1. Stressors Affecting Fluid & Electrolyte Balance
NUR 101
FALL 2008
LECTURE # 15 & #16
K. Burger, MSEd, MSN, RN, CNE

2. Body Fluids Water= most important nutrient for life.
Water= primary body fluid. Adult weight is 55-60% water.
Loss of 10% body fluid = 8% weight loss SERIOUS
Loss of 20% body fluid = 15% weight loss FATAL
Fluid gained each day should = fluid lost each day (2 -3L/day average)
What is the minimum output per hour necessary to maintain renal function?
30ml/hr

3. Functions of Body Fluid
Medium for transport
Needed for cellular metabolism
Solvent for electrolytes and other constituents
Helps maintain body temperature
Helps digestion and elimination
Acts as a lubricant

4. Mechanisms of Fluid Gain and Loss
Fluid intake 1500ml
Food intake 1000ml
Oxidation of nutrients ml (10ml of H20 per 100 Kcal)
Loss
“Sensible” Can be seen. Urine ml Sweat ml
“Insensible” Not visible. Skin (evaporation) 500ml Lungs ml Feces ml

5. Regulation of Fluids
Hypothalmus –thirst receptors (osmoreceptors) continuosly monitor serum osmolarity (concentration). If it rises, thirst mechanism is triggered. +Vasopressin (AKA ADH )– increasing H20 reabsorption
Pituitary regulation- posterior pituitary releases ADH (antidiuretic hormone) in response to increasing serum osmolarity. Causes renal tubules to retain H20.
Thirst is a late sign of water deficit
What controls or regulates the fluids in our body?
Thirst –simplest way to maintain fluid balance
Thirst center failure- onconscious or confused pt. To not respond
Which age group is most prone to dehydration because their body’s weight is mostly water?

6. Regulation of Fluids (continued )
Renal regulation- Nephron receptors sense decreased pressure (low osmolarity) and kidney secretes RENIN. Renin – Angiotensin I – Angiotensin II
Angiotensin II causes Na and H20 retention by kidneys AND…..
Stimulates Adrenal Cortex to secrete Aldosterone which causes kidneys to excrete K and retain Na and H20.
What also is increased here?

7. Consider This….
The Geriatric Client -normal physiological aging results in decreased thirst mechanism decreased # of sweat glands decreased renal function -there also may be decreased mobility and/or cognitive function which impacts their ability to get adequate fluid intake.

8. Variations in Body Fluids
Elderly: Have lower % of total body fluid than younger adults
Women: Have lower % total body fluid than men
WHY DO YOU THINK THIS IS ?????
Increased risk for fluid/electrolyte imbalance with decreased muscle since muscle cells hold more water
Muscle tissue has more H20 content THAN adipose tissue

9. Intracellular fluid (ICF)
Fluid Compartments
Extracellular Fluid (ECF)
Fluid outside the cell.
1/3 of body’s H20
More prone to loss
3 types:
Interstitial- fluid around/between cells
Intravascular- (plasma) fluid in blood vessels
Transcellular –CSF, Synovial fluid etc
Intracellular fluid (ICF)
Fluid inside the cell
Most (2/3) of the body’s H20 is in the ICF.
NOTE: Potter & Perry speaks to the “percentage of body weight” % of BODY WEIGHT = ICF fluid % of BODY WEIGHT = ECF fluid
Transcellular fluid is a negligible amount

10. Consider this….
Age variations exist in regards to H20 content of fluid compartments
Infants = 60% of H20 is found in ECF 40% of H20 is found in ICF
What might this mean in regards to fluid loss for an infant?
This is reverse of adults THEREFORE the infant is more susceptible to fluid loss
Reverse of adults!
Infant MORE PRONE to fluid LOSS!

