Presentation is loading. Please wait.

Presentation is loading. Please wait.

Fluid & Electrolyte Imbalance N132. Fluid Imbalance.

Similar presentations


Presentation on theme: "Fluid & Electrolyte Imbalance N132. Fluid Imbalance."— Presentation transcript:

1 Fluid & Electrolyte Imbalance N132

2 Fluid Imbalance

3 Fluid Volume Deficit (Hypovolemia, Isotonic Dehydration) Common Causes – Hemorrhage – Vomiting – Diarrhea – Burns – Diuretic therapy – Fever – Impaired thirst

4 Clinical Manifestations Signs/Symptoms – Weight loss – Thirst – Orthostatic changes in pulse rate and bp – Weak, rapid pulse – Decreased urine output – Dry mucous membranes – Poor skin turgor

5 Treatment/Interventions (FVD) Fluid Management – Diet therapy – Mild to moderate dehydration. Correct with oral fluid replacement. – Oral rehydration therapy – Solutions containing glucose and electrolytes. E.g., Pedialyte, Rehydralyte. – IV therapy – Type of fluid ordered depends on the type of dehydration and the clients cardiovascular status.

6

7 Nursing Implications Monitor postural heart rate and bp when getting patients out of bed

8 Fluid Volume Excess Common Causes: – Congestive Heart Failure – Early renal failure – IV therapy – Excessive sodium ingestion – SIADH – Corticosteroid

9 Clinical Manifestations Signs/Symptoms – Increased BP – Bounding pulse – Venous distention – Pulmonary edema Dyspnea Orthopnea (diff. breathing when supine) crackles

10 Treatment/Interventions (FVE) Drug therapy – Diuretics may be ordered if renal failure is not the cause. Restriction of sodium and saline intake I/O Weight

11 More to consider? Age – Infants – Older adults Prior medical history – Acute illness – Chronic illness – Environmental factors – Diet – Lifestyle – Medications

12 Physical Assessment – Body systems – I/O – Weight – Labs

13 Electrolyte Imbalance

14 Hypokalemia (<3.5mEq/L) Pathophysiology – – Decrease in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli

15 Hypokalemia (<3.5mEq/L) Contributing factors: – Diuretics – Shift into cells – Digitalis – Water intoxication – Corticosteroids – Diarrhea – Vomiting

16

17 Hypokalemia (<3.5mEq/L) Interventions – Assess and identify those at risk – Encourage potassium-rich foods – K+ replacement (IV or PO) – Monitor lab values – D/c potassium-wasting diuretics – Treat underlying cause

18 Hyperkalemia (>5.0mEq/L) Pathophysiology – An inc. in K+ causes increased excitability of cells.

19 Hyperkalemia (>5.0mEq/L) Contributing factors: – Increase in K+ intake – Renal failure – K+ sparing diuretics – Shift of K+ out of the cells

20

21 Hyperkalemia (>5.0mEq/L) Interventions – Need to restore normal K+ balance: – Eliminate K+ administration – Inc. K+ excretion Lasix Kayexalate (Polystyrene sulfonate) – Infuse glucose and insulin – Cardiac Monitoring

22 Hyponatremia (<135mEq/L) Contributing Factors – Excessive diaphoresis – Wound Drainage – NPO – CHF – Low salt diet – Renal Disease – Diuretics

23 Hyponatremia (<135mEq/L) Assessment findings: – Neuro - Generalized skeletal muscle weakness. Headache / personality changes. – Resp.- Shallow respirations – CV - Cardiac changes depend on fluid volume – GI – Increased GI motility, Nausea, Diarrhea (explosive) – GU - Increased urine output

24 Hyponatremia (<135mEq/L) Interventions/Treatment – Restore Na levels to normal and prevent further decreases in Na. – Drug Therapy – (FVD) - IV therapy to restore both fluid and Na. If severe may see 2-3% saline. (FVE) – Administer osmotic diuretic (Mannitol) to excrete the water rather than the sodium. – Increase oral sodium intake and restrict oral fluid intake.

25 Hypernatremia (>145mEq/L) Contributing Factors – Hyperaldosteronism – Renal failure – Corticosteroids – Increase in oral Na intake – Na containing IV fluids – Decreased urine output with increased urine concentration

26 Hypernatremia (>145mEq/L) Contributing factors (cont’d): – Diarrhea – Dehydration – Fever – Hyperventilation

27 Hypernatremia (>145mEq/L) Assessment findings: – Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes – Resp. – Pulmonary edema – CV – Diminished CO. HR and BP depend on vascular volume.

