Fluid and electrolyte balances and imbalances
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Transcript of Fluid and electrolyte balances and imbalances
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Fluid and Electrolytes, Balance and Disturbances
By: Ms.
katherina
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Mechanism for fluid and
electrolyte movement
osmosis
diffusion
filtration
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osmosis
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diffusion
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diffusion
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filtration
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Fluid and electrolyte balances
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cations
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sodium potassium
calcium magnesium
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Electrolytes are measured
milliequivalent per litre of water
(mEq / L)
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Equivalent refers to the chemical combining power of a substance or the power of cations to unite with anions to form molecules
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sodium
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most abundant cat ion in the extracellular fluid
sodium is regulated by
Salt intake Aldosterone
Urinary output
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functionsMaintain balance of extracellular fluid,
thereby it controls the movements of the water between fluid compartments
Transmission of nerve impulses
Neuro muscular and myocardial impulse transmission
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Normal concentration of sodium
135 to 145 mEq/L
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POTASSIUM
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Main intracellular cat ionHelps in maintaining fluid
balance of the intracellular fluidPotassium is regulated by
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functionsRegulates neuromuscular excitability and
muscle contraction
Needed for glycogen formation and protein sunthesis
Correction of acid base imbalances. Potassium ion can be exchanged with
hydrogen ion (H+)
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Normal concentration of potassium
3.5 to 5.3 mEq/L
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CALCIUM
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Calcium is the most abundant element in the body
Calcium is extracellular fluid Regulated by the action of Thyroid gland parathyroid
gland
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Parathyroid hormone (PTH) controls the balance among bone calcium, gastrointestinal absorption and kidney excretion of calcium.
Thyrocalcitonin from the thyroid gland inhibits the release of calcium from bones, thus playing a minor role in determining serum calcium levels.
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functionsMaintenance of cell membrane, its integrity
and structure
Conduction of nerve impulses in the skeletal muscle
Stimulation and depolarization and contraction of cardiac muscles
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functionsAids in blood coagulation
Growth and formation of bones
Muscle relaxation
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Normal concentration of calcium
4 to 5 mEq/L
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MAGNESIUM
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Magnesium is the second most important cat ion in the intracellular fluid
It has an inhibitory effect on skeletal muscles.
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functionsPrecipitation of metabolic activities of
cells
Enzyme activity
Neuro chemical activity
Muscular excitability
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Normal concentration of magnesium
1.5 to 2.4 mEq/L
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anions
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phosphate chloride
bicarbonate
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PHOSPHATE
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Phosphate is a buffer anion in extracellular and intracellular fluid
Phosphate absorption is through gastrointestinal tract in a range of 3 to 12 mg/100 ml
Calcium and phosphate are inversely proportional.
When one rises the other falls
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Serum phosphate is regulated by
kidneys
Parathyroid hormone
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Activated vitamin D
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functions
Promotes normal neuromuscular action
Development and maintenance of bones and teeth
Participates in carbohydrate metabolism
Assist in acid base regulation
Maintains levels of ATP ( Adenosine Triphosphate) and thus energy levels
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Normal concentration of phosphate
2.5 to 4.5 mEq/L
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chloride
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Chlorides are found in extracellular and intracellular fluids
The chloride ion balances the cations within the extracellular fluid
The ion exchange helps to maintain the electrical neutrality
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Chloride is regulated through kidneys
The dietary intake of chloride and the amount excreted in urine are closely related
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Normal concentration of chloride
100 to 106 mEq/L
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bicarbonate
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Bicarbonate is found in extracellular and intracellular fluids
It is a major chemical buffer in the body
Regulation is through kidneys
It is an essential component of the carbonic acid-bicarbonate buffering system essential to acid base balance
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Normal arterial bicarbonate value
