Assessment & Care of Pt's With Fluid & Electrolyte Imbalances
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| Percent of water in total body weight | 55-60%
Babies: Higher water body weight.
Elders: Less water body weight.
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| Intracellular Fluid | Fluid inside cells
*Most fluid in this compartment
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| Extracellular Fluid | Fluid outside of cells.
Consists of interstitial and vascular fluids.
i.e. Plasma
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| Interstitial Fluid | "Third Space" Fluid between cells
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| Define Homeostasis and 3 processes | 1.Filtration
2.Diffusion
3.Osmosis
to control normal fluid and electrolyte imbalance
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| Define Filtration | HIGH to LOW PRESSURE
Movement of fluid through a cell/blood vessel because of pressure differences.This occurs because water volume presses outwards against the walls (Hydrostatic Pressure)
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| Clinical examples of Filtration (2) | *Blood pressure- Moves blood from heart to capillaries where filtration can occur.
*Edema-Occurs from pressure differences
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| Define Diffusion | HIGH to LOW CONCENTRATION to find equalization.
Free movement of particles and electrolytes across a permeable membrane.
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| Clinical examples of Diffusion (2) | *Capillary Membranes-transportation of electrolytes and particles through membranes.
*Sodium Pumps-Active Transport
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| Facilitate Diffusion example | Glucose cannot enter most cell membranes without the help of insulin
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| Define Osmosis | LOW to HIGH CONCENTRATION of WATER ONLY!
Dilute fluid (less concentrated) moves to more concentrated to make it more dilute.
Milliosmoles per Liter/Solution
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| Clinical example of Osmosis | *Thirst Mechanism- feeling of thirst is caused by the activation of brain cells that respond to change in ECF osmolarity
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| Normal Osmolarity Level AKA "Isotonic" | -Norm: 270-300 mOsm/L
->300:Hypertonic (Pull water from isotonic fluid space)
-<300:Hypotonic (Water pulled from hypo-osmotic fluid into isotonic fluid space
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| Routes of Fluid Loss | *Kidneys most important (Filtration, Re absorption, Excretion)
*Insensible water loss (500-1000mL/day) from skin, lungs stool
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| Define Obligatory Urine Output and norm | (400-600mL/day) Minimum amount of urine needed to excrete toxic waste products
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| Aldosterone | Secreted by adrenal cortex if sodium levels are low.
-Prevents water and sodium loss
-Increases blood osmolarity and volume
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| Antidiuretic Hormone (Vasopressin) | *Acts directly on kidney tubules
-Produced in brain
-Stored in posterior pituitary gland
-Controlled by hypothalamus in response to blood osmolarity
-Results in more water being absorbed from tubules and returned to blood=decreased blood osmolarity
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| Natriuretic Peptides | "Too much fluid, get rid of some"
*Effects opposite of Aldosterone
Secreted in response to increased blood volume and BP which stretch heart tissue
Secreted by the ANP & BNP
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| Dehydration S/S | Hypotension
↑HR
↑RR (may need O2)
Tenting
Dry Mucous Membranes
∆ Mental Status
↑ Temp
Concentrated/Decreased Urine
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| Dehydration Lab Assessment | Hemoconcentration=
Elevated Hemoglobin, Hematocrit, Serum Osmolarity, Glucose, Protein, BUN, Electrolyte
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| Normal Specific Gravity Level | 1.010-1.025
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| Fluid Overload S/S | Edema
↑HR
↑BP
↑RR
Neck vein Distension
*Daily Weight most accurate measure
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| Define Electrolyte | Substances in body fluids that carry an electrical charge
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| Body Fluids | Are electrochemically neutral (Have equal number of + and - ions)
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| How is the body's homeostasis controlled? | By balance of dietary intake of electrolytes with renal excretion or re absorption
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| Sodium | *Major extracellular cation
Vital for skeletal muscle contractions, cardiac contraction, nerve impulse transmission, normal osmolarity and volume of the ECF.
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| Normal Sodium Level | 135-145 mmol/L
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| Hyponatremia | *Confusion
*Muscle Weakness (First check Respiratory Status!!)
-↑ GI Motility
-Nausea, Diarrhea
-Change in Cardiac Output
(Hyper/Hypovolemia)
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| Hyponatremia Interventions | *Monitor the patients response to therapy and preventing hypernatremia and fluid overload. Treat with fluids and sodium.
