Fluid & Electrolyte ImbalanceN132

Fluid Imbalance

Fluid Volume Deficit(Hypovolemia, Isotonic Dehydration) Common Causes

HemorrhageVomiting DiarrheaBurnsDiuretic therapyFeverImpaired thirst

Clinical ManifestationsSigns/Symptoms

Weight lossThirstOrthostatic changes in pulse rate and bpWeak, rapid pulseDecreased urine outputDry mucous membranesPoor skin turgor

Treatment/Interventions (FVD) Fluid Management

Diet therapy Mild to moderate dehydration. Correct with oral fluid replacement. Oral rehydration therapy Solutions containing glucose and electrolytes. E.g., Pedialyte, Rehydralyte.IV therapy Type of fluid ordered depends on the type of dehydration and the clients cardiovascular status.

Nursing ImplicationsMonitor postural heart rate and bp when getting patients out of bed

Fluid Volume Excess Common Causes:

Congestive Heart FailureEarly renal failureIV therapyExcessive sodium ingestionSIADHCorticosteroid

Clinical ManifestationsSigns/Symptoms

Increased BPBounding pulseVenous distentionPulmonary edemaDyspneaOrthopnea (diff. breathing when supine)crackles

Treatment/Interventions (FVE)Drug therapy

Diuretics may be ordered if renal failure is not the cause.Restriction of sodium and saline intakeI/OWeight

More to consider?Age

InfantsOlder adultsPrior medical history

Acute illnessChronic illnessEnvironmental factorsDietLifestyleMedications

Physical Assessment

Body systemsI/OWeightLabs

Electrolyte Imbalance

Hypokalemia (

Hypokalemia (

Hypokalemia (

Hyperkalemia (>5.0mEq/L)Pathophysiology An inc. in K+ causes increased excitability of cells.

Hyperkalemia (>5.0mEq/L)Contributing factors:

Increase in K+ intakeRenal failureK+ sparing diureticsShift of K+ out of the cells

Hyperkalemia (>5.0mEq/L)Interventions

Need to restore normal K+ balance:Eliminate K+ administrationInc. K+ excretionLasixKayexalate (Polystyrene sulfonate)Infuse glucose and insulinCardiac Monitoring

Hyponatremia (

Hyponatremia (

Hyponatremia (

Hypernatremia (>145mEq/L)Contributing Factors

HyperaldosteronismRenal failureCorticosteroidsIncrease in oral Na intakeNa containing IV fluidsDecreased urine output with increased urine concentration

Hypernatremia (>145mEq/L)Contributing factors (contd):

DiarrheaDehydrationFeverHyperventilation

Hypernatremia (>145mEq/L)Assessment findings:

Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexesResp. Pulmonary edemaCV Diminished CO. HR and BP depend on vascular volume.

Hypernatremia (>145mEq/L)GU Dec. urine output. Inc. specific gravitySkin Dry, flaky skin. Edema r/t fluid volume changes.

Hypernatremia (>145mEq/L)Interventions/Treatment

Drug therapy (FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.Diet therapyMild Ensure water intake

Hypocalcemia (

Hypocalcemia (

Hypocalcemia (

Positive Trousseaus Sign

Positive Chvosteks Sign

Hypocalcemia (

Hypercalcemia (>10.5mg/dL)Contributing factors:

Excessive calcium intakeExcessive vitamin D intakeRenal failureHyperparathyroidismMalignancyHyperthyroidism

Hypercalcemia (>10.5mg/dL)Assessment findings:

Neuro Disorientation, lethargy, coma, profound muscle weaknessResp. Ineffective resp. movementCV - Inc. HR, Inc. BP. , Bounding peripheral pulses, Positive Homans sign. Late Phase Bradycardia, Cardiac arrestGI Dec. motility. Dec. BS. ConstipationGU Inc. urine output. Formation of renal calculi

Hypercalcemia (>10.5mg/dL)Interventions/Treatment

Eliminate calcium administrationDrug TherapyIsotonic NaCL (Inc. the excretion of Ca)DiureticsCalcium reabsorption inhibitors (Phosphorus)Cardiac Monitoring

Hypophosphatemia (

Hypophosphatemia (

Hypophosphatemia (

Hyperphosphatemia (>4.5mg/L)Causes few direct problems with body function. Care is directed to hypocalcemia.Rarely occurs

Hypomagnesemia (

Hypomagnesemia (

Hypomagnesemia (

Hypermagnesemia (>2.0mEq/L)Contributing factors:

Increased Mag intakeDecreased renal excretion

Hypermagnesemia (>2.0mEq/L)Assessment findings:

Neuro Reduced or weak DTRs. Weak voluntary muscle contractions. Drowsy to the point of lethargyCV Bradycardia, peripheral vasodilatation, hypotension. ECG changes.

Hypermagnesemia (>2.0mg/dL)Interventions

Eliminate contributing drugsAdminister diureticCalcium gluconate reverses cardiac effectsDiet restrictions