Fluid

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Fluid Electrolyte Imbalance

• N132

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Fluid Imbalance
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Fluid Volume Deficit(Hypovolemia, Isotonic
Dehydration)

• Common Causes
• Hemorrhage
• Vomiting
• Diarrhea
• Burns
• Diuretic therapy
• Fever
• Impaired thirst

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Clinical Manifestations

• Signs/Symptoms
• Weight loss
• Thirst
• Orthostatic changes in pulse rate and bp
• Weak, rapid pulse
• Decreased urine output
• Dry mucous membranes
• Poor skin turgor

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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.

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Safety Alert
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Nursing Implications

• Monitor postural heart rate and bp when getting
  patients out of bed

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Fluid Volume Excess

• Common Causes
• Congestive Heart Failure
• Early renal failure
• IV therapy
• Excessive sodium ingestion
• SIADH
• Corticosteroid

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Clinical Manifestations

• Signs/Symptoms
• Increased BP
• Bounding pulse
• Venous distention
• Pulmonary edema
• Dyspnea
• Orthopnea (diff. breathing when supine)
• crackles

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Treatment/Interventions (FVE)

• Drug therapy
• Diuretics may be ordered if renal failure is not
  the cause.
• Restriction of sodium and saline intake
• I/O
• Weight

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More to consider?

• Age
• Infants
• Older adults
• Prior medical history
• Acute illness
• Chronic illness
• Environmental factors
• Diet
• Lifestyle
• Medications

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• Physical Assessment
• Body systems
• I/O
• Weight
• Labs

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Electrolyte Imbalance

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Hypokalemia (lt3.5mEq/L)

• Pathophysiology
• Decrease in K causes decreased excitability of
  cells, therefore cells are less responsive to
  normal stimuli

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Hypokalemia (lt3.5mEq/L)

• Contributing factors
• Diuretics
• Shift into cells
• Digitalis
• Water intoxication
• Corticosteroids
• Diarrhea
• Vomiting

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Hypokalemia (lt3.5mEq/L)

• Interventions
• Assess and identify those at risk
• Encourage potassium-rich foods
• K replacement (IV or PO)
• Monitor lab values
• D/c potassium-wasting diuretics
• Treat underlying cause

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Hyperkalemia (gt5.0mEq/L)

• Pathophysiology An inc. in K causes increased
  excitability of cells.

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Hyperkalemia (gt5.0mEq/L)

• Contributing factors
• Increase in K intake
• Renal failure
• K sparing diuretics
• Shift of K out of the cells

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Hyperkalemia (gt5.0mEq/L)

• Interventions
• Need to restore normal K balance
• Eliminate K administration
• Inc. K excretion
• Lasix
• Kayexalate (Polystyrene sulfonate)
• Infuse glucose and insulin
• Cardiac Monitoring

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Hyponatremia (lt135mEq/L)

• Contributing Factors
• Excessive diaphoresis
• Wound Drainage
• NPO
• CHF
• Low salt diet
• Renal Disease
• Diuretics

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Hyponatremia (lt135mEq/L)

• Assessment findings
• Neuro - Generalized skeletal muscle weakness.
  Headache / personality changes.
• Resp.- Shallow respirations
• CV - Cardiac changes depend on fluid volume
• GI Increased GI motility, Nausea, Diarrhea
  (explosive)
• GU - Increased urine output

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Hyponatremia (lt135mEq/L)

• Interventions/Treatment
• Restore Na levels to normal and prevent further
  decreases in Na.
• Drug Therapy
• (FVD) - IV therapy to restore both fluid and Na.
  If severe may see 2-3 saline.
• (FVE) Administer osmotic diuretic (Mannitol) to
  excrete the water rather than the sodium.
• Increase oral sodium intake and restrict oral
  fluid intake.

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Hypernatremia (gt145mEq/L)

• Contributing Factors
• Hyperaldosteronism
• Renal failure
• Corticosteroids
• Increase in oral Na intake
• Na containing IV fluids
• Decreased urine output with increased urine
  concentration

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Hypernatremia (gt145mEq/L)

• Contributing factors (contd)
• Diarrhea
• Dehydration
• Fever
• Hyperventilation

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Hypernatremia (gt145mEq/L)

• Assessment findings
• Neuro - Spontaneous muscle twitches. Irregular
  contractions. Skeletal muscle wkness.
  Diminished deep tendon reflexes
• Resp. Pulmonary edema
• CV Diminished CO. HR and BP depend on
  vascular volume.

