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Nursing Care of Clients with Altered Fluid, Electrolyte, and

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Presentation on theme: "Nursing Care of Clients with Altered Fluid, Electrolyte, and"— Presentation transcript:

1 Nursing Care of Clients with Altered Fluid, Electrolyte, and Acid–Base Balance

2 Fluid and Electrolyte Balance
Necessary for life, homeostasis Nursing role: help prevent, treat fluid, electrolyte disturbances

3 Fluid Approximately 60% of typical adult is fluid Intracellular fluid
Varies with age, body size, gender Intracellular fluid Extracellular fluid Intravascular Interstitial Transcellular “Third spacing”: loss of ECF into space that does not contribute to equilibrium

4 Electrolytes Active chemicals that carry positive (cations), negative (anions) electrical charges Major cations: sodium, potassium, calcium, magnesium, hydrogen ions Major anions: chloride, bicarbonate, phosphate, sulfate, and proteinate ions Electrolyte concentrations differ in fluid compartments

5 Regulation of Fluid Movement of fluid through capillary walls depends on Hydrostatic pressure: exerted on walls of blood vessels Osmotic pressure: exerted by protein in plasma Direction of fluid movement depends on differences of hydrostatic, osmotic pressure

6 Regulation of Fluid Osmosis: area of low solute concentration to area of high solute concentration Diffusion: solutes move from area of higher concentration to one of lower concentration Filtration: movement of water, solutes occurs from area of high hydrostatic pressure to area of low hydrostatic pressure Active transport: physiologic pump that moves fluid from area of lower concentration of one of higher concentration

7 Active Transport Physiologic pump that moves fluid from area of lower concentration to one of higher concentration Movement against concentration gradient Sodium-potassium pump: maintains higher concentration of extracellular sodium, intracellular potassium Requires adenosine (ATP) for energy

8 Fluids Animation

9 Fluid Volume or Electrolyte Imbalance
Causes of fluid loss Vomiting, diarrhea Gastrointestinal suctioning, intestinal fistulas, and intestinal drainage Diuretic therapy, renal disorders, endocrine disorders Sweating from excessive exercise, increased environmental temperature Hemorrhage Chronic abuse of laxatives

10 Fluid Volume or Electrolyte Imbalance
Cause of Fluid Loss in the Older Adult Self limiting fluids (fear of incontinence) Physical disabilities Cognitive impairments Older adults without air conditioning



13 Fluid Volume Imbalances
Fluid volume deficit (FVD): hypovolemia Fluid volume excess (FVE): hypervolemia

14 Fluid Volume Deficit Loss of extracellular fluid exceeds intake ratio of water Electrolytes lost in same proportion as they exist in normal body fluids Dehydration: loss of water along with increased serum sodium level May occur in combination with other imbalances

15 Fluid Volume Deficit (cont’d)
Dehydration Causes: fluid loss from vomiting, diarrhea, GI suctioning, sweating, decreased intake, inability to gain access to fluid Risk factors: diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, third space shifts

16 Fluid Volume Deficit (cont’d)
Manifestations: rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural hypotension, rapid weak pulse, increased temperature, cool clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness, cramps Laboratory data: elevated BUN in relation to serum creatinine, increased hematocrit Serum electrolyte changes may occur


18 Fluid Volume or Electrolyte Imbalance
Treatment for Fluid Volume Deficit (FVD) Oral, intravenous, or enteral routes Manage the effects and prevent further complications by monitoring intake, assessing lab values, and observing vital signs and skin integrity

19 Fluid Volume Deficit - Nursing Management
I&O, VS Monitor for symptoms: skin and tongue turgor, mucosa, UO, mental status Measures to minimize fluid loss Oral care Administration of oral fluids Administration of parenteral fluids

20 Fluid Volume Excess Due to fluid overload or diminished homeostatic mechanisms Risk factors: heart failure, renal failure, cirrhosis of liver Contributing factors: excessive dietary sodium or sodium-containing IV solutions Manifestations: edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased BP, pulse pressure and CVP, increased weight, increased UO, shortness of breath and wheezing Medical management: directed at cause, restriction of fluids and sodium, administration of diuretics

