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Fluid and electrolyte
- 1. Fluid and Electrolyte Imbalances
- 2. Objectives Define Key Terms associated with Fluids and Electrolytes Describe the Assessment for Fluid and Electrolytes Imbalances Discuss the Nursing Interventions in Maintaining Fluid and Electrolyte Homeostasis
- 3. Homeostasis 60% of body consists of fluid Intracellular space Extracellular space Electrolytes -active ions: Cation positive Anion negative
- 4. 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
- 5. Active Transport Osmosis
- 6. 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
- 8. 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
- 9. Dehydration Fluid Overload
- 11. Gains and Losses of fluid Gain Loss Solid foods water and electrolytes Drinks move in a variety of Thirst center Ways - sensible and Insensible. Kidneys Skin Lungs GI tract
- 12. Fluid Imbalances Fluid Deficit Fluid Excess Isotonic – fluid and Isotonic – Only ECF is electrolytes loss equally; expanded decline in circulating blood Hypertonic – excessive volume Na+ intake; fluid shifts from Hypertonic – fluid loss ICF to ECF exceeds loss of electrolytes Hypotonic – water Hypotonic – electrolytes intoxication; life threatening; loss exceeds loss of water fluid moves in ICF and all compartment expands
- 13. Developmental Considerations Elderly Skin - elasticity impaired 45% 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
- 14. 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, coordinati on, and tremors Renal - weight loss, fluid balance record Lab data –elevated haemoglobins, haematocrits, glu cose, protein, blood urea
- 15. Intervention for Fluid Imbalance Dehydration Oral Fluid Replacement Water, Oral Electrolytes IV Therapy Check closely for Fluid Overload - Input and Output Check vital signs Drug Therapy Depending on cause: Antiemetic, Antidiarrhoea, Antibiotic, Dysrhythmias Oral care, artificial tears, saliva
- 16. Over-Hydration Fluid Imbalance Interventions Isotonic Over-Hydration Drug therapy Osmotic diuretics, then Loop Hypotonic Over-Hydration diuretic (Lasix) Water intoxication; fluid moves Vital Signs into ICF Check IV fluids hourly – Input and Output Hypertonic Over-Hydration Daily weight, serum and Fluid pulled from ICS electrolytes level, ECG Diet Therapy Restrict fluid and sodium intake
- 18. 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
- 19. Electrolytes Basic Principles in Treatment Electrolyte Deficits Electrolyte Excess Drug Supplements Antagonist – block Foods absorption Hydration Assess – Vital signs, Cease foods or ECG changes medications high in Remove the cause electrolytes Assess – Vital signs, ECG changes Remove the cause
- 20. Sodium Electrolyte Imbalances Hyponatraemia N+ Hypernatraemia Clinical Manifestation Clinical Manifestation Irritability, confusion, dizziness, tremors, Restlessness, intense thirst, dry swollen seizures, coma, dry mucous tongue, twitching, weight membrane, cold, clammy skin, weight loss, lethargy, seizures, coma, flushed gain, muscle spasms, nausea, vomiting skin, peripheral/pulmonary oedema Assess mental, muscle weakness, GI Assess mental status, muscle twitching distress, hypovolaemia, fluid and irregular muscle contractions, Vital input/output, Vital Signs Signs, BP in hypovolaemia, BP with bounding pulses in hypervolaemia, fluid Notify MO input/output Replace Na+ slowly, Saline IV infusions Notify MO Check ADH levels If fluid loss - hypotonic IV fluids Monitor electrolytes if Na+ K+ If fluid and Na+ loss - isotonic IV fluid Diet therapy Restrict Na+
- 21. Potassium Electrolyte Imbalances Hypokalaemia K+ Hyperkalaemia Clinical Manifestation Clinical Manifestation Hand grasp weak, hyporeflexia, paresthesia, GI upset, irritability, muscle weakness, shallow irregular pulse respirations, pulse thready and weak, dysrhythmia, lethargic, Assess ECG changes, Vital Signs, confusion, coma, GI upset, hypo Fibre/Fluid intake activity Notify MO Assess Vital Signs, ECG changes; Stop K+ - oral or IV Fibre and Fluid intake Administer K+ excreting diuretics (lasix) and Kayexlate Notify MO Dialysis if severe Administer K+ oral or IV Monitor lab results
