1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 33 Fluids and Electrolytes

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Fluid compartments –Intracellular Within cell –Extracellular Within blood vessels –Interstitial Between cells Fluid that surrounds cells (continued)

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Fluid compartments –Movement of molecules Solute –Substance dissolved in solution Solvent –Liquid that contains substance in solution (continued)

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Fluid compartments –Movement of molecules Permeability –Capability of substance, molecule, or ion to diffuse through membrane Semipermeable –Selectively permeable (continued)

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Body water distribution –45 to 75 percent of total weight –Fat Free of water –Replenish through ingestion Electrolytes (continued)

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Movement of body fluids –Physiological forces –Transportation of water, foods, gases, wastes, and ions –Maintains balance between extracellular and intracellular fluid volumes (continued)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Regulators of fluid balance –Fluid and food intake and loss –Skin –Lungs –Gastrointestinal tract –Kidneys (continued)

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Acid-base balance –Homeostasis of hydrogen ion concentration in body fluids Acid –Donates hydrogen ions Base –Accepts hydrogen ions (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Fluid and Acid- Base Balance Regulators of acid-base balance –Buffer systems –Respiratory regulation of acid-base balance –Renal control of hydrogen ion concentration

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Fluid and Electrolyte Balance Age Lifestyle

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrolyte Disturbances Sodium –Hyponatremia Sodium deficit –Hypernatremia Sodium excess (continued)

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrolyte Disturbances Potassium –Hypokalemia Potassium deficit –Hyperkalemia Potassium excess (continued)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrolyte Disturbances Calcium –Hypocalcemia Calcium deficit –Hypercalcemia Calcium excess (continued)

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrolyte Disturbances Magnesium –Hypomagnesemia Magnesium deficit –Hypermagnesemia Magnesium excess (continued)

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrolyte Disturbances Phosphate –Hypophosphatemia Phosphorous deficit –Hyperphosphatemia Phosphorous excess (continued)

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Electrolyte Disturbances Chloride –Hypochloremia Chloride deficit –Hyperchloremia Chloride excess

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Acid-Base Disturbances Laboratory data –ABGs Oxygen Carbon dioxide pH Bicarbonate ion (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Acid-Base Disturbances Laboratory data –ABGs Sodium Potassium Chloride (continued)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Acid-Base Disturbances Respiratory alkalosis –Carbonic acid deficit Respiratory acidosis –Carbonic acid excess (continued)

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Acid-Base Disturbances Metabolic acidosis –Bicarbonate deficit Metabolic alkalosis –Bicarbonate excess

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Assessment –Health history Lifestyle Diet Religion Weight changes Fluid output (continued)

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Assessment –Health history Gastrointestinal disturbances Fever Wounds Disease Special therapies (continued)

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Assessment –Physical exam Daily weight Vital signs Intake and output Edema Skin turgor (continued)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Assessment –Physical exam Oral cavity Eyes Jugular and hand veins Neuromuscular system (continued)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Assessment –Diagnostic and laboratory data Hemoglobin and hematocrit Osmolality Urine pH Serum albumin (continued)

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Diagnosis –Excess fluid volume –Deficient fluid volume –Risk for deficient fluid volume (continued)

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Diagnosis –Other nursing diagnoses: Impaired gas exchange Decreased cardiac output Risk for infection Impaired oral mucous membrane Deficient knowledge (continued)

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Planning and outcome identification –NOC for fluid and electrolytes: Nutritional status –Food and fluid intake Electrolyte and acid-base balance Fluid balance Fluid overload severity Hydration (continued)

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Planning and outcome identification –Collaboration (continued)

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Implementation –Monitor daily weight –Measure vital signs –Measure intake and output –Provide oral hygiene (continued)

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Implementation –Initiate oral fluid therapy NPO Restricted fluids Forced fluids –Maintain tube feeding (continued)

32. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Implementation –Monitor intravenous therapy Parenteral fluids Equipment Administration set Preparation of intravenous solution Initiation of intravenous therapy (continued)

33. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Implementation –Monitor intravenous therapy Administration of intravenous therapy Flushing Regulation of intravenous flow rate Calculation of flow rate Flow-control devices (continued)

34. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Implementation –Manage intravenous therapy Hypervolemia Infiltration Phlebitis Intravenous dressing change –Discontinue intravenous therapy (continued)

35. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Implementation –Transfuse blood Whole blood and blood products Administration of whole blood or blood component Safety measures (continued)

36. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Implementation –Employ complementary therapy Traditional Chinese medicine –Food –Plants –Herbs (continued)

37. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluids, Electrolytes, and the Nursing Process Evaluation –Ongoing process Client’s responses Vital signs Fluids Output Intravenous site –Necessary changes