Fluid, electrolyte, and acid- base balance. pptx II

intErnational University Of the caRIbbeaN FLUID, ELECTROLYTE AND ACID-BASE BALANCE :

intErnational University Of the caRIbbeaN FLUID, ELECTROLYTE AND ACID-BASE BALANCE PRESENTED BY SOPHIA CAIN-BETTON RN, CCRN, BSN, MSN March 17, 2011

Objectives:

Objectives At the end of the session students will be able to : Describe the various fluid compartments of the body Describe the sources of water Explain how fluids move between fluid compartments in the body Describe the regulatory mechanisms of fluids and electrolytes in the body. Describe the role of buffers, the lungs, and the kidneys in regulating and maintaining acid-base balance in the body. Identify the causes of common acid-base and electrolyte imbalances and their manifestations. March 17, 2011

Objectives:

Objectives Interpret acid-base and electrolyte imbalances from given scenarios. Formulate nursing diagnoses related to fluid, electrolyte, and acid-base imbalances. Describe the nursing management of a client with fluid and electrolyte imbalance. March 17 2011

Introduction :

Introduction The adult body constitute between 55% and 60% of total body mass in females and males respectively. In good health a delicate balance of fluids is maintained in the body. This balance, or physiologic homeostasis, depends on multiple physiologic processes that regulate fluid intake and output and the movement of water and electrolytes between the body compartments. July 8, 2010

Fluid Compartments:

Fluid Compartments Body fluids are present in two main compartments inside cells and outside cells Intracellular fluid (ICF) or cytosol- the fluid within the cell Extracellular fluid (ECF)-the fluid outside the cell and include all other body fluids. ECF is divided into interstitial fluid ( occupies the microscopic spaces between tissue cells) and plasma (the liquid portion of blood) July 8, 2010

Fluid Compartments:

Fluid Compartments 80 % of ECF is intestinal fluid, while 20 % of ECF is plasma Other extracellular fluid group as interstitial fluid include lymph in lymphatic vessels, cerebrospinal fluid in the nervous system; Synovial fluid in joints; acqueous humor and vitreous body in the eyes ; endolymph and perilymph in the ears; and pleural, pericardial, and peritoneal fluids between serous membranes July 8, 2010

fluid and electrolyte Regulatory mechanisms :

fluid and electrolyte Regulatory mechanisms March 17, 2011

Regulatory mechanisms for fluids:

Regulatory mechanisms for fluids Thirst center in the brain - antidiuretic hormone (ADH) Kidneys Renin - Angiotensin-Aldosterone System Atria Natriuretic Factor (ANF) March 17 2011

Regulatory mechanisms for electrolytes:

Regulatory mechanisms for electrolytes Sodium (NA + ) : Renal reabsorption or excretion Aldosterone increases NA + reabsorption in the collecting ducts of the nephron . Potassium (K + ): Renal excretion and conservation. Aldosterone increases K + excretion Insulin helps move K + into cells tissue damage and acidosis shifts K + out of cells into ECF. March 17, 2011

Regulatory mechanisms for electrolytes:

Regulatory mechanisms for electrolytes Chloride ( Cl - ) is excreted and reabsorbed along with sodium in the kidneys. Aldosterone increases chloride reabsorption with sodium. Bicarbonate (HCO 4 - ) excretion and reabsorption is done by the kidneys. Regeneration occurs also by the kidneys. March 17, 2011

Regulatory mechanisms for acid-base balance :

Regulatory mechanisms for acid-base balance Body fluids are maintained within a narrow range that is slightly alkaline. The normal pH is 7.35-7.45 Buffers bicarbonate (HCO 3 - ) carbonic acid (H 2 CO 3 ) March 17, 2011

Regulatory mechanisms for acid-base balance :

Regulatory mechanisms for acid-base balance Lungs carbon dioxide (CO 2 ) Kidneys Bicarbonate Hydrogen ions March 17,, 2011

Acid-base imbalances:

Acid-base imbalances March 17, 2011

Normal values for ABG:

Normal values for ABG PaO 2 80 -100 mmHg Sao 2 95-100 mmHg pH 7.35-7.45 PaCO 2 35-45 mmHg HCO 3 22-26 mEq /L March 17, 2011

Acid-base Imbalances:

Acid-base Imbalances Condition Possible Causes Manifestations Respiratory Acidosis PaCO2 > 45 mmHg pH < 7.35 CNS depression Head trauma Over sedation Anaesthesia Pneumothorax Hypovolemia Bronchial obstruction Increased pulse & respiratory rate Restlessness Headache, dizziness Confusion, decreased levels of consciousness Dyspnea March 17, 2011

Acid-base Imbalances:

Acid-base Imbalances Condition Possible Causes Manifestations Respiratory Alkalosis PaCO2 < 35 mmHg pH > 7.45 Anxiety and nervousness Fear Hyperventilation Pain Fever Hypoxia overventilation SOB, chest tightness Palpitations Sweating Light-headedness Decreased concentration March 17, 2011

