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Fluid and electrolyte balances and imbalances

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Fluid and electrolyte balances and imbalances

  1. 1. Fluid and Electrolytes,Balance and Disturbances By: Ms. katherina
  2. 2. Mechanism for fluid and electrolyte movementosmosis filtration diffusion #
  3. 3. osmosis #
  4. 4. diffusion #
  5. 5. diffusion #
  6. 6. filtration #
  7. 7. Fluid and electrolyte balances #
  8. 8. cations #
  9. 9. sodium potassiumcalcium magnesium #
  10. 10. Electrolytes are measured milliequivalent per litre of water (mEq / L) #
  11. 11. Equivalent refers to the chemicalcombining power of a substance orthe power of cations to unite withanions to form molecules #
  12. 12. #
  13. 13.  most abundant cat ion in the extracellular fluid sodium is regulated bySalt intake Aldosterone Urinary output #
  14. 14. functionsMaintain balance of extracellular fluid, therebyit controls the movements of the water between fluid compartments Transmission of nerve impulses Neuro muscular and myocardial impulse transmission #
  15. 15. Normal concentration of sodium 135 to 145 mEq/L #
  16. 16. #
  17. 17. Main intracellular cat ionHelps in maintaining fluid balance of the intracellular fluidPotassium is regulated by #
  18. 18. functionsRegulates neuromuscular excitability and muscle contraction Needed for glycogen formation and protein sunthesis Correction of acid base imbalances. Potassium ion can be exchanged with hydrogen ion (H+) #
  19. 19. Normal concentration of potassium 3.5 to 5.3 mEq/L #
  20. 20. #
  21. 21. Calcium is the most abundant element in the bodyCalcium is extracellular fluidRegulated by the action of Thyroid gland parathyroid gland #
  22. 22. Parathyroid hormone (PTH) controls the balance among bone calcium, gastrointestinal absorption and kidney excretion of calcium.Thyrocalcitonin from the thyroid gland inhibits the release of calcium from bones, thus playing a minor role in determining serum calcium levels. #
  23. 23. functionsMaintenance of cell membrane, its integrity and structure Conduction of nerve impulses in the skeletal muscleStimulation and depolarization and contraction of cardiac muscles #
  24. 24. functions Aids in blood coagulationGrowth and formation of bones Muscle relaxation #
  25. 25. Normal concentration of calcium 4 to 5 mEq/L #
  26. 26. #
  27. 27. Magnesium is the second most important cat ion in the intracellular fluidIt has an inhibitory effect on skeletal muscles. #
  28. 28. functionsPrecipitation of metabolic activities of cells Enzyme activity Neuro chemical activity Muscular excitability #
  29. 29. Normal concentration of magnesium 1.5 to 2.4 mEq/L #
  30. 30. anions #
  31. 31. chloridephosphate bicarbonate #
  32. 32. #
  33. 33. Phosphate is a buffer anion in extracellular and intracellular fluidPhosphate absorption is through gastrointestinal tract in a range of 3 to 12 mg/100 mlCalcium and phosphate are inversely proportional. When one rises the other falls #
  34. 34. Serum phosphate is regulated by kidneys Parathyroid hormone #
  35. 35. Activated vitamin D #
  36. 36. functionsDevelopment and maintenance of bones and teeth Promotes normal neuromuscular action Participates in carbohydrate metabolism Assist in acid base regulation Maintains levels of ATP ( Adenosine Triphosphate) and thus energy levels #
  37. 37. Normal concentration of phosphate 2.5 to 4.5 mEq/L #
  38. 38. #
  39. 39. Chlorides are found in extracellular and intracellular fluidsThe chloride ion balances the cations within the extracellular fluidThe ion exchange helps to maintain the electrical neutrality #
  40. 40. Chloride is regulated through kidneysThe dietary intake of chloride and the amount excreted in urine are closely related #
  41. 41. Normal concentration of chloride 100 to 106 mEq/L #
  42. 42. #
  43. 43. Bicarbonate is found in extracellular and intracellular fluidsIt is a major chemical buffer in the bodyRegulation is through kidneysIt is an essential component of the carbonic acid-bicarbonate buffering system essential to acid base balance #
  44. 44. Normal arterialbicarbonate value 22 to 26 mEq/L #
  45. 45. Normal venousbicarbonate value 24 to 30 mEq/LIn venous blood, bicarbonate is measured as carbondioxide content #