11. Fluid Balance Dynamic process
Balance between body fluids and electrolytes
Attraction between ions (electrolytes) and water (fluids) causes fluids to move across membranes and leave their compartments.
SEE NEXT SLIDES FOR IN-DEPTH

12. Solvent (H20) Movement
Cell membranes are semipermeable allowing water to pass through
Osmosis- major way fluids transported Water shifts from low solute concentration to high solute concentration to reach homeostasis (balance).
Water is a solvent
Concentration of particles in solution (pulling action = osmolarity)
Isotonic have almost same osmolarity as plasma therefore there is no pull

13. Osmolarity Concentration of particles in solution
The greater the concentration (Osmolarity) of a solution, the greater the pulling force (Osmotic pressure)
Normal serum (blood) osmolarity = mOSM/kg
A solution that has HIGH osmolarity is one that is > serum osmolarity = HYPERTONIC solution
A solution that has LOW osmolarity is one that is < serum osmolarity = HYPOTONIC solution
A solution that has equal osmolarity as serum = ISOTONIC solution
Osmosis, by the way, is the reason that drinking salt water will kill you.
The HIGH osmolarity salt water in the GI system rapidly pulls water into the GI system and excretion – rapidly dehydrating cells
SEE NEXT SLIDES FOR FURTHER DISCUSSION

14. Hypertonic Fluids
Hypertonic fluids have a higher concentration of particles (high osmolality) than ICF
This higher osmotic pressure shifts fluid from the cells into the ECF
Therefore Cells placed in a hypertonic solution will shrink

15. Hypertonic Fluids Used to temporarily treat hypovolemia
Used to expand vascular volume
Fosters normal BP and good urinary output (often used post operatively)
Monitor for hypervolemia ! Not used for renal or cardiac disease. THINK – Why not?
D5% 0.45% NS
D5% NS
D5% LR
Used for post op, decreases intracellular edema, fosters normal BP and good urinary output.
D51/2NS, D5NS, D5RL
Hyperal
Pulmonary Edema

16. Hypotonic Fluids
Hypotonic fluids have less concentration of particles (low osmolality) than ICF
This low osmotic pressure shifts fluid from ECF into cells
Cells placed in a hypotonic solution will swell
ECF- extracellular fluids

17. Hypotonic Fluids Used to “dilute” plasma particularly in hypernatremia
Treats cellular dehydration
Do not use for pts with increased ICP risk or third spacing risk
0.45%NS
0.33%NS

18. Isotonic Fluid
Isotonic fluids have the same concentration of particles (osmolality) as ICF ( mOsm/L)
Osmotic pressure is therefore the same inside & outside the cells
Cells neither shrink nor swell in an isotonic solution, they stay the same
ICF intracellular fluid - fluid inside the cell
D5W isotonic /Normal saline solution is isotonic because it has almost the same concentration of sodium as blood.
Used to replace Ecvlume

19. Isotonic Fluid Expands both intracellular and extracellular volume
Used commonly for: excessive vomiting,diarrhea
0.9% Normal saline
D5W
Ringer’s Lactate

20. Other Osmotic Factors ALBUMIN ( a serum protein )
Albumin in the serum has osmotic properties called colloid pressure
Albumin pulls H20 from the interstitial compartments into the intravascular compartments (serum). Helps to maintain BP.
Persons with low serum albumin levels tend to retain fluid in their interstitial layers. What abnormal assessments might you find in the client with low serum albumin levels?
Edema, hypotension

21. Hmmm…….
What type of IV fluid (hypotonic – isotonic – hypertonic) might be of benefit to this client with low albumin levels?
Hypertonic

22. Consider this….
When tissue injury occurs, proteins pathologically leak from the intravascular space into the intersititial space. Termed: Third spacing
This explains __________ as a sign of the inflammatory process.
EDEMA
EDEMA

23. Solute Movement - Diffusion
Movement of solutes from high concentration to low concentration
It is a PASSIVE movement DOWN the concentration gradiant. (requires no energy)
Many body processes use diffusion. Example: O2 and CO2 exchange
Rate is affected by: concentration gradiant, permeability-surface area-thickness of membranes, and size of particles. (Fick’s Law)
Filtration- from pressure to low pressure

24. Solute Movement –other mechanisms
Active transport- requires energy (ATP) to move from low concentration to high concentration (uphill) Example: Na / K pump
May be enhanced by carrier molecules with binding sites on cell membrane Example: Glucose (Insulin promotes the insertion of binding sites for Glucose on cell membranes).

