1. Chapter 37 Fluid, Electrolyte, and Acid-Base Balance
Fundamentals of Nursing: Standards & Practices, 2E
Chapter 37
Fluid, Electrolyte, and Acid-Base Balance

2. Physiology of Fluid and Acid-Base Balance
Fluid Compartments
Cells, blood vessels and tissue space contain the body’s fluid
Terms used to described compartmentalized body fluid are
Intracellular fluid: within the cell
Extracellular fluid: within the blood vessels
Interstitial fluid: between cells; fluid that surrounds cells
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Terms used to describe movement of molecules in body fluids are
Solute: substance dissolved in a solution
Solvent: liquid that contains a substance in solution
Permeability: capability of a substance, molecule, or ion to diffuse through a membrane (covering of tissue over a surface, organ, or separating spaces)
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Semipermeable: selectively permeable (all membranes in the body allow some solutes to pass through the membrane without restriction but will prevent the passage of other solutes)
Permeable membranes allow fluid and solutes to pass into and out of the cell.
Blood vessels have permeable membranes that bathe and feed the cells.
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Body Fluid Distribution
Water represents 45% to 75% of the body’s total weight.
Body fat is essentially free of water, making the ratio of water to body weight greater in leaner people than in obese people.
Ingesting liquids and food products replenishes body fluid.
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Electrolytes
An electrolyte is a compound that, when dissolved in water or another solvent, forms or dissociates into ions.
Review Table 37-1 regarding distribution of electrolytes in body fluids.
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7. Movement of Body Fluids
Physiological forces transport molecules of water, foods, gases, wastes, and ions to maintain a balance between extracellular and intracellular fluid volumes.
Review Table 37-2 regarding movement of body fluids.
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Regulators of Fluid Balance
Fluid and Food Intake and Loss
Skin
Lungs
Gastrointestinal Tract
Kidneys
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Acid-Base Balance
Acid-base balance refers to the homeostasis of the hydrogen ion concentration in body fluids.
Acid is a substance that donates hydrogen ions.
Base is a substance that accepts hydrogen ions.
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Regulators of Acid-Base Balance
Buffer Systems
Respiratory Regulation of Acid-Base Balance
Renal Control of Hydrogen Ion Concentration
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11. Factors Affecting Fluid and Electrolyte Balance
Age
Lifestyle
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12. Disturbances in Electrolyte and Acid-Base Balance
Electrolyte Disturbances
Sodium
Hyponatremia is a deficit in the extracellular level of sodium.
Hypernatremia is an excess in the extrcellular level of sodium.
Potassium
Hypokalemia is a decrease in the extracellular level of potassium.
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Hyperkalemia is an increase in the extracellular level of potassium.
Calcium
Hypocalcemia is a decrease in the extracellular level of calcium.
Hypercalcemia is an increase in the extracellular level of calcium.
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Magnesium
Hypomagnesemia is a decrease in the extracellular level of magnesium and usually occurs with hypokalemia and hypocalcemia.
Hypermagnesemia refers to an increase in the extracellular level of magnesium.
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Phosphate
Hypophosphatemia is a decreased extracellular level of phosphorus.
Hyperphosphatemia is an increased extracellular level of phosphorus.
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Chloride
Hypochloremia is a decrease in the extracellular level of chloride.
Hyperchloremia is an increase in the extracellular level of chloride.
Review Table 37-3 The Clinical Management of Clients Experiencing Common Electrolyte Disturbances.
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Acid-Base Disturbances
Laboratory Data
Respiratory Acidosis (Carbonic Acid Excess)
Respiratory Alkalosis (Carbonic Acid Deficit)
Metabolic Acidosis (Bicarbonate Deficit)
Metabloc Alkalosis (Bicarbonate Excess)
Review Table 37-4 Respiratory and Metabolic Acidosis and Alkalosis
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Assessment
Health History
Physical Examination
Daily Weight
Vital Signs
Intake and Output
Edema
Skin Tugor
Buccal (Oral) Cavity
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Eyes
Jugular and Hand Veins
Neuromuscular System
Diagnostic and Laboratory Data
Hemoglobin and Hematocrit Indices
Osmolality
Urine pH
Serum Albumin
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Nursing Diagnosis
Excess Fluid Volume
Deficient Fluid Volume
Risk for Deficient Fluid Volume
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Other Nursing Diagnosis
Impaired Gas Exchange
Decreased Cardiac Output
Risk for Infection
Altered Oral Mucous Membrane
Deficient Knowledge
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22. Outcome Identification and Planning
Expected outcomes for clients with fluid imbalances are not only specific to their primary diagnosis, but also require inclusion of outcomes relative to interventions.
Achievement of the goals and the client’s expected outcomes indicates resolution of the problem.
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Implementation
Monitor Daily Weight
Measure Vital Signs
Measure Intake and Output
Provide Oral Hygiene
Review Procedure 37-1 on measuring intake and output
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Oral Fluid Therapy
Nothing by Mouth
Restricted Fluids
Forced Fluids
Maintain Tube Feeding
Monitor Intravenous Therapy
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Monitor Intravenous Therapy
Parenteral Fluids
Equipment
Review Table 37-5 on common intravenous solutions
Preparing an Intravenous Solution.
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Review Procedure 37-2 on preparing an intravenous solution.
Initiating IV Therapy
Administering IV Therapy
Review Procedure 37-3 on administering an IV solution.
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Managing IV Therapy
Review Procedure 37-4 on managing IV therapy and dressing change.
Blood Transfusion
Review Procedure 37-5 on administering a blood transfusion.
Complementary Therapy
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Evaluation
Evaluation is an ongoing process for clients with fluid, electrolyte, and acid-base imbalances.
Nurse should focus on the client’s responses when evaluating whether timeframes and expected outcomes are realistic.
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