fluid and electrolyte
TRANSCRIPT
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Fluid and ElectrolyteImbalances
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Objectives
Define Key Terms associated with Fluids and ElectrolytesDescribe the Assessment for Fluid and Electrolytes ImbalancesDiscuss the Nursing Interventions in Maintaining Fluid and Electrolyte Homeostasis
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Homeostasis
60% of body consists of fluid
Intracellular spaceExtracellular space
Electrolytes -active ions:
Cation positiveAnion negative
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Regulation of Body Fluid Compartments
Osmosis is diffusion of water caused by fluid gradient.
Diffusion is movement of a substance from area of higher concentration to one of lower concentration.
Active Transport is movement of substance across permeable membrane and gradient; requires energy and pump. E.g. Sodium/potassium pump
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Active Transport Osmosis
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Regulation of Body Fluid Compartments (cont’d)
Filtration - the movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure
Osmolality - reflects the concentration of fluid that affects the movement of water between fluid compartments by osmosis
Osmotic pressure - the amount of hydrostatic pressure required to stop the flow of water by osmosis
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Homeostatic pressure
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Osmolarity
Isotonic – same solute concentration, equal, no movement across membrane
Hypertonic/hyper-osmotic – greater concentration osmotic pressure water pulled into fluid to equalize
Hypotonic/hypo-osmotic – lesser concentration osmotic pressure water pulled out of fluid to equalize
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Dehydration Fluid Overload
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Gains and Losses of fluid
GainSolid foods DrinksThirst center
Loss
water and electrolytesmove in a variety ofWays - sensible andInsensible.KidneysSkinLungsGI tract
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Fluid ImbalancesFluid Deficit
Isotonic – fluid and electrolytes loss equally; decline in circulating blood volume
Hypertonic – fluid loss exceeds loss of electrolytes
Hypotonic – electrolytes loss exceeds loss of water
Fluid Excess
Isotonic – Only ECF is expanded
Hypertonic – excessive Na+ intake; fluid shifts from ICF to ECF
Hypotonic – water intoxication; life threatening; fluid moves in ICF and all compartment expands
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Developmental ConsiderationsElderly
Skin - elasticity impaired45% to 50% of body weight in older adults is water, loss of muscle
mass and reduced ratio of lean to total body weight
Sites for skin turgor: Forehead, Sternum, Abdomen
Renal - decrease filtration, water loss, poor excretion
Muscular – higher risk of dehydration, decrease fluid intake
Neuro - diminished reflexes such as thirst centre decreased fluid, leading to dehydration
Endocrine - atrophy of muscle adrenal, poor Na, K regulation, prone to hyponatraemia and hyperkalaemia
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Nursing Assessment
Skin elasticity, oedema, skin dryness, mucous membrane
Vital Signs -Increase respiratory rate in response to hypoxia, hypotension
Altered Mental status – confusion, lethargic
Neuromuscular - assessment of muscle tone and strength, movement, coordination, and tremors
Renal - weight loss, fluid balance record
Lab data –elevated haemoglobins, haematocrits, glucose, protein, blood urea
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Intervention for Fluid ImbalanceDehydration
Oral Fluid ReplacementWater, Oral Electrolytes
IV TherapyCheck closely for FluidOverload - Input and OutputCheck vital signsDrug TherapyDepending on cause:Antiemetic, Antidiarrhoea,Antibiotic, DysrhythmiasOral care, artificial tears, saliva
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Over-HydrationFluid Imbalance
Isotonic Over-Hydration
Hypotonic Over-Hydration Water intoxication; fluid moves into ICF
Hypertonic Over-Hydration Fluid pulled from ICS
Interventions
Drug therapyOsmotic diuretics, then Loop
diuretic (Lasix)Vital Signs Check IV fluids hourly – Input
and OutputDaily weight, serum and
electrolytes level, ECGDiet TherapyRestrict fluid and sodium intake
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Electrolyte Imbalances
Hypo and Hypernatraemia (Na+)135-146 mmol/L
Hypo and Hyperkalaemia (K+)3.5 - 5.0 mmol/L
Hypo and Hypercalcaemia (Ca+)2.2 – 2.67mmol/L
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ElectrolytesBasic Principles in Treatment
Electrolyte Deficits
Drug SupplementsFoods
Assess – Vital signs,ECG changesRemove the cause
Electrolyte Excess
Antagonist – blockabsorptionHydrationCease foods ormedications high inelectrolytesAssess – Vital signs,ECG changesRemove the cause
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Sodium Electrolyte ImbalancesN+
HyponatraemiaClinical ManifestationIrritability, confusion, dizziness, tremors, seizures, coma, dry mucous membrane, cold, clammy skin, weight gain, muscle spasms, nausea, vomiting
Assess mental, muscle weakness, GI distress, hypovolaemia, fluid input/output, Vital Signs
Notify MOReplace Na+ slowly, Saline IV infusionsCheck ADH levelsMonitor electrolytes if Na+ K+ Diet therapy
HypernatraemiaClinical ManifestationRestlessness, intense thirst, dry swollen tongue, twitching, weight loss, lethargy, seizures, coma, flushed skin, peripheral/pulmonary oedema
Assess mental status, muscle twitching and irregular muscle contractions, Vital Signs, BP in hypovolaemia, BP with bounding pulses in hypervolaemia, fluid input/output
Notify MOIf fluid loss - hypotonic IV fluids If fluid and Na+ loss - isotonic IV fluidRestrict Na+
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Potassium Electrolyte ImbalancesK+
Hypokalaemia
Clinical ManifestationHand grasp weak, hyporeflexia, muscle weakness, shallow respirations, pulse thready and weak, dysrhythmia, lethargic, confusion, coma, GI upset, hypo activity
Assess Vital Signs, ECG changes; Fibre and Fluid intake
Notify MOAdminister K+ oral or IVMonitor lab results
Hyperkalaemia
Clinical Manifestationparesthesia, GI upset, irritability, irregular pulse
Assess ECG changes, Vital Signs, Fibre/Fluid intake
Notify MOStop K+ - oral or IVAdminister K+ excreting diuretics (lasix) and KayexlateDialysis if severe
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ECG Changes
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Calcium Electrolyte ImbalancesCa+
Hypocalcaemia
Clinical Manifestations - Vitamin D deficiency, numb and tingling fingers, muscle cramps, weak/thready pulse, tachycardia/bradycardia, seizures
Assess - Vital Signs, bowel sounds, Trousseau’s and Chvosteck’s signs
Notify MOAdminister Calcium gluconate, foods high in calcium, assess for injurySeizure precautions
Hypercalcaemia
Clinical Manifestations - osteoporosis, prolonged immobilization, decreased muscle tone, weakness, lethargy, kidney stones, bradycardia, dysrhythmias, deep tendon reflexes without paresthesia
Assess - Vital Signs, ECG – T wave, QT interval Homan’s sign, mental status, muscle weakness, bowels sounds Renal calculi - strain urine, Input/output
Discontinue calcium oral or IV drugs (antacids), Notify MO - Saline IV, Lasix diuretics, calcium binders, NSAID, dialysis
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Trousseau’s sign
Homan’s sign
Chvosteck’s sign
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Complications of Intravenous Therapy
Systemic Complications
Fluid overloadAir embolism –Dyspnoea, Cyanosis
Septicemia and other infection
Cease IV FluidsNotify MO
Local Complications
Infiltration and ExtravasationsPhlebitisThrombophlebitisHematomaClotting and Obstruction
Stop infusion at onceWarm or cold compressesNotify MO
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Thank you