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

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

3. Important: Avoid dehydration
Causes: Nausea, vomiting, GI suctioning, medications(diuretics) Kidney disease, not drinking enough (elderly/new 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

4. 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?

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

6. 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)

7. 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)

8. 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)

9. 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)

10. 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)

11. 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