25. Filtration Solvent AND solute movement
Passage from an area of High Pressure to an area of Low Pressure Termed: Hydrostatic Pressure
Example: Arterioles have higher pressure than ICF Fluid, oxygen and nutrients move into cells Venules have lower pressure than ICF Fluid, carbon dioxide and wastes move out of cells

26. Fluid volume deficit FVD (Hypovolemia)
Loss of both H20 and electrolytes from ECF.
Causes include: Increased output, Hemorrhage, vomiting, diarrhea, burns, OR
Fluid shift out of vascular space ( “third spacing” ) into interstitial spaces
Dehydration: Fluid intake is not sufficient to meet the body’s needs.
Dehydration- if water isn’t adequately replaced dehydration results
Dx Tests
Elevated HCT
Elevated NA
Sp. Gravity above 1.030
Monitor lab work
Cause- unless unconscious
Sudden wt. change is a major indicator of fluid loss

27. Dehydration
Isotonic dehydration = H20 & electrolyte loss in equal amounts; diarrhea and vomiting
Hypertonic dehydration = H20 loss greater than electrolyte loss; excessive perspiration, diabetes insipidus

28. Assessment FVD - Hypovolemia
Cardiovascular:
Diminished peripheral pulses; quality 1+(thready)
Decreased BP & orthostatic hypotension
Increased HR
Flat neck & hand veins in dependent position
Elevated Hematocrit (Hct)
Gastrointestinal:
Thirst
Decreased motility; diminished bowel sounds, possible constipation

29. Assessment FVD – Hypovolemia (continued)
Neuromuscular:
Decreased CNS activity (lethargy to coma)
Possible fever
Skeletal muscle weakness
Hyperactive DTR
Renal:
Decreased output
Increased spec grav of urine
Weight loss
Hypernatremia
Integumentary:
Dry mouth & skin
Poor turgor (tenting)
Pitting edema
Sunken eyeballs
Respiratory:
Increased rate and depth

30. Nursing Diagnosis - FVD
Deficient Fluid Volume R/T loss of GI Fluids via vomiting AEB elevated Hct, dry mucous membranes, decreased output, thirst

31. Planning - FVD
Client will demonstrate fluid balance aeb moist mucous membranes, balanced I & O measurements, Hct WNL, by ….

32. Interventions for FVD - Hypovolemia
Prevent further fluid loss
Oral rehydration therapy
IV therapy
Medications; antiemetics, antidiarrheals
Monitor CV, Resp, Renal, GI status
Monitor electrolytes – possible supplement rx
MONITOR WEIGHT and I & O
Oral- keep fluids at bedside, offer frequently
IV fluids, blood & other parenteral measures Hyperal etc.
Meds- depending on the cause
Diarrhea give anti diarrhea meds
Vomiting give anti emetics
Vasopressors if pt. In shock cause vasoconstriction and increase BP

33. NCLEX Practice Intravenous fluids are ordered for your client
who is experiencing diarrhea and vomiting for
the past 2 days. Which IV solution would the
nurse expect to see prescribed?
D5NS
0.45%NS
D51/2NS RL
Ringers Lactate = ISOTONIC for replacement of ISOTONIC DEHYDRATION (loss of fluid & Electrolyte)

34. Fluid Volume Excess FVE - Hypervolemia
Fluid overload is an excess of body fluid - overhydration
Excess fluid volume in the intravascular area-hypervolemia
Excess fluid volume in interstitial spaces edema
Increase in vascular blood
Third spacing could be in the abd- ascites
pleural effusion in the lungs

35. Fluid Volume Excess Causes: Increased Na/H2O retention
Excessive intake of Na (PO or IV)
Excessive intake of H2O ( PO or IV) (Water intoxication)
Syndrome of inappropriate antidiuretic hormone (SIADH)
Renal failure, congestive heart failure
Retention-
Intake- Poorly controlled IV therapy/ rapid hypertonic solution/ excessive sodium bicarb / excessive Na intake