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| Hypernatremia | *Twitching
Confusion
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| Potassium | *Cardiac
*Major intracellular cation
*80% of K loss if from kidneys
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| Normal Potassium Level | 3.5-5.0 mEq/L
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| Hypokalemia S/S | *Cardiovascular Changes
-Weak Pulse
-Dysrhythmias
-Muscle weakness
*Decreased Peristalsis
-Confusion
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| Hypokalemia Interventions | -Ensure adequate oxygenation
-Monitor response to therapy
-Prevent injury from K administration *Never IV PUSH,IM, or SubQ Potassium
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| Foods High in Potassium | -Prunes, Raisins
-Apricots
-Nuts/Seeds
-Fish
-Beans
-Avacados
-Dark Chocolate
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| Hyperkalemia | *Cardiovascular problems are most severe and result in most deaths
-Increase GI motility, Diarrhea
-Muscle Twitching
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| Hyperkalemia Interventions | -Cardiac Monitoring
-Drug Therapy (Kayexalate, glucose and insulin, dialysis)
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| Normal Calcium Level | 9.0-10.5 mg/dL
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| Calcium | -Closely r/t phosphorus & magnesium
-Stored in the bones
-Vitamin D is required for absorption
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| Parathyroid Hormone (PTH) is released when... | Calcium levels are low
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| Thyrocalcitonin (TCT) is released when... | Calcium levels are high
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| Percentage of people that are Lactose Intolerant | 75-90%
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| Hypocalcemia S/S | *Risk of bleeding
-Paresthesia (numbness/tingling)
-Trousseaus's or Chvostek's Sign
-↑Peristalsis
-Skeletal Changes(Chronic)
-EKG Changes
*Frequent spasms (Charley horses
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| Trousseaus's Sign | Hand, finger spasm with BP cuff inflated 1-4 minutes
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| Chvostek's Sign | One-sided facial twitching when brushed
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| Hypocalcemia Interventions | -Injury prevention (brittle bones)
-Seizure Precautions
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| Hypercalcemia S/S | *Risk of blood clots
-Cardiovascular changes are most serious and life threatening
-Altered LOC
-↓Peristalsis
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| Hypercalcemia Interventions | -Dialysis
-Cardiac Monitoring
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| Normal Phosphorus Level | 3.0-4.5 mg/dL
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| The most phosphorus can be found where? | In the bones. About 80%
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| What is phosphorus needed for in the body? | For activating vitamins and enzymes, forming adenosine triphosphate, and assisting in cell growth and metabolism
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| The relationship between Calcium and Phosphorus | ↑Calcium = ↓Phosphorus
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| Foods high in Phosphorus | -Meats
-Fish
-Dairy products
-Nuts
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| Clinical situations that would cause Hypophosphatemia | -Malnutrition
-Starvation
-Malignancy
-Alcohol Abuse
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| Hypophosphatemia S/S | -Most apparent in cardia, Musculoskeletal, and hematologic systems, and CNS.
-↓Cardiac Output
-Muscle Breakdown
-CNS Changes(Not til severe)
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| Hypophosphatemia Interventions | -Vitamin D Supplements
*Decreasing intake of foods high in Calcium
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| Hyperphosphatemia | -Can be from renal insufficiency
-Does not cause many problems, worst problems include the relationship with calcium. ↑Phosphorus=↓Ca
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| Hyperphosphatemia Interventions | Since Phosphorus and Calcium have a reciprocal relationship, management of hyperphosphatemia entails management of hypocalcemia
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| Normal Magnesium Level | 1.3-2.1 mg/dL
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| Magnesium | Critical for skeletal muscle contraction, carb metabolism, ATP formation, vitamin activation, and cell growth
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| Hypomagnesemia is caused by... | Increased membranes excitability and the accompanying serum calcium and potassium imbalances.
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| Hypomagnesemia S/S | -Muscle contractions, numbness/tingling
-Chvostek's & Trousseaus's Sign
-Confusion, depression/psychosis
-↓Peristalsis
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| Hypomagnesemia Drug Intervention | Magnesium Sulfate-Give IV, never IM
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| Hypermagnesemia occurs when... | excitable membranes are less excitable and need a stronger-than-normal stimulus to respond
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| Hypermagnesemia S/S | -↓BP, ↓HR
-Cardiac Arrest
-Lethargy/coma
-↓Reflexes
-Respiratory failure r/t muscle weakness
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| OTC Meds high in Magnesium | -Antacids
-Milk of Mag
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| Normal Chloride Level | 98-106 mEq/L
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| Chloride | *Major Extracellular Anion
-Usually occurs as a result of other electrolyte imbalances
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