- 22. ECG Changes
- 23. Calcium Electrolyte Imbalances Hypocalcaemia Ca+ Hypercalcaemia Clinical Manifestations - Vitamin D Clinical Manifestations - osteoporosis, deficiency, numb and tingling prolonged immobilization, decreased fingers, muscle muscle tone, weakness, lethargy, kidney cramps, weak/thready stones, bradycardia, dysrhythmias, deep tendon reflexes without paresthesia pulse, tachycardia/bradycardia, seizu res Assess - Vital Signs, ECG – T wave, QT interval Assess - Vital Signs, bowel Homan’s sign, mental status, muscle sounds, Trousseau’s and Chvosteck’s weakness, bowels sounds Renal calculi - strain urine, Input/output signs Discontinue calcium oral or IV drugs Notify MO (antacids), Notify MO - Saline IV, Lasix Administer Calcium gluconate, foods diuretics, calcium binders, NSAID, high in calcium, assess for injury dialysis Seizure precautions
- 24. Trousseau’s sign Homan’s sign Chvosteck’s sign
- 25. Complications of Intravenous Therapy Systemic Complications Local Complications Fluid overload Infiltration and Extravasations Air embolism –Dyspnoea, Cyanosis Phlebitis Thrombophlebitis Septicemia and other infection Hematoma Clotting and Obstruction Cease IV Fluids Notify MO Stop infusion at once Warm or cold compresses Notify MO
- 26. Thank you
Notas do Editor
- Homeostasis – a tendency of biological systems to maintain stability while continually adjusting to conditions that are optimal for survival.
- Osmosisis diffusion of water caused by fluid gradient.Diffusionis 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
- Sodium-Potassium PumpSodium concentration is higher in ECF than ICFSodium enters cell by diffusionPotassium exits cell into ECF
- Filtration- the movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressureOsmolality - reflects the concentration of fluid that affects the movement of water between fluid compartments by osmosisOsmotic pressure - the amount of hydrostatic pressure required to stop the flow of water by osmosis
- Isotonic– same solute concentration, equal, no movement across membraneHypertonic/hyper-osmotic– greater concentration osmotic pressure water pulled intofluid to equalizeHypotonic/hypo-osmotic– lesser concentration osmotic pressure water pulled outof fluid to equalize
- Gain - solid foods, Drinks, thirst centerLoss - water and electrolytesmove in a variety ofWays - sensible andInsensible.KidneysSkinLungsGI tract
- Fluid DeficitIsotonic – fluid and electrolytes loss equally; decline in circulating blood volumeHypertonic – fluid loss exceeds loss of electrolytesHypotonic – electrolytes loss exceeds loss of waterFluid ExcessIsotonic – Only ECF is expandedHypertonic – excessive Na+ intake; fluid shifts from ICF to ECFHypotonic – water intoxication; life threatening; fluid moves in ICF and all compartment expands
- Skin – elasticity; Renal – decrease filtration; increase water loss; poor excretion of waste products;Muscle mass – lean – greater risk of dehydration and decrease fluid intake;Neuro – diminished reflexes such as the thirst center; decrease fluid, risk of dehydration;Endocrine – atrophy of muscle and adrenal; regulation of Na and K poor; prone to hyponatraemia and hyperkalaemia
- Nursing AssessmentSkin elasticity, oedema, skin dryness, mucous membraneVital Signs -Increase respiratory rate in response to hypoxia, hypotensionAltered Mental status – confusion, lethargicNeuromuscular - assessment of muscle tone and strength, movement, coordination, and tremorsRenal - weight loss, fluid balance recordLab data –elevated haemoglobins, haematocrits, glucose, protein, blood urea
- Intervention for Fluid ImbalanceDehydrationOral Fluid ReplacementWater, Oral ElectrolytesIV TherapyCheck closely for FluidOverload - Input and OutputCheck vital signsDrug TherapyDepending on cause:Antiemetic, Antidiarrhoea,Antibiotic, DysrhythmiasOral care, artificial tears, saliva
