Fluid And Electrolytes Blue Print
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| Electrolytes are | substances that carry an electrical charge when dissolved in fluid.
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| The delicate balance of fluids, electrolytes, acids, and bases is ensured by an adequate intake of | water and nutrients, physiologic mechanisms that regulate fluid volume and chemical processes that buffer the blood to keep pH nearly neutral.
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| Standard formula for calculating daily fluid intake is as follows: | 100mL/kg for the first 10kg of weight + 50ml/kg for the next 10kg of weight +
15ml/kg per remaining kg of weight.
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| isotonic | concentration is the same on both sides of the membrane
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| Filtration promotes the movement of fluid and some dissolved substances through a semipermeable membrane according to pressure differences. It relocates water and chemicals from an area of | high pressure to an area of lower pressure.
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| Filtration also affects how the kidneys excrete fluid and wastes and then selectively | reabsorb water and other chemicals that need to be conserved.
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| Active transport requires | an energy source, a substance called ATP to drive dissolved chemicals from an area of low concentration to an area of higher concentration.
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| An example of active transport is the | sodium potassium pump system.
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| Most body water is located | within cells (intracellular fluid)
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| The rest is located between cells | interstitial fluid and in the plasma of blood (intervascular fluid)
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| Fluid imbalance is a general term describing any of several conditions in which the bodys water is not in the proper volume or location. Common fluid imbalances include | hypovolemia, hypervolemia, and Third-spacing
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| Hypovolemia refers to | a low volume of extracellular fluid. electrolytes are usually also depleted.
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| hypovolemia patients are those who typically have: | lethargy, depressed, vomiting, dementia, fever, difficulty swallowing, diarrhea, cannot speak to communicate their needs, eat poorly, require assistance to drink , paralysis, limited ROM, take diuretics, laxatives or drugs that cause dehydration,
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| Dehydration results when | the volume of body fluid is significantly reduced in both extracellular and intracellular departments.
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| In dehydration all fluid compartments have decreased volume, in hypovolemia, only | blood volume is low.
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| The most common fluid imbalance in older adults is | dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic meds, laxatives, or enemas may also deplete fluid volumes.
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| Factors that contribute to hypovolemia include | inadequate fluid intake, fluid loss in excess of fluid intake such as hemorrhage, prolonged vomiting or diarrhea, wound loss, or profuse urination or perspiration, translocation of fluid to compartments where it is trapped
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| When circulatory volume is decreased, BP falls and the heart compensates by | increasing the heart rate to maintain adequate cardiac output.
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| Hypovolemia eventually depeletes intracellular fluid which can affect | cellular functions.
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| One of the earliest symptoms of hypovolemia is | thirst.
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| Foods High in Salt or Sodium | processed meats, fast food, frozen meals, salted/smoked fish, cheeses, cocoa/hotchoco, canned vegges, foods in brine (pickles), soup, boxed casseroles, salted snack foods, seasonings
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| Because aging causes skin to lose elasticity, assessing skin turgor may be ineffective to detect fluid volume deficint in older adults. If assessing skin turgor in older clients use | the skin of the forehead or sternum.
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| Hypervolemia means that there is a | high olume of WATER in the intraVASCULAR fluid compartment.
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| Hypervolemia is caused by | excessive oral or iv intake of fluids, consequense of heart failure, kidney disease, fluid retention, excessive salt intake, adrena gland dysfunction,
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| Hypervolemia can lead to | circulatory overload a fluid volume that exceeds what is normal and can potentially compromise cardiopulmonary function.
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| Signs of hypervolemia | weight gain, elevated BP, increased breathing effort, pitting edema, depenedent edema, jugular neck veins prominent upon sitting, moist lung sounds.
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| Medical Mgmt Hypervolemia | restrict fluids and salt - given diuretics
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| Obtaining weight | daily, before breakfast, same clothes, same scale, same time,
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| 2 pound loss of weight equals | 1L of body fluid
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| Third spacing describes the | translocation of fluid from the intravascular or intercellular space to tissue compartments where it becomes trapped and useless.
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| Third spacing signs symptoms | Same symptoms as hypovolemia except weight loss, localized enlargement of organs (ascites), generalized edema,
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| Medical Mgmt of third spacing | administer IV solutions, blood products, to restore colloidal osmotic pressure, IV diuretic may be ordered to reduced potential for circulatory overload.
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| Electrolyte imbalances occur when there is a | deficit or excess of electrolytes or when they are translocated to any one or more fluid compartnemts,
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| Electrolyte imbalances are identified primarily by measuring their | levels in the serum (watery portion of blood)
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| Electrolyte deficites sometimes result from | inadequate intake of food that provides their natural source, administering iv solutions that contain not enough needed electrolytes, and conditions that deplete electrolytes (vomit, diarrhea), certain medications that deplete electrolytes
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| Factors that contribute to excess electrolytes include an | overabundance of orally consumed or parentally admindstered electrolytes, kidney failure, and endocrine dysfunction.
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| Several factors can lead to fluid and electrolyte imbalance in older adults | Decreased renal function, Enema use, Laxatives, poor appetite, erratic meal patterns, inability to prepare nutritious meals,
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| Sodium is the chief cation (positively charged electrolyte) in extracellular fluid. It is essential for | maintaining normal nerve and muscle activity, regulating osmotic pressure, and preserving acid-base balance
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| Causes of Hyponatremia | profuse diaphoresis, excessive ingestion of plain water or administration of non electrolyte IV fluids, profuse diuresis, loss of gi secretions and addison's disease.