22 to 26 mEq/L
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Normal venous bicarbonate value
24 to 30 mEq/L
In venous blood, bicarbonate is measured as
carbondioxide content
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FLUID VOLUME DISTURBANCES
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Fluid volume deficit
hypovolemia
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Fluid Volume DeficitMild – 2% of body weight loss
Moderate – 5% of body weight loss
Severe – 8% or more of body weight loss
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Pathophysiologyresults from loss of
body fluids and occurs more rapidly when coupled with decreased fluid intake
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Clinical manifestations
Acute Weight loss
Decreased skin turgor
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Concentrated urine
flattened neck veins
Postural hypotension
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Weak, rapid, heart rate
Oliguria
Increased temperature
Decreased central venous pressure
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Nursing Diagnosis Fluid volume Deficit r/t Insufficient intake, vomiting,
diarrhea, hemorrage, m/b dry mucous
membranes
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Nursing management Restore fluids by oral or IV
Treat underlying cause Monitor I & O at least every 8
hours Daily weight Vital signs Skin turgor Urine concentration
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Fluid volume excess
hypervolemia
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Pathophysiology may be related
to fluid overload or diminished function of the homeostatic mechanisms responsible for regulating fluid balance
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Contributing factors
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Clinical manifestations
Edema
Distended neck veins
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Tachycardia
Increased blood Pressure
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Increased weight
crackles
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Nursing Diagnosis Fluid volume excess r/t CHF, excess sodium intake,
renal failure
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Nursing management
Preventing FVE
Detecting and Controlling FVE
Teaching patients about edema
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Electrolyte Imbalances
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SODIUM
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SodiumNormal range – 135 to 145
mEq/L
Primary regulator of ECF volume (a loss or gain of sodium is usually accompanied by a loss or gain of water)
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HYPONATREMIA
Sodium level less than 135 mEq/L
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causesVomiting Diarrhea
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Sweating Diuretics
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Clinical manifestations
Poor skin turgor
Decreased saliva
production
Dry mucosa
Anorexiavomiting
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Clinical manifestations
Orthostatic hypotension
Altered mental status
Nausea/ abdominal cramping
Confusion & lethargy
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Nursing interventions Assess clinical manifestations
Monitor fluid intake and output, vital signs and lab data.
Encourage food and fluids high in Na
Limit water intake.
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HYPERNATREMIA
Sodium level more than 145 mEq/L
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CAUSESLoss of fluids
Water deprivation
Excessive salt intake
Conditions like Diabetes insipidus, heatstroke
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Pathophysiology- Fluid deprivation in patients
who cannot perceive, respond to, or communicate their thirst
- Most often affects very old, very young, and cognitively impaired patients
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Clinical manifestations- Thirst
- Sticky mucous membranes
- Flushed skin
- Postural hypotension
- Dry, swollen tongue
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Nursing interventions Monitor intake and output
Monitor behavioural changes
Monitor lab findings
Encourage fluids
Monitor diet as ordered(salt restriction)
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POTASSIUM
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Normal serum potassium concentration is 3.5 to 5.5 mEq/L
Major Intracellular electrolyte and 98% of the body’s potassium is inside the cells
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HYPOKALEMIA
Potassium level less than 3.5 mEq/L
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CAUSESLoss of K+ in the form of
vomittings ,GI suction
poor K intake
diuretics
steroid administration
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Clinical manifestations Muscle weakness Leg cramps Fatigue Lethargy Anorexia Nausea, vomitting Decreased bowel sounds Decreased bowel motility Cardiac dysrhythmias Depressed deep tendon reflex
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Nursing interventions
Monitor heart rate and rhythmMonitor clients receiving
DIGITALISAdminister oral K+ as ordered
with food /fluidsAdminister IV K+ as
ordered ,flow rate not more than 10-20 meq/hr
Teach patients about potassium rich diet and to reduce potassium wastage
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HYPERKALEMIA
Potassium level more than 5.5
mEq/L
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Causes Decreased renal potassium
excretion as seen with renal failure and oliguria
High potassium intake Renal insufficiency
Shift of potassium out of the cell as seen in acidosis
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Clinical manifestations
Skeletal muscle weakness/paralysis
ECG changes – such as peaked T waves, widened QRS complexes
Heart block
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Nursing interventions