  46. 46. FLUID VOLUMEDISTURBANCES #
  47. 47. Fluidvolume deficit hypovolemia #
  48. 48. Fluid Volume DeficitMild – 2% of body weight lossModerate – 5% of body weight lossSevere – 8% or more of body weight loss #
  49. 49. Pathophysiology results from loss ofbody fluids and occursmore rapidly when coupledwith decreased fluidintake #
  50. 50. Clinical manifestationsAcute Weight lossDecreased skin turgor #
  51. 51. Concentrated urine flattened neck veinsPostural hypotension #
  52. 52. Weak, rapid, heart rate OliguriaIncreased temperatureDecreased central venous pressure #
  53. 53. Nursing DiagnosisFluid volume Deficit r/tInsufficient intake, vomiting, diarrhea,hemorrage, m/b dry mucous membranes #
  54. 54. Nursing managementRestore fluids by oral or IVTreat underlying causeMonitor I & O at least every 8 hoursDaily weightVital signsSkin turgorUrine concentration #
  55. 55. Fluidvolume excess hypervolemia #
  56. 56. Pathophysiology may be related tofluid overload ordiminished function of thehomeostatic mechanismsresponsible for regulatingfluid balance #
  57. 57. Contributing factors #
  58. 58. Clinical manifestations EdemaDistended neck veins #
  59. 59. TachycardiaIncreased blood Pressure #
  60. 60. Increased weight crackles #
  61. 61. Nursing DiagnosisFluid volume excess r/t CHF, excess sodium intake, renal failure #
  62. 62. Nursing managementPreventing FVEDetecting and Controlling FVETeaching patients about edema #
  63. 63. Electrolyte Imbalances #
  64. 64. SODIUM #
  65. 65. SodiumNormal range – 135 to 145 mEq/L Primary regulator of ECF volume (a loss or gain of sodium is usually accompanied by a loss or gain of water) #
  66. 66. HYPONATREMIA Sodium level less than 135 mEq/L #
  67. 67. causesVomiting Diarrhea #
  68. 68. Sweating Diuretics #
  69. 69. Clinical manifestations Poor skin turgor Dry mucosa Decreasedsaliva production Anorexia vomiting #
  70. 70. Clinical manifestations Nausea/Orthostatic abdominalhypotension cramping Confusion & Altered mental lethargy status #
  71. 71. Nursing interventions Assess clinical manifestations Monitor fluid intake and output, vital signs and lab data. Encourage food and fluids high in Na Limit water intake. #
  72. 72. HYPERNATREMIA Sodium level more than 145 mEq/L #
  73. 73. CAUSESLoss of fluids Water deprivation Excessive salt intake Conditions like Diabetes insipidus, heatstroke #
  74. 74. Pathophysiology- Fluid deprivation in patients who cannot perceive, respond to, or communicate their thirst- Most often affects very old, very young, and cognitively impaired patients #
  75. 75. Clinical manifestations- Thirst- Sticky mucous membranes- Flushed skin- Postural hypotension- Dry, swollen tongue #
  76. 76. Nursing interventionsMonitor intake and outputMonitor behavioural changesMonitor lab findingsEncourage fluidsMonitor diet as ordered(salt restriction) #
  77. 77. POTASSIUM #
  78. 78. Normal serum potassiumconcentration is 3.5 to 5.5 mEq/L Major Intracellular electrolyteand 98% of the body’s potassium isinside the cells #
  79. 79. HYPOKALEMIA Potassium level less than 3.5 mEq/L #
  80. 80. CAUSESLoss of K+ in the form of vomittings ,GI suction poor K intake diuretics steroid administration #
  81. 81. Clinical manifestations Muscle weakness Leg cramps Fatigue Lethargy Anorexia Nausea, vomitting Decreased bowel sounds Decreased bowel motility Cardiac dysrhythmias Depressed deep tendon reflex #
  82. 82. Nursing interventionsMonitor heart rate and rhythmMonitor clients receiving DIGITALISAdminister oral K+ as ordered with food /fluidsAdminister IV K+ as ordered ,flow rate not more than 10-20 meq/hrTeach patients about potassium rich diet and to reduce potassium wastage #
  83. 83. HYPERKALEMIA Potassium level more than 5.5 mEq/L #
  84. 84. Causes Decreased renal potassium excretion as seen with renal failure and oliguria High potassium intake Renal insufficiency Shift of potassium out of the cell as seen in acidosis #
  85. 85. Clinical manifestationsSkeletal muscle weakness/paralysisECG changes – such as peaked T waves, widened QRS complexesHeart block #
  86. 86. Nursing interventionsMonitor ECG changes – telemetryAdminister Calcium solutions to neutralize the potassiumMonitor muscle toneGive KayexelateGive Insulin and D50W #