28 Hypernatremia (>145mEq/L) GU – Dec. urine output. Inc. specific gravity Skin – Dry, flaky skin. Edema r/t fluid volume changes.

29 Hypernatremia (>145mEq/L) Interventions/Treatment – Drug therapy (FVD).45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics. – Diet therapy Mild – Ensure water intake

30 Hypocalcemia (<9.0mg/dL) Contributing factors: – Dec. oral intake – Lactose intolerance – Dec. Vitamin D intake – End stage renal disease – Diarrhea

31 Hypocalcemia (<9.0mg/dL) Contributing factors (cont’d): Acute pancreatitis Hyperphosphatemia Immobility Removal or destruction of parathyroid gland

32 Hypocalcemia (<9.0mg/dL) Assessment findings: – Neuro –Irritable muscle twitches. Positive Trousseau’s sign. Positive Chvostek’s sign. – Resp. – Resp. failure d/t muscle tetany. – CV – Dec. HR., dec. BP, diminished peripheral pulses – GI – Inc. motility. Inc. BS. Diarrhea

33 Positive Trousseau’s Sign

34 Positive Chvostek’s Sign

35 Hypocalcemia (<9.0mg/dL) Interventions/Treatment – Drug Therapy Calcium supplements Vitamin D – Diet Therapy High calcium diet – Prevention of Injury Seizure precautions

36 Hypercalcemia (>10.5mg/dL) Contributing factors: – Excessive calcium intake – Excessive vitamin D intake – Renal failure – Hyperparathyroidism – Malignancy – Hyperthyroidism

37 Hypercalcemia (>10.5mg/dL) Assessment findings: – Neuro – Disorientation, lethargy, coma, profound muscle weakness – Resp. – Ineffective resp. movement – CV - Inc. HR, Inc. BP., Bounding peripheral pulses, Positive Homan’s sign. Late Phase – Bradycardia, Cardiac arrest – GI – Dec. motility. Dec. BS. Constipation – GU – Inc. urine output. Formation of renal calculi

38 Hypercalcemia (>10.5mg/dL) Interventions/Treatment – Eliminate calcium administration – Drug Therapy – Isotonic NaCL (Inc. the excretion of Ca) – Diuretics – Calcium reabsorption inhibitors (Phosphorus) – Cardiac Monitoring

39 Hypophosphatemia (<2.5mg/L) Contributing Factors: – Malnutrition – Starvation – Hypercalcemia – Renal failure – Uncontrolled DM

40 Hypophosphatemia (<2.5mg/L) Assessment findings: (Chart 13-7) Neuro – Irritability, confusion CV – Dec. contractility Resp. – Shallow respirations Musculoskeletal - Rhabdomyolysis Hematologic – Inc. bleeding Dec. platelet aggregation

41 Hypophosphatemia (<2.5mg/L) Interventions – Treat underlying cause – Oral replacement with vit. D – IV phosphorus (Severe) – Diet therapy Foods high in oral phosphate

42 Hyperphosphatemia (>4.5mg/L) Causes few direct problems with body function. Care is directed to hypocalcemia. Rarely occurs

43 Hypomagnesemia (<1.4mEq/L) Contributing factors: – Malnutrition – Starvation – Diuretics – Aminoglcoside antibiotics – Hyperglycemia – Insulin administration

44 Hypomagnesemia (<1.4mEq/L) Assessment findings: *Neuro - Positive Trousseau’s sign. Positive Chvostek’s sign. Hyperreflexia. Seizures *CV – ECG changes. Dysrhythmias. HTN *Resp. – Shallow resp. *GI – Dec. motility. Anorexia. Nausea

45 Hypomagnesemia (<1.4mEq/L) Interventions: – Eliminate contributing drugs – IV MgSO4 – Assess DTR’s hourly with MgSO4 – Diet Therapy

46 Hypermagnesemia (>2.0mEq/L) Contributing factors: – Increased Mag intake – Decreased renal excretion

47 Hypermagnesemia (>2.0mEq/L) Assessment findings: Neuro – Reduced or weak DTR’s. Weak voluntary muscle contractions. Drowsy to the point of lethargy CV – Bradycardia, peripheral vasodilatation, hypotension. ECG changes.

48 Hypermagnesemia (>2.0mg/dL) Interventions – Eliminate contributing drugs – Administer diuretic – Calcium gluconate reverses cardiac effects – Diet restrictions


Download ppt "Fluid & Electrolyte Imbalance N132. Fluid Imbalance."

Similar presentations


Ads by Google