Fluid and ElectrolyteImbalances

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

Homeostasis

60% of body consists of fluid

Intracellular spaceExtracellular space

Electrolytes -active ions:

Cation positiveAnion negative

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

Active Transport Osmosis

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

Homeostatic pressure

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

Dehydration Fluid Overload

Gains and Losses of fluid

GainSolid foods DrinksThirst center

Loss

water and electrolytesmove in a variety ofWays - sensible andInsensible.KidneysSkinLungsGI tract

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

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

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

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

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

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

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

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+

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

ECG Changes

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

Trousseau’s sign

Homan’s sign

Chvosteck’s sign

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

Thank you