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| Manifestations of Hyponatremai | mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, personality changes. Convulsions or coma can occur
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| Hyponatremia levels | below 135 mEq/L
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| Hypernatremia is caused by | profuse watery diarrhea, excessive salt intake without water intake, high fever, decreased water intake, excessive administration of solutions that contain sodium, excessive water loss without loss of sodium, and severe burns
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| Hypernatremia results in | thirst, dry sticky mucous membranes, decreased urine output, fever, rough dry tongue, lethargy which can progress to coma
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| Hypernatremia levels | above 145mEq/L
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| Older adults are at increased risk for hyponatremia related to the kidneys inability | to excrete water and the sluggish renin-angiotensin-aldosterone response
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| Hypernatremia is common in older adults it may be manifested as | confusion.
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| Nursing mgmt for sodium imbalances | assess vital signs every 1-4 hours, closely monitor IV, dietary restrctions or supplements
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| Potassium is the chief electrolyte found in | intracellular fluid.
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| Contribute to hypokalemia | potassium wasting diuretics (Lasix, Edecrin, Hydrodiuril), severe vomiting or diarrhea, Large doses of corticosteroids, IV insulin and glucose, and prolonged administration of nonelectrolyte parenteral fluids
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| Hypokalemia causes | weakness, fatigue, anorexia, nausea, vomiting, cardiac dysrhthmias, leg cramps, muscle weakness, paresthesias, hypotension, falccid paralysis, and even death
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| Hypokalemia is potassium below levels of | 3.0mEq/L
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| Treatment of hypokalemia | increase oral intake of potassium rich foods or use a prescribed oral potassium replacement.
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| Hyperkalemia can occur with | severe renal failure, in which the kidneys cannot excrete potassium, severe burns, administration of potassium sparing diuretics, overuse of potassium supplements, salt subs or some diet sodas, potassium rich foods, crushing injuries, addisons disease,
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| Hyperkalemia symptoms | diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias
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| Serum potassium level with hyperkalemia is above | 5.5mEq/L
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| Severe Hyperkalemia treatment | IV combo of regular insulin and glucose that temporarily shifts eserum potassium into cells within 30 minutes of administration.
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| If IV potassium is ordered it must be diluted in an IV solution and administered at a rate below | 10mEq/hour Observe infusion frequently to verify it is being administered properly
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| Food containing potassium | veggies, dried peas and beans, wheat bran, bananas, oranges, orange juice, melons, prune juice, potatoes, milk
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| POtassium should never be administered to a client with | insufficient kidney function.
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| Parathyroid gland regulates | serum calcium level
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| Calcium is necessary for | blood clotting, smooth, skeletal and cardiac muscle function, transmission of ausesnerve impulses.
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| Vit D is needed for | calcium absorption!!!!!!!!!!!!!!!!!!!!!!!!!! YAY!!!!!!!!!!!!!!!!!!!!!
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| Causes of hypocalcemia | vitamin d deficiency, hypoparathyroidism, severe burns, acute pancreatitis, certaind rugs like corticosteroids, rapid admin of blood that contain anticalcium additive, intestinal malabsorp. disorders, accidental surgical removal of parathyroid glands
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| Hypocalcemia is evidenced by | tingling in extremities and around the mouth, muscle and abdominal cramps, chvosteks sign, trousseaus sign, mental changes, laryngeal spasms w/airway obstruction, tetany, seizures, bleeding, and cardiac dysrhythmias.
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| Trousseau's sign | spasm of the fingers, hand and wrist when a blood pressure cuff is inflated to a level between the clients systolic and diastolic BP for 3 minutes
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| Chvostek's sign | unilateral spasm of facial muscles is elicited by tapping over the facial nerve which lies approximately 2cm anterior to earlobe
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| Hypercalcemia is associated with | parathyroid gland tumors, multiple fractures, paget's disease, hyperparathyroidism, excessive doses of vit. d, prolonged immobilizations, some chemotherapy agents and certain malignant diseases
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| Hypercalcemia causes | deep bone pain, constipation, anorexia, NV, polyuria, thirst, pathologic fractures, mental changes (decreased memory and attention span)
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| Chronic hypercalcemia can promote the formation of | kidney stones
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| Total serum calcium levels in hypercalcemia is above | 10mg/dL
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| Hypokalemia causes abnormal heart rate or rhythm, especially in people receiving | cardiac glycosides such as digitalis preparations
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| The nurse closely monitors the client with hypocalcemia for | neurologic manifestations (tetany, seixures, spasms), cardiac dysrhythmias and airway obstruction. seizure precautions are necessary. Routinely check for bruises/bleeding. encourage fluids
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| Magnesium is found in | bone cells and specialized cells of the heart, liver, and skeletal muscles. it is involved in tramsission of nerve impulses and muscle excitability and activates several enzyme systems.
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| Hypomagnesemia is caused by | chronic alcoholis,diabetic ketoacidosis, severe renal disease, severe burns, severe malnutrition, preg-induced hypertension, intestinal malabsorption syndromes, excessive diuresis, hyperaldosteronism, and prolonged gastric suction
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| Signs and symptoms of hypomagnesium | tachycardia, cardiac dysrhythmias, neuromuscular irritability, paresthesia of extremities, leg and foot cramps, hypertension, mental changes, positive chvosteks and trousseaus, dysphagia, and seizures
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| When administering electrolytes to correct or prevent a deficiency, measure the dose | carefully and give only as directed by the physician.
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| Hypermagnesemia can be a consequence of | renal failure, addisons disease, excessive use of antacids or laxatives that contain magnesium and hyperparathyroidism
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| Clients with hypermagnesemia experience | flushing, warmth, hypotension, lethargy, drowsiness, bradycardia, muscle weakness, depressed respirations, and coma.
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| If administering IV mag sulfate (to treat mag imbalances) | be sure to frequently check BP because it can produce vasodilation and subsexuent hypotension. VS requires close monitoring
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