Fluid Imbalances Sodium 135 - 145 mEq/L Potassium 3.5 - 5.0 mEq/L Calcium 9 - 10.5 mg/dL Magnesium 1.5 - 2.5 mEq/L Phosphorus 2.5 - 4.5 mEq/dL
Fluid and Electrolytes Necessary for life, homeostasis Nursing role: anticipate, identify and respond to possible imbalances Intracellular fluid 2/3 of body fluid, skeletal muscle mass Extracellular Fluid Intravascular: plasma, erythrocytes, leukocytes, thrombocytes Interstitial: lymph Transcellular: cerebrospinal, pericardial, synovial Electrolytes Regulation Of Fluids -Active chemicals that carry positive (cations) and Movement of fluid through capillary walls negative (anions) electrical charges depends on -Electrolyte concentrations differ in fluid - Direction of fluid movement depends on compartments differences of hydrostatic, osmotic pressure - Major cations: sodium, potassium, calcium, Hydrostatic pressure: exerted on walls of blood magnesium, hydrogen ions vessels - Major anions: chloride, bicarbonate, phosphate, - Osmotic pressure: exerted by protein in plasma sulfate, proteinate ions - Expressed in terms of millieguivalents (mEg) Labs: Fluid BUN Approximately 60% of typical adult is fluid Creatinine Varies with age, body size, gender Hematocrit Sodium specific gravity
Hypovolemia Signs and Symptoms Weight Loss (acute) Decreased Skin Turgor Oliguria Decreased BP/Increased Pulse and Temp Flattened Neck Veins Muscle Cramps Cool, clammy skin Diagnosis Hemodilution BUN & Creatinine Serum osmolality Specific gravity Health History and Physical Assessment Medical Management . Isotonic IV Replacement, then to
Hypervolemia Signs and Symptoms Acute weight gain Edema, distended neck veins Crackles, Increased CVP, Increased blood pressure Increased urine output Increased respiratory rate Diagnosis Hemoconcentration BUN and creatinine . Serum osmolality Sodium Health History and Assessment Medical Management Pharmacologic Therapy: Loop Diuretics: Furosemide (Lasix), Thiazide
hypotonic solutions Correct Cause Prevent Shock Nursing Management Monitor I&O Daily weight Monitor urine specific gravity Vital signs closely monitored Monitor Orthostatic blood pressure Monitor for hypothermia Assess skin turgor Identify risk factors
Diuretics(Hydrochlorothiazide) Dialysis Nutrition Therapy: Sodium Restriction . Treat Cause Nursing Management 1&0 Weights daily Breath sounds Identify risk Assess edema . Nutrition education . Position HOB elevated Geriatric Considerations for Fluid Imbalances 0 Skin turgor and functional assessment 0 Sensitivity to Fluid Status changes
Hyponatremia Signs and Symptoms Anorexia, N/V Headache Lethargy Muscle Cramps Dizziness Confusion (oxygen) Seizures Increased Pulse, Decreased BP Diagnosis Serum Sodium Health History and Assessment Medical Management Sodium Replacement Water Restriction Treat Cause Isotonic solutions Nursing Management Monitor for Risk (falls) Assessment and Health History Monitor Dietary Intake
Hypernatremia Signs and Symptoms . Thirst Elevated temperature Swollen, Dry mucous membranes Confusion (oxygen) Hallucinations Restlessness and Irritability Tonic Clonic Seizures . Increased BP and Pulse Diagnosis Serum Sodium Urine Sodium . Urine Specific Gravity and Osmolality Assessment and Health History Medical Management . IV Fluid Replacement Hypotonic fluids Treat Cause Nursing Management . Follow and monitor Prescribed Treatments
Hypokalemia Signs and Symptoms Fatigue
Hyperkalemia Signs and Symptoms Dysrhythmias
Anorexia/N/V Muscle Weakness/Leg Cramps Polyuria Decreased Bowel Function Ventricular Fibrillation up to Asystole -Decreased BP Diagnosis Serum Potassium ECG Medical Management -Increase Potassium Intake in Diet (foods rich in potassium) -Potassium Supplementation (parenteral administration) Nursing Management -Physical Assessment Cardiac Monitoring -Follow prescribed treatments and monitor for effect