36. Assessment FVE - Hypervolemia
CV: Elevated pulse; 4+ bounding, elevated BP, distended neck & hand veins, ventricular gallop (S3) Hyponatremia
Resp: Dyspnea, Moist Crackles,Tachypnea
Integumentary: Periorbital edema Pitting or Non-pitting edema
GI: Increased motility Stomach cramps Nausea & Vomiting
Renal: Weight gain
Decreased spec grav of urine
Neuromuscular: Altered LOC, headache, skeletal muscle twitching

37. Nursing Diagnosis - FVE
Fluid volume excess
R/T excessive H20 intake
AEB confusion, headache, muscle twitching, abdominal cramps, elevated BP and HR, hyponatremia.

38. Planning - FVE
Client will demonstrate fluid balance by balanced I & O measurements, Serum Na WNL, etc. by ….

39. Interventions FVE - Hypervolemia
Restore normal fluid balance, prevent further overload
Drug therapy; diuretics
Diet therapy; decrease Na & fluids
Monitor intake and output (I & O)
Monitor weights
Monitor electrolytes
Monitor CV, Resp, Renal systems
Drug therapy- - diuretics for overhydration increases excretion of water and sodium
Diet-- restricting fluid and sodium intake
Monitor lab work

40. Clinical Application
You have been assigned to care for an 80y.o. client admitted with hypernatremia that has an IV infusing 0.45% 100ml/hr via pump and an indwelling urinary catheter. At 11am you assess an output in the urinary drainage bag of 150ml dk amber urine. You also notice that the client is SOB while speaking on the phone to her daughter.
What do you think is happening??
What will you do??

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42. Electrolytes Work with fluids to keep the body healthy and in balance
They are solutes that are found in various concentrations and measured in terms of milliequivalent (mEq) units
Can be negatively charged (anions) or positively charged (cations)
For homeostasis body needs: Total body ANIONS = Total body CATIONS
1 mEq MILLIEQUIVALENT = 1 MG OF HYDROGEN

43. Electrolytes Cations Positively charged Sodium Na+ Potassium K+
Calcium Ca++
Magnesium Mg++
Anions
Negatively charged
Chloride Cl-
Phosphate PO4-
Bicarbonate HCO3-
Each will be discussed except Bicarbonate as that plays a role in acid base balance which will be covered in NR33

44. Electrolyte Functions
Regulate water distribution
Muscle contraction
Nerve impulse transmission
Blood clotting
Regulate enzyme reactions (ATP)
Regulate acid-base balance

45. Sodium Na+ 135-145mEq/L Major Cation Chief electrolyte of the ECF
Regulates volume of body fluids
Needed for nerve impulse & muscle fiber transmission (Na/K pump)
Regulated by kidneys/ hormones
Na concentrations effected by water intake and salt untake
Hormones -Aldsterone

46. Hmmm…
Hyper and Hypo Natremia are the most
common electrolyte disturbances. Why do
you think that is?
It is most abundant in the EXTRACELLULAR FLUID and therefore more prone to fluctuation.

47. Hyponatremia Serum Na+ <135mEq/L
Results from excess of water or loss of Na+
Water shifts from ECF into cells
S/S: abd cramps, confusion, N/V, H/A, pitting edema over sternum
Tx: Diet/IV therapy/fluid restrictions
Causes
Poor IV therapy- IV therapy increased water in blood Na is diluted
CHF
Renal Failure
GI: vomiting diarrhea drainage
Skin: sweating burns
diuretic drugs TX
Diet- foods high in sodium
- IV solutions ordered if hypovolemia (low volume)
Fluid excess- osmotic diuretics ordered to promote excretion of water rather than sodium (mannitol)
Fluid restriction till Na returns to norm
Lop diueretics to to remove excess fluid
Assess: VS skin integrity, seizures, I & O/ monitor lytes

