean for the body?
Unable to maintain homeostasis
-
What do we look at when there's a fluid imbalance?
Volume or distribution of water or electrolytes.
-
What are deficits in the body known as?
Hypovolemia
-
What are excesses in the body known as?
Hypervolemia
-
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
-
What is the body composed of ?
-
What's the solvent in your body?
Water
-
What are the solutes in our body?
Electrolytes
-
Electrolytes are made of...
Ions
-
What are the two types of ions?
-
What's a positive charge ion known as?
Cation
-
What's a negative charge ion known as?
Anion
-
milliequivalents/Liter
mEq/L
-
How would you define what electrolytes are?
Charged particles or ions that are dissolved in body.
-
List the major positive ions or cations.
-
List major negative ions or Anions.
-
The 6 major electrolytes in the body are:
- 1. Sodium
- 2. Potassium
- 3. Calcium
- 4. Chloride
- 5. Phosphorus
- 6. Magnesium
-
What test results indicate fluid deficit?
- Increased hematocrit
- Increased serum electrolyte levels
- Increased blood urea nitrogen (BUN) levels
- Increased serum osmolarity
-
What test results indicate fluid excess?
- ↓hematocrit
- ↓serum electrolyte levels
- ↓BUN levels
- Reduced serum osmolarity
-
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
-
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
-
What is the normal level of Potassim K?
3.5-5.0 mEq/L
-
When there's an increase in urine output what happens to K?
decreased K, not stored well and excreted by kidneys
-
This ion is a major ICF cation, and is only 2% in ECF.
Potassium
-
This is essential for the sodium potassium pump to work.
Potassium
-
This electrolyte helps with the transmission of nerve impulses, metabolism, muscle contraction, and cardiac rhythm.
Potassium
-
What electrolyte is regulated by intake, but not stored well?
Potassium
-
This ion is eliminated by the kidneys.
Potassium
-
This ion has little tolerance for fluctuations.
Potassium
-
When Potassium levels are abnormal what happens? What's affected?
Become symptomatic quickly and affects the cardiac muscle function
-
This ion plays a major role in acid-base balance of the body.
Potassium
-
What are some foods high in Potassium?
- Bananas
- Fat free or skim milk
- OJ
- Prune juice
-
Potassium Imbalance can lead to what...
- 1. Hypokalemia
- 2. Hyperkalemia
-
What is the #1 cause of hypokalemia?
Diuretics
-
What kinds of s/s do diuretics cause?
- ↑urine,
- GI loss
- polyuria
- extreme sweating
- weak
- cardiac dysrhythmias, irreg. pulse
-
This potassium imbalance of low K can lead to...
- Renal Failure
- ↑intake
- Fluid Volume deficit
-
What are the s/s and of Hyperkalemia?
- Anxiety
- parethesia (tingling, numbness)
- dysrhythmia
- abdominal cramps
- diarrhea
-
Someone who has a dysrhythmia due to irregular pulse, what ion levels should we check?
Potassium level
-
How much Mg is found in the ICF?
31%
-
How much Mg is found in bone?
67%
-
This ion is needed for metabolism, cardiac & skeletal muscle excitability, and neurochemical activity.
Mg
-
This ion is regulated by dietary intake, kidney, and PTH.
Mg
-
About 1/3 of this ion is found in our cells, and 2/3 found in our bones.
Mg
-
List some foods high in Mg.
- Pumpkin seeds
- Spinach boiled
- Chard boiled
- Soybeans cooked
-
↓Mg can lead to... due to...
Hypomagnesemia due to malnutrition or alcoholism.
-
What are s/s of hypomagnesemia?
- tremors
- confusion
- hyper deep tendon reflexes
-
↑Mg can lead to... due to...
Hypermagnesemia due to renal failure, excess intake
-
What are s/s of hypermagnesemia?
- N/V
- lethargy
- decrease in deep tendon reflexes
- decrease in RR
- hypotension
-
This is the main ICF anion.
Phosphorus
-
85% exists with Ca in bone and teeth
Phosphorus
-
This ion is regulated by dietary intake, kidneys, GI absorptions & PTH
Phosphorus
-
This ion maintains acid-base balance, metabolism, maintains bones and teeth, and neuromuscular action.
Phosphorus
-
This electrolyte is essential for bone formation.
Phosphorus
-
This ion helps with transmission of nerve impulses.
Phosphorus
-
List some foods high in Phosphorus.
- Cottage cheese
- Cereal 100% bran
- Wheat Bran
- Beef Sirloin
- Yogurt fruit flavored
-
What is the normal level for Sodium?
135 - 145 mEq/L
-
This ion controls and regulates volume of body fluids.
Sodium
-
This is the main ECF cation.
Sodium
-
This ion maintains water balance in ECF, transmission of nerve impulses, and acid-base balance.
Sodium
-
This ion is regulated by dietary intake and aldosterone.
Sodium
-
We lose this electrolyte through the GI tract, skin loss, and diuretics.