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Hypernatremia (gt145mEq/L)

• GU Dec. urine output. Inc. specific gravity
• Skin Dry, flaky skin. Edema r/t fluid volume
  changes.

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Hypernatremia (gt145mEq/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 therapy
• Mild Ensure water intake

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Hypocalcemia (lt9.0mg/dL)

• Contributing factors
• Dec. oral intake
• Lactose intolerance
• Dec. Vitamin D intake
• End stage renal disease
• Diarrhea

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Hypocalcemia (lt9.0mg/dL)

• Contributing factors (contd)
• Acute pancreatitis
• Hyperphosphatemia
• Immobility
• Removal or destruction of parathyroid gland

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Hypocalcemia (lt9.0mg/dL)

• Assessment findings
• Neuro Irritable muscle twitches.
• Positive Trousseaus sign.
• Positive Chvosteks sign.
• Resp. Resp. failure d/t muscle tetany.
• CV Dec. HR., dec. BP, diminished peripheral
  pulses
• GI Inc. motility. Inc. BS. Diarrhea

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Positive Trousseaus Sign
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Positive Chvosteks Sign
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Hypocalcemia (lt9.0mg/dL)

• Interventions/Treatment
• Drug Therapy
• Calcium supplements
• Vitamin D
• Diet Therapy
• High calcium diet
• Prevention of Injury
• Seizure precautions

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Hypercalcemia (gt10.5mg/dL)

• Contributing factors
• Excessive calcium intake
• Excessive vitamin D intake
• Renal failure
• Hyperparathyroidism
• Malignancy
• Hyperthyroidism

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Hypercalcemia (gt10.5mg/dL)

• Assessment findings
• Neuro Disorientation, lethargy, coma, profound
  muscle weakness
• Resp. Ineffective resp. movement
• CV - Inc. HR, Inc. BP. , Bounding peripheral
  pulses, Positive Homans sign.
• Late Phase Bradycardia, Cardiac arrest
• GI Dec. motility. Dec. BS. Constipation
• GU Inc. urine output. Formation of renal
  calculi

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Hypercalcemia (gt10.5mg/dL)

• Interventions/Treatment
• Eliminate calcium administration
• Drug Therapy
• Isotonic NaCL (Inc. the excretion of Ca)
• Diuretics
• Calcium reabsorption inhibitors (Phosphorus)
• Cardiac Monitoring

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Hypophosphatemia (lt2.5mg/L)

• Contributing Factors
• Malnutrition
• Starvation
• Hypercalcemia
• Renal failure
• Uncontrolled DM

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Hypophosphatemia (lt2.5mg/L)

• Assessment findings (Chart 13-7)
• Neuro Irritability, confusion
• CV Dec. contractility
• Resp. Shallow respirations
• Musculoskeletal - Rhabdomyolysis
• Hematologic Inc. bleeding
• Dec. platelet aggregation

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Hypophosphatemia (lt2.5mg/L)

• Interventions
• Treat underlying cause
• Oral replacement with vit. D
• IV phosphorus (Severe)
• Diet therapy
• Foods high in oral phosphate

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Hyperphosphatemia (gt4.5mg/L)

• Causes few direct problems with body function.
  Care is directed to hypocalcemia.
• Rarely occurs

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Hypomagnesemia (lt1.4mEq/L)

• Contributing factors
• Malnutrition
• Starvation
• Diuretics
• Aminoglcoside antibiotics
• Hyperglycemia
• Insulin administration

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Hypomagnesemia (lt1.4mEq/L)

• Assessment findings
• Neuro - Positive Trousseaus sign. Positive
  Chvosteks sign. Hyperreflexia. Seizures
• CV ECG changes. Dysrhythmias. HTN
• Resp. Shallow resp.
• GI Dec. motility. Anorexia. Nausea

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Hypomagnesemia (lt1.4mEq/L)

• Interventions
• Eliminate contributing drugs
• IV MgSO4
• Assess DTRs hourly with MgSO4
• Diet Therapy

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Hypermagnesemia (gt2.0mEq/L)

• Contributing factors
• Increased Mag intake
• Decreased renal excretion

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Hypermagnesemia (gt2.0mEq/L)

• Assessment findings
• Neuro Reduced or weak DTRs. Weak voluntary
  muscle contractions. Drowsy to the point of
  lethargy
• CV Bradycardia, peripheral vasodilatation,
  hypotension. ECG changes.

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Hypermagnesemia (gt2.0mg/dL)

• Interventions
• Eliminate contributing drugs
• Administer diuretic
• Calcium gluconate reverses cardiac effects
• Diet restrictions