21 Fluid Volume Excess - Nursing Management
I&O and daily weights; assess lung sounds, edema, other symptoms; monitor responses to medications- diuretics Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions Monitor, avoid sources of excessive sodium, including medications Promote rest Semi-Fowler’s position for orthopnea Skin care, positioning/turning

22 Manifestations of Imbalances
Hyponatremia Muscle cramps, weakness, fatigue Dulled sensorium, irritability, personality changes Hypernatremia Most serious effects are seen in the brain Lethargy, weakness, irritability can progress to seizures, coma, and death

23 Manifestations of Imbalances
Hypokalemia EKG changes (flattened or inverted T waves) Skeletal muscle weakness Hyperkalemia Cardiac arrest Paresthesias Abdominal cramping

24 Manifestations of Imbalances
Hypocalcemia Tetany, paresthesias, muscle spasms Hypotension Anxiety, confusion, psychosis Hypercalcemia Muscle weakness, fatigue Personality changes Anorexia, nausea, vomiting

25 Manifestations of Imbalances
Hypomagnesemia Muscle weakness and tremors Dysphasia Tachycardia hypertension Mood and personality changes Hypermagnesemia Depressed deep tendon reflexes Hypotension Respiratory depression

26 Manifestations of Imbalances
Hypophosphatemia Muscle pain and tenderness Muscle weakness and paresthesias Confusion Manifestations of hypophosphatemia Muscle spasms, tetany Soft tissue calcifications

27 Maintaining Acid-Base Balance
Normal plasma pH : hydrogen ion concentration Major extracellular fluid buffer system; bicarbonate-carbonic acid buffer system Kidneys regulate bicarbonate in ECF Lungs under control of medulla regulate CO2, carbonic acid in ECF

Plasma pH is an indicator of hydrogen ion (H+) concentration. Normal range pH (7.35–7.45). Buffer systems Kidneys Lungs The H+ concentration is extremely important: Increased concentration H+ Increased acidity Lower the pH. Deceased H+ concentration Increased alkalinity Higher the pH. pH range compatible with life (6.8–7.8)

29 Acid-Base Disorders Acidosis: hydrogen ion concentration above normal (pH below 7.35) Alkalosis: hydrogen ion concentration below normal (pH above 7.45) Metabolic Acidosis: bicarbonate is decreased in relation to the amount of acid

30 Acid-Base Disorders Metabolic Alkalosis: excess of bicarbonate in relation to the amount of hydrogen ion Respiratory Acidosis: CO2 is retained, caused by sudden failure of ventilation due to chest trauma, aspiration of foreign body, acute pneumonia, and overdose of narcotics or sedatives Respiratory Alkalosis: CO2 is blown off, caused by mechanical ventilation and anxiety with hyperventilation

31 Arterial Blood Gases pH 7.35 - (7.4) - 7.45 PaCO2 35 - (40) - 45 mm Hg
HCO3ˉ 22 - (24) - 26 mEq/L Assumed average values for ABG interpretation PaO2 80 to 100 mm Hg Oxygen saturation >94% Base excess/deficit ±2 mEq/L

DISORDER INITIAL EVENT COMPENSATION Respiratory acidosis ↑ PaCO2, ↑ or normal Kidneys eliminate H and HCO3 −, ↓ pH retain HCO3− Respiratory alkalosis ↓ PaCO2, ↓ or normal Kidneys conserve H+ and HCO3−, ↑ pH excrete HCO3− Metabolic acidosis ↓ or normal PaCO2, Lungs eliminate CO2, ↓ HCO3−, ↓ pH conserve HCO3− Metabolic alkalosis ↑ or normal PaCO2, Lungs ↓ ventilation to↑ ↑ HCO3−, ↑ pH PCO2, kidneys conserve H+ to excrete HCO3−

33 IV Site Selection

34 Complications of IV Therapy
Fluid overload Air embolism Septicemia, other infections Infiltration, extravasation Phlebitis Thrombophlebitis Hematoma Clotting, obstruction

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