- Over-HydrationFluidImbalanceIsotonic Over-HydrationHypotonic Over-Hydration Water intoxication; fluid moves into ICFHypertonic Over-Hydration Fluid pulled from ICSInterventionsDrug 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 intakeNotify MO
- Hypo and Hypermagnesaemia (Mg+)Hypo and Hyperphosphataemia (Phos+)Hypo and Hyperchloraemia (Cl-)
- Excessive – Hyper electrolytes; Antagonist – medication to block absorption, or binders to electrolytes that excrete the excess electrolytes via renal or GI system; last resort is dialysis.Complications – heart rate, dysrhythmias, ECG, Vital Signs
- Assess mental status, cardiovascular, Neuromuscular, GI; Vital signs, weights, I &O if fluid excess or loss and needs monitoring.GI distress – increase motility, nausea, diarrhea, and abdominal cramping; bowel sounds hyperactive; bowels watery and frequent; Hyponatraemia with hypovolaemia – rapid weak, thready pulse, neck veins flat, severe hypotension (diastolic down); Hypervolaemia – Blood pressure normal or high; pulses difficult to palpate if edema.In hypernatraemia – irritability – overexcited tissues; mental status – seizures, memory impaired and possible attention span delay, lethargic, drowsy. Cardiovascular – If hypovolaemia – faint peripheral pulses, hypotension, orthostatic hypertension, pulse pressure is reduced.Diuretics if excess fluids,
- K+ - cause major cell excitability, in particular nerve and muscle, and cellular processes; increase cell uptake of K+(hypo K+) in metabolic alkalosis and insulin use. GI – decreased peristalsis, constipation, abdominal distention- paralytic ileus;Mental status – loss problem solving ability;EKG – ST- segment depressed, T wave flat or inverted and increase U wave; dysrhythmias can be fatal.IV K+ - severely irritating to tissues – never given SQ or IM, and given in 1 liter; Oral potassium – liquid, unpleasant taste. But with protocol and frequent lab monitoring, it does well to raise K+ levels.In treatment – for constipation – fiber, fluids; asses for respiratory distress – hypoxemia ( decrease blood oxygen levels or hypercapnia – increase CO2 levels)K sparing diuretics, foods high in K+; Older adults at risk due to meds, mental status, physiological changes.Hyperkalaemia – Tall, peak T waves, prolong PR intervals, flat or absent P waves and wide QRS’ high K+ levels – complete heart block, asystole and ventricular fibrillation; paresthesia – tingling numbness in hands and feet and around mouth; treat with sodium polystyrene sulfonate
- Hypocalcaemia - seizuresHypocalcaemia – excitable tissues – heart, muscles, nerves, and intestinal smooth muscles. Blood-clotting requires calcium in excessive calcium may have increase clotting especially if viscosity of blood.EKG – changes in T wave and QT intervalsCalcium binders – to lower serum calcium levels – drugs that interfere with calcium uptake – NSAID, ( calcium inhibitor - reabsorption to bones).
- Trousseau’s sign – Carpal spasm can be extracted by compressing the upper arm causing ischaemia to the nerves distallyHoman’s sign – Pain obtained in the calf when the foot is dorsiflexed, symptomatic of venous thrombosisChvosteck’s sign – a spasm of the facial muscles which occurs in tetany.
- Isotonic - Lactated Ringers Solution or Normal SalineHypotonic - .45% NaClHypertonic – 5 or 10% Dextrose ( concentration)Common complication or problem with IV fluids – infectionLocal complications – Infiltration and extravasations – escape of fluid from its normal course into surrounding tissues. Phlebitis inflammation of vein; Thrombophlebitis – inflammation with blood clot. HaematomaAir embolism – another complication – dyspnoea, cyanosis, weak, hypotension, unresponsiveness. Omit starting IV and peripheral and central and midline catheters
- Thank you for your time any questions??????