48. Lets think about … Hyponatremia
What are some medical conditions that may cause a dilutional hyponatremia? CHF Renal Failure SIADH ( Cancer, pituitary trauma ) Addisons Disease ( hypoaldosteronism & Na loss )
What are some conditions that might cause actual loss of sodium from the body? GI losses – nasogastric suctioning, vomiting, diarrhea Certain diuretic therapies
Permanent neurological damage can occur when serum Na levels fall below 110 mEq/L. Why? Hypotonic environment swells cells, increasing ICP – brain damage

49. Hypernatremia Serum Na+> 145mEq/L
Results from Na+ gained in excess of H2O OR Water is lost in excess of Na+
Water shifts from cells to ECF
S/S: thirst, dry mucous membranes & lips, oliguria, increased temp & pulse,flushed skin,confusion
Tx: IV therapy/diet
Causes- increased Na intake- rapid infusion of saline solution/po intake
loss of water – diarrhea/DM/decreased water intake/ impaired thirst center/can’t swallow
Fluid shift from ICF to ECF ….(Na pulls h2o out of cells, kidneys excrete Na and water follows)
Tx-if caused by fluid loss Need slow gradual return to normal Na+ by IV hypotonic solution 0.45%NS
Pt. Teaching avoid high Na foods, canned soups, processed foods, ketchup AVOID antacids high in sodium bicarb
I&O, review diet, meds,
Moniotr weight, note change LOC

50. Let’s think about…. Hypernatremia
What are some medical conditions that may cause elevated serum Na? Renal failure Diabetes Insipidus Diabetes Mellitus ( hyperglycemic dehydration) Cushings syndrome (hyperaldosteronism)
What are some other patient populations at risk for hypernatremia? Elderly ( decreased thirst mechanism ) Patient’s receiving: -tube feedings -corticosteroid drugs -certain diuretic therapies
Seizures, coma, death my result if hypernatremia is left untreated. Why? Cells loose fluid into the ECF causing irreversible cell damage.

51. Critical Thinking Hypo / Hyper Natremia
For the client experiencing
FVE & hyponatremia d/t
excessive intake of water,
which IV solution would you
expect the physician to
order?
D5NS NS
D5W
½ NS
For the client experiencing
FVD and hypernatremia
d/t excessive water loss,
which IV solution would
you expect the physician
to order?
D5 ½ NS
D5RL
D5W
½ NS

52. Potassium K+ 3.5-5.0 mEq/L Chief electrolyte of ICF
Major mineral in all cellular fluids
Aids in muscle contraction, nerve & electrical impulse conduction, regulates enzyme activity, regulates IC H20 content, assists in acid-base balance
Regulated by kidneys/ hormones
Inversely proportional to Na

53. Hypokalemia Serum level < 3.5mEq/L
Results from decreased intake, loss via GI/Renal & potassium depleting diuretics
Life threatening-all body systems affected
S/S muscle weakness & leg cramps, decreased GI motility, cardiac arrhythmias
Tx: diet/supplements/IV therapy
Effects skeletal/cardiac/smooth muscle
Causes:
Inadequate intake
Alcoholism/
Diuretics
Excessive Vomiting & diarrhea Tx
ID cause
High K diet, …oranges, broccoli, meat protein foods,banana, apricots
PO supplements common
IV therapy always diluted…

54. Lets think about … Hypokalemia
What are some medical conditions that may cause a hypokalemia? Renal Disease / CHF (dilutional) Metabolic Alkalosis
Cushings Disease ( Na retention leads to K loss )
What are some conditions that might cause actual loss of potassium from the body? GI losses – nasogastric suctioning, vomiting, diarrhea Certain diuretic therapies Inadequate intake – ( body cannot conserve K, need PO intake)
Cardiac arrest may occur when serum K levels fall below 2.5 mEq/L. Why? Increased cardiac muscle irritability leads to PACs and PVCs, then AF

55. Hyperkalemia Serum level >5 mEq/L
Results from excessive intake, trauma, crush injuries, burns, renal failure
S/S muscle weakness, cardiac changes, N/V, parathesias of face/fingers/tongue
Tx:diet/meds/IV therapy/ possible dialysis
…(false rise due to tight tourniquet or hemolized specimen) occurs
Poor elimination by kidneys
Parathesia -tingling
Tx-Depends on cause
Hold Kmeds, low K diet orderd
Kayexalate administered to increase excretion of K
IV therapy add volume to dilute K+
Monitor for fluid overload.