Monitor ECG changes – telemetry
Administer Calcium solutions to neutralize the potassium
Monitor muscle tone Give Kayexelate Give Insulin and D50W
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CALCIUM
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Normal serum calcium level is 4 to 5 mEq/L
More than 99% of the body’s calcium is located in the skeletal system
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HYPOCALCEMIA
Calcium level less than 4 mEq/L
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Causes- Vitamin D/Calcium
deficiency- Primary/surgical
hyperparathyroidism- Pancreatitis- Renal failure
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Clinical Manifestations
Tetany and cramps in muscles of extremities
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Trousseau’s sign – carpal spasms
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Chvostek’s sign – cheek twitching
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Seizures, mental changes
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ECG shows prolonged QT intervals
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Nursing interventions- IV/PO Calcium Carbonate or
Calcium Gluconate- Encourage increased dietary
intake of Calcium- Monitor neurlogical status- Establish seizure precautions
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HYPERCALCEMIA
Calcium level more than 5 mEq/L
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Causes- Hyperparathyroidism- Prolonged immobilization- Thiazide diuretics- Large doses of Vitamin A and D
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Clinical manifestations
- Muscle weakness, nausea and vomiting
- Lethargy and confusion- Constipation- Cardiac Arrest
(high level)
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Nursing interventions
- Eliminate Calcium from diet- Monitor neurological status- Increase fluids (IV or PO)- Calcitonin
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MAGNESIUM
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Normal serum magnesium level is 1.5 to 2.4 mEq/L
Thought to have a direct effect on peripheral arteries and arterioles
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HYPOMAGNESEMIA
magnesium level less than 1.5 mEq/L
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Causes- Chronic Alcoholism
- Diarrhea, or any disruption in small bowel function
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- TPN
- Diabetic ketoacidosis
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Clinical manifestations
- Neuromuscular irritability- Positive Chvostek’s and
Trousseau’s sign- EKG changes with prolonged
QRS, depressed ST segment, and cardiac dysrhythmias
- May occur with hypocalcemia and hypokalemia
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• Starved – possible cause of hypomagnesemia
• Seizures• Tetany• Anorexia and arrhythmias• Rapid heart rate• Vomiting• Emotional lability• Deep tendon reflexes
increased
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Nursing interventions
- IV/PO Magnesium replacement, including Magnesium Sulfate
- Give Calcium Gluconate if accompanied by hypocalcemia
- Monitor for dysphagia, give soft foods
- Measure vital signs closely
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Foods high in Magnesium:
Green leafy vegetables
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Nuts
Legumes
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Seafood
Chocolate
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HYPERMAGNESEMIA
magnesium level more than 2.4
mEq/L
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Causes- Renal failure- Untreated diabetic
ketoacidosis- Excessive use of antacids
and laxatives
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Clinical manifestations- Flushed face and skin warmth
- Mild hypotension
- Heart block and cardiac arrest
- Muscle weakness and even paralysis
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RENAL• Reflexes decreased (plus
weakness and paralysis)• ECG changes (bradycardia and
hypotension)• Nausea and vomiting• Appearance flushed• Lethargy (plus drowsiness and coma)
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Nursing interventions- Monitor Mg levels- Monitor respiratory rate- Monitor cardiac rhythm- Increase fluids- IV calcium for emergencies
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PHOSPHORUS
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Normal serum phosphorus level is 2.5 to 4.5 mg/100 ml
- Phosphate levels vary inversely to calcium levels
- High Calcium = Low Phosphate
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HYPOPHOSPHOTEMIA
Phosphorus level less than 2.5 mEq/L
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Causes- Most likely to occurs with
overzealous intake or administration of simple carbohydrates
- Severe protein-calorie malnutrition (anorexia or alcoholism)
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Clinical manifestations
- Muscle weakness- Seizures and coma- Irritability- Fatigue- Confusion- Numbness
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Nursing interventions- Prevention is the goal- IV Phosphorus for severe - Prevention of infection- Monitor phosphorus levels- Increase oral intake of
phosphorus rich foods
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Foods rich in phosphorus
- Milk and milk products- Poultry- Whole grains- Organ meats- Nuts- Fish
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HYPERPHOSPHOTEMIA
Phosphorus level more than 4.5
mEq/L
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Causes- Renal failure
- Chemotherapy
- Hypoparathyroidism
- High phosphate intake
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Clinical manifestations
- Tetany- Muscle weakness- Similar to Hypocalcemia because
of reciprocal relationship
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Nursing interventions- Treat underlying cause
- Avoid phosphorus rich foods
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