Sodium
-
↓Na can lead to... due to...
Hyponatremia due to GI loss, adrenal insufficiency, increased sweating, use of diuretics
-
↑Na can lead to... due to...
Hypernatremia due to increase in water loss, water deprivation, increased ingestion of salt.
-
What are the s/s of hyponatremia?
- confusion
- wt loss
- postural hypotension
- convulsions
- tachycardia
-
What are the s/s of hypernatremia?
- thirst
- fever
- convulsions
- dry-flushed skin
-
This ion maintains osmotic pressure in the blood.
Chloride
-
This ion produces hydrochloric acid maintaining the acidity of gastric fluids.
Chloride
-
This ion is the main ECF anion.
Chloride
-
This electrolyte is regulated by dietary intake and by the kidneys.
Chloride
-
This ion is excreted with diuresis or vomiting.
Chloride
-
This ion is a major cation in teeth and bone, found equally in ICF and ECF.
Calcium
-
Calcium balance depends on...
- Vitamin D
- Parathyroid hormone
- Calcitonin
-
Premenopausal women need how much calcium daily?
1000mg/day
-
Menopausal women who have hip fractures need how much Calcium/day?
1200mg/day
-
This ion helps with the transmission of nerve impulses, muscle contractions, coagulation, and cardiac contraction.
Calcium
-
Women who are at risk for osteoporosis have ↓vitamin D, how can they increase vit D?
-
What some sources high in Calcium?
- Sun
- Milk
- Soy Milk
- Viactive
- Yogurt
-
↓Ca leads to... due to...
Hypocalcemia due to Vit D deficiency, pancreatitis
-
What are s/s of hypocalcemia?
- numbness
- tingling
- tetany (contracted/spasm)
- muscle cramps
- Trousseau's sign
- Chvostek's sign
-
-
-
↑Ca leads to... due to...
Hypercalcemia due to malignancy.
-
What are the s/s of hypercalcemia?
- N/V
- weakness
- decreased LOC
- cardiac arrest
- anorexic
-
A pt is admitted to hospital for hypocalcemia. Nursing interventions related to which system would have highest priority?
D. neuromuscular
-
This ion is regulated by the kidneys, present in both ECF and ICF, and regulates acid-base balance, and has very tight control.
Bicarbonate
-
This is necessary for cell function and metabolism.
Acid-Base Balance
-
Acid Base Balance includes:
- CO₂
- HCO₃
- Bicarbonate (buffer)
-
CO₂ role in acid-base balance is...
acid regulated by lungs (respiratory)
-
HCO₃ role in acid-base balance is...
base regulated by kidneys (metabolic)
-
This substance can absorb or release H⁺ to correct acid-base imbalance.
Buffer like bicarbonate
-
ABG's are...
Arterial Blood Gases are the best evaluator of acid-base balance.
-
This measures the hydrogen concentration in body fluids
pH
-
-
↓H⁺
more alkaline (basic)
-
Arterial blood should be kept at
7.35 - 7.45 pH
-
Anything below 7.35 pH can lead to...
Acidosis
-
Anything above 7.45 pH can lead to...
Alkalosis
-
To become more basic...
an acid releases hydrogen.
-
To become more acidic...
a base traps hydrogen.
-
This does not eliminate enough CO₂ , ↑CO₂ and ↑H
Respiratory acidosis
-
This eliminates too much CO₂ , ↓CO₂ , ↓H
Respiratory alkalosis
-
Respiratory acidosis occurs in pts with what Dx...
- CHF - post-op pt taking opiates
- COPD - hypoventilation
- pneumonia - chronic asthmatic
-
Respiratory alkalosis occurs in pts with Dx...
- hyperventilation
- anxious pt
-
This acid base imbalance has a loss of bicarb from ECF, ↑H and ↓bicarb, ↓pH
Metabolic Acidosis
-
This eliminates too much CO₂, ↓H , ↑bicarb , ↑pH, and vomiting is the most common cause.
Metabolic alkalosis
-
To prevent excessive changes in pH we need what major buffers in ECF...
-
Other buffers include:
- Plasma proteins
- Hemoglobin
- Phosphates
-
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
-
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
-
How do the kidneys regulate our acid-base balance of our body?
regulate by selectively excreting or conserving bicarb and hydrogen ions
-
Which organs are slower to respond to change?
Kidneys
-
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
-
pts who vigorously exercise need...
↑electrolytes
-
Nursing History we would need include:
- current and past medical history
- meds & Tx
- Food/Fluid Intake
- Fluid Output
- Fluid, Electrolyte, Acid-Base Imbalances
-
-
-
These are meds to watch:
- Diuretics- K
- Steroids
- Electrolyte supplements
- Antibiotics (meds affect kidneys) - nephrotoxicity
- Respiratory depressants- opioids- long term use
- NSAID's
- TPN
-
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
-
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)
-
How do we find the hematocrit?
Find out hemoglobin level and x3 to find hematocrit
-
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
-
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)
-
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
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