56. Lets think about … Hyperkalemia
What are some medical conditions that may cause hyperkalemia? Renal Disease=most common cause Burns and other major tissue trauma Metabolic Acidosis
Addison’s Disease ( Na loss leads to K retention )
What are some conditions that might cause potassium levels to rise in the body? Certain diuretic therapies Excessive intake – ( inappropriate supplements)
Cardiac arrest may occur when serum K levels rise above mEq/L. Why? Decreased electrical impulse conduction leads to bradycardia and eventual asystole.

57. Critical Thinking Potassium IV additives
Which of the following interventions will the
nurse undertake when administering
parenteral K additives?
Monitor the IV site for phlebitis
Place on cardiac monitor if > 10 mEq
Assure of adequate mixing of K in solution
Monitor for elevated K levels
Monitor for decreased Na levels
Administer potassium by slow IV push method
NEVER!!!

58. Calcium Ca++
mEq/L
Most abundant in body but: 99% in teeth and bones
Needed for nerve transmission, vitamin B12 absorption, muscle contraction & blood clotting
Inverse relationship with Phosphorus
Vitamin D needed for Ca absorption
mg/deciliter dL
Vit D needed for Ca absorption

59. Hypocalcemia Serum Ca < 4.3mEq/L
Results from low intake, loop diuretics, parathyroid disorders, renal failure
S/S osteomalacia, EKG changes, numbness/tingling in fingers, muscle cramps / tetany, seizures, Chovstek Sign & Trousseau Sign
Tx: diet/IV therapy
Common after thyroid surgery
Chovstek sign-Tap facial nerve in front of ear= facial spasm
Trousseau- carpal spasm after BP cuff inflated due to increased neuromuscular excitability
TX -Ca supplements…dietary. Dairy green veg, sardines salmon
If severe-IV calcium gluconate

60. Chovstek Trousseau

61. Lets think about … Hypocalcemia
What are some medical conditions that may cause hypocalcemia? Hypoparathyroidism (low PTH levels = decreased release of Ca from bones) S/P thryoid surgery ( low Calcitonin = decreased release of Ca from bones) Acute pancreatitis Crohns Disease Hyperphosphatemia ( ESRF)
What are some other conditions that might cause low Ca?
GI losses – nasogastric suctioning, vomiting, diarrhea Long term immobilization Lactose intolerance
If hypocalcemia is prolonged, the body will utilize stored Ca from bones. What complication might arise? Fractures ( late sign )

62. Hypercalcemia Serum Ca > 5.3mEq/L
Results from hyperparathyroidism, some cancers, prolonged immobilization
S/S muscle weakness, renal calculi, fatigue, altered LOC, decreased GI motility, cardiac changes
Tx: medication/ IV therapy
Remember it’s in the blood not the bones
Causes-high intake
TX-Depends on cause encourage mobility,immobilization causes demineralization of bones leading to fractures remove parathyroid tumors
encourage fluids to prevent renal calculi
Lower Ca by IV therapy causes diuresis encouraging kidney excretion
Calcium binding meds given to promote excretion of calcium.

63. Lets think about … Hypercalcemia
What are some medical conditions that may cause hypercalcemia? Hyperparathyroidism (high PTH levels = increased release of Ca from bones) Paget’s Disease Some Cancers – Multiple Myleoma Chronic Alcoholism ( with low serum phosphorus )
What are some other conditions that might cause low Ca?
Excessive intake of Ca OR Vitamin D Excessive intake of OTC antacids
If hypercalcemia is uncorrected, AV block and cardiac arrest may occur.

