Fluid and Electrolytes It’s all about balance…..

Brief Overview Osmosis- lower to higher concentrate Diffusion-higher to lower concentrate You want homeostasis: a stable internal fluid environment. Brief Overview

Important: Avoid dehydration Causes: Nausea, vomiting, GI suctioning, medications(diuretics) Kidney disease, not drinking enough (elderly/new babies @ high risk) What will I see? Thirst(maybe- this is a late sign and elderly thirst mechanism impaired) dry skin, concentrated urine , sticky, dry mucous membranes, confusion, fatigue, dizziness(postural hypotension),tachycardia(rapid pulse) Important: Avoid dehydration

One of the most basic indicators of dehydration is the BMP(basic metabolic panel) See example- called a fishbone- one for BMP and one for important CBC results(complete blood count) Need to know “ballpark” values- each facility uses own range but within a few points or so… What do I need to know?

Most Common Imbalances High/ Low Sodium(NA) High/Low Potassium (K+) High BUN/cr (blood urea nitrogen & creatinine) Most Common Imbalances

Hypernatremia(high sodium) Causes: Medications(diuretics), low H20 intake or excessive water loss What will I see? Restlessness, irritability, decreased u/o(urinary output),low grade temp, facial flushing, edema What will I do as a nurse? Decreased NA intake, diuretics, increase water intake, monitor I&O (intake &output) Hypernatremia(high sodium)

Hyponatremia (Low Sodium) Causes: too much water intake, severe N/V/D (nausea,vomiting,diarrhea) What will I see? Headaches, seizure activity, loss of appetite, weak, low B/P What will I do as a nurse? What will I do as a nurse? Fluid restriction of free water, I&O(intake/output), monitor for seizure activity, NA tablets or extra salt to meals. Hyponatremia (Low Sodium)

Hyperkalemia (High Potassium) Causes: ESRD(end stage renal disease), DM(Diabetes), dehydration What will I see? EKG abnormalities, N/V/D, minimal urinary output, numbness, SOB(shortness of breath) CP (chest pain) What will I do as a nurse? Low K+ diet(refer to dietician) diuretics, or Kayexlate which is a liquid which binds the K+ for bowel excretion- will give them copious loose stools Hyperkalemia (High Potassium)

Hypokalemia (Low potassium) Causes: diuretics, excessive N/V/D What will I see? Lethargy, anorexia, weak, muscle cramps What will I do as a nurse? Oral or IV replacement of K+, high K+ foods Hypokalemia (Low potassium)

Elevated BUN/Cr (blood urea nitrogen, creatinine) Causes: High protein diet, kidney disease, dehydration,CHF (Congestive heart failure) What will I see? Elevated B/P, edema, fatigue, decreased u/o What will I do as a nurse? Monitor labs, I&O, VS (vital signs), education re: the condition causing the elevation Elevated BUN/Cr (blood urea nitrogen, creatinine)

Nursing Diagnosis examples Risk for electrolyte imbalance Excess fluid volume Deficient fluid volume Risk for imbalanced fluid volume Risk for deficient fluid volume …these are but a few- need to make sure it is patient centered Nursing Diagnosis examples