  87. 87. CALCIUM #
  88. 88. Normal serum calcium level is 4to 5 mEq/L More than 99% of the body’scalcium is located in the skeletalsystem #
  89. 89. HYPOCALCEMIA Calcium level less than 4 mEq/L #
  90. 90. Causes- Vitamin D/Calcium deficiency- Primary/surgical hyperparathyroidism- Pancreatitis- Renal failure #
  91. 91. Clinical Manifestations Tetany and cramps in muscles ofextremities #
  92. 92. Trousseau’s sign – carpal spasms #
  93. 93. Chvostek’s sign – cheek twitching #
  94. 94. Seizures, mental changes #
  95. 95. ECG shows prolonged QT intervals #
  96. 96. Nursing interventions- IV/PO Calcium Carbonate or Calcium Gluconate- Encourage increased dietary intake of Calcium- Monitor neurlogical status- Establish seizure precautions #
  97. 97. HYPERCALCEMIA Calcium level more than 5 mEq/L #
  98. 98. Causes- Hyperparathyroidism- Prolonged immobilization- Thiazide diuretics- Large doses of Vitamin A and D #
  99. 99. Clinical manifestations- Muscle weakness, nausea and vomiting- Lethargy and confusion- Constipation- Cardiac Arrest (high level) #
  100. 100. Nursing interventions- Eliminate Calcium from diet- Monitor neurological status- Increase fluids (IV or PO)- Calcitonin #
  101. 101. MAGNESIUM #
  102. 102. Normal serum magnesium levelis 1.5 to 2.4 mEq/L Thought to have a directeffect on peripheral arteriesand arterioles #
  103. 103. HYPOMAGNESEMIA magnesium level less than 1.5 mEq/L #
  104. 104. Causes- Chronic Alcoholism- Diarrhea, or any disruption in small bowel function #
  105. 105. - TPN- Diabetic ketoacidosis #
  106. 106. #
  107. 107. Clinical manifestations- Neuromuscular irritability- Positive Chvostek’s and Trousseau’s sign- EKG changes with prolonged QRS, depressed ST segment, and cardiac dysrhythmias- May occur with hypocalcemia and hypokalemia #
  108. 108. • Starved – possible cause of hypomagnesemia• Seizures• Tetany• Anorexia and arrhythmias• Rapid heart rate• Vomiting• Emotional lability• Deep tendon reflexes increased #
  109. 109. Nursing interventions- IV/PO Magnesium replacement, including Magnesium Sulfate- Give Calcium Gluconate if accompanied by hypocalcemia- Monitor for dysphagia, give soft foods- Measure vital signs closely #
  110. 110. Foods high in Magnesium:Green leafy vegetables #
  111. 111. NutsLegumes #
  112. 112. SeafoodChocolate #
  113. 113. HYPERMAGNESEMIA magnesium level more than 2.4 mEq/L #
  114. 114. Causes- Renal failure- Untreated diabetic ketoacidosis- Excessive use of antacids and laxatives #
  115. 115. Clinical manifestations- Flushed face and skin warmth- Mild hypotension- Heart block and cardiac arrest- Muscle weakness and even paralysis #
  116. 116. RENAL• Reflexes decreased (plus weakness and paralysis)• ECG changes (bradycardia and hypotension)• Nausea and vomiting• Appearance flushed• Lethargy (plus drowsiness and coma) #
  117. 117. Nursing interventions- Monitor Mg levels- Monitor respiratory rate- Monitor cardiac rhythm- Increase fluids- IV calcium for emergencies #
  118. 118. PHOSPHORUS #
  119. 119. Normal serum phosphorus level is 2.5 to 4.5 mg/100 ml- Phosphate levels vary inversely to calcium levels- High Calcium = Low Phosphate #
  120. 120. HYPOPHOSPHOTEMIA Phosphorus level less than 2.5 mEq/L #
  121. 121. Causes- Most likely to occurs with overzealous intake or administration of simple carbohydrates- Severe protein-calorie malnutrition (anorexia or alcoholism) #
  122. 122. Clinical manifestations- Muscle weakness- Seizures and coma- Irritability- Fatigue- Confusion- Numbness #
  123. 123. Nursing interventions- Prevention is the goal- IV Phosphorus for severe- Prevention of infection- Monitor phosphorus levels- Increase oral intake of phosphorus rich foods #
  124. 124. Foods rich in phosphorus- Milk and milk products- Poultry- Whole grains- Organ meats- Nuts- Fish #
  125. 125. HYPERPHOSPHOTEMIA Phosphorus level more than 4.5 mEq/L #
  126. 126. Causes- Renal failure- Chemotherapy- Hypoparathyroidism- High phosphate intake #
  127. 127. Clinical manifestations- Tetany- Muscle weakness- Similar to Hypocalcemia because of reciprocal relationship #
  128. 128. Nursing interventions- Treat underlying cause- Avoid phosphorus rich foods #
  129. 129. #
  130. 130. #

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