64. Magnesium Mg2+ 1.5-2.5mEq/L Most located within ICF
Needed for activating enzymes, electrical activity, metabolism of carbs/proteins, DNA synthesis
Regulated by intestinal absorption and kidney

65. Hypomagnesemia Serum < 1.5mEq/L
Results from decreased intake, prolonged NPO status, chronic alcoholism & nasogastric suctioning
S/S: muscle weakness, cardiac changes, mental changes, hyperactive reflexes & other hypocalcemia S/S.
Tx: replacement IV therapy restore normal Ca levels ( Mg mimics Ca) seizure precautions

66. Hypomagnesemia Common in critically ill patients
Associated with high mortality rates
Increases cardiac irritability and ventricular dysrhythmias - especially in patients with recent MI
Maintenance of adequate serum Mg has been shown to reduce mortality rates post MI

67. Hypermagnesemia Serum>2.5mEq/L
Results from renal failure, increased intake
S/S: flushing, lethargy, cardiac changes (decreased HR),decreased resp, loss of deep tendon reflexes
Tx: restrict intake diuretic rx
Flushing due to peripheral vasodilation
Resp. deep shallow and slow

68. Chloride Cl- 95-105mEq/L Most abundant anion in ECF
Combines with Na to form salts
Maintains water balance, acid-base balance, aids in digestion (hydrochoric acid) & osmotic pressure (with Na and H20)
Regulated by kidneys
Follows Sodium (Na)

69. Hypochloremia Serum level 96mEq/L
Results from prolonged vomiting & suctioning
S/S metabolic alkalosis, nerve excitability, muscle cramps, twitching, hypoventilation, decreased BP if severe
Tx: diet/IV therapy
Tx:
correct cause, diet increase Cl, vomiting reduce it, replacement thru IV therapy… can br given orally ie. Salty broth

70. Hyperchloremia Serum level > 106mEq/L
Results from excessive intake or retention by kidneys – metabolic acidosis
S/S Arrhythmias, decreased cardiac output, muscle weakness, LOC changes, Kussmauls’s respirations
Tx: restore fluid & electrolyte balance
Tx- treat underlying cause, VS, reorient if confused
Kussmals –rapid and deep without pauses above 20/min

71. Phosphate PO4-
mg/dl
Needed for acid-base balance,neurological & muscle function, energy transfer ATP & affects metabolism of carbs/proteins/lipids, B vitamin synthesis
Found in the bones
Regulated by intake and kidneys
Inversely proportional to Calcium Therefore some regulation by PTH as well

72. Hypophosphatemia Serum level < 1.8mEq/L
Results from decreased intestinal absorption and increased excretion
S/S bone & muscle pain, mental changes, chest pain, resp. failure
Tx: Diet/ IV therapy
Tx- vs,
assess resp, neuro status
IV meds safety

73. Hyperphosphatemia Serum level> 2.6mEq/L
Results from renal failure, low intake of calcium
S/S: neuromuscular changes (tetany), EKG changes, parathesia-fingertips/mouth
Tx: Diet; hypocalcemic interventions Medications: phosphate binding
The body can tolerate hyperphosphatemia fairly well BUT the accompanying hypocalcemia is a larger problem!
Tx: Correct the under lying cause..renal failure, diet, decreased absorption, Iv fluids, vs
Diet limit foods

74. Critical Thinking - NCLEX
The nurse is caring for a client with renal failure whose magnesium level is 3.6 mg/dL. Which of the following signs would the nurse most likely expect to note in the client based on this Mg level?
Twitching
Hyperactive reflexes
Irritability
Loss of deep tendon reflexes

75. Electrolyte homeostasis
This means to maintain balance… to control by balancing the dietary intake of electrolytes with the renal excretion and reabsorption of electrolytes

76. Interventions for F/E balance
Assess patient carefully- note changes
Monitor I & O (Intake & Output)
Monitor weight changes
Monitor urine
Monitor vs
Monitor lab results and dx test
Maintain proper IV therapy
Note changes- significant factor

77. Summary Fluid compartments in the body must balance
Body systems regulate F&E balance
Assessment of body fluid is important to determine causes of imbalance
Interventions for imbalances are based on the cause