Acid-base Imbalances:

Acid-base Imbalances Condition Possible Causes Manifestations Metabolic Acidosis HCO3 < 22 mEq /L pH < 7.35 Increased acids Renal failure Ketoacidosis Starvation Loss of base Diarrhoea Intestinal fistula Lethargy, confusion Headache Restlessness Nausea & vomiting Kussmaul respiration March 17, 2011

Acid-base Imbalances:

Acid-base Imbalances Condition Possible Causes Manifestations Metabolic Alkalosis HCO3 > 26 mEq /L pH > 7.45 Gain of base Excessive intake of bicarbonate Lactate administration in dialysis Excess ingestion of antacids Loss of acids Vomiting Hypokalemia Nasogastric suctioning Diuretics Increased levels of aldosterone Muscle twitching and cramps Tetany Dizziness Weakness Depressed respiration Nausea and vomiting Marc 17, 2011

Electrolyte imbalances:

Electrolyte imbalances March 17, 2011

Normal Electrolyte Values for Adults:

Normal Electrolyte Values for Adults Sodium- 135-145 mEq /L Potassium- 3.5-5 mEq /L Chloride- 95-106 mEq /L Calcium- 4.5-5.5 mEq /L or 8.5-10.5 mg/dl Magnesium- 1.5-2.5 mEq /L or 1.6-2.5 mg/dl Phosphate - 1.8-2.6 mEq /L Serum osmolality 280-300 mOsm /kg water *Normal laboratory values vary from agency to agency. March 17, 2011

Electrolyte Imbalances:

Electrolyte Imbalances Condition Possible Causes Manifestations Hyponatremia Serum sodium level < 135 mEq /L Decreased sodium intake Vomiting and diarrhoea Aldosterone deficiency Excessive water intake Muscle weakness Dizziness, headache Hypotension Tachycardia and shock Mental confusion Stupor and coma March 17, 2011

Electrolyte Imbalances:

Electrolyte Imbalances Condition Possible Causes Manifestations Hypernatremia Serum sodium > 145 mEq /L Dehydration Water deprivation Excessive sodium intake Intense thrist Hypertension Oedema Aggitation convulsions March 17, 2011

Electrolyte Imbalances:

Electrolyte Imbalances Condition Possible Causes Manifestations Hyperkalemia Serum potassium > 5 mEq /L Excessive intake of potassium Renal failure Aldosterone deficiency Irritability Nausea, vomiting Diarrhoea Muscular weakness March 17, 2011

Electrolyte Imbalances:

Electrolyte Imbalances Condition Possible Cause Manifestations Hypokalemia Serum potassium < 3.5mEq/L Excessive loss in vomiting and diarrhoea Decreased potassium intake Kidney disease hyperaldosteronism Muscle fatigue Mental confusion Increased urine output Shallow respiration March 17, 2011

Scenarios :

Scenarios March 17, 2011

Scenario 1:

Scenario 1 A patient complains of having muscle twitching, lethargy and headache for one week. Her serum sodium level was 120 mEq /L, potassium 3.6 mEq /L on investigation. Which electrolyte imbalance is this patient experiencing? March 17, 2011

Scenario 2:

Scenario 2 A patient with chronic renal failure was admitted with history of irritability, confusion, muscle weakness and diarrhea for the past week. Laboratory findings was serum potassium 5.9 mEq /L, sodium 135 mEq /L and ABG readings were: pH 7.11 PCO 2 40 mmHg HCO 3 12 mEq /L PO2 90 mmHg o2 sat 60% Interpret the above results March 17, 2011

Scenario 3:

Scenario 3 A patient has the following arterial blood gas (ABG) reading. pH 7.35 PCO 2 36 mmHg PO 2 98 mmHg HCO 3 26 mEq /L Sao 2 96% Interpret the above results March 17, 2011

Scenario 4:

Scenario 4 Mr. C. who was diagnosed with myocardial infarction reported having severe chest pain despite the administration of nitroglycerine. The doctor ordered an ABG, on 3L o2 via nasal prongs. Assess his ABG values pH 7.52 PCO 2 28 mmHg HCO 3 22 mEq /L PO 2 50 mmHg O 2 Sat 91% March 17, 2011

Scenario 5:

Scenario 5 The following ABG results were recorded for a patient who has been vomiting for one week. Laboratory serum potassium and sodium values were 2.8 mEq /L and 10 mEq /L. Assess each value. pH 7.25 PCO 2 36 mmHg HCO 3 18 mEq /L PO 2 85 mmHg O 2 Sat 96% March 17, 2011

Scenario 6:

Scenario 6 The following ABG results were recorded for a patient unresolved bronchospasm. Interpret each value and the acid-base abnormality. pH 7.27 PCO 2 55 mmHg HCO 3 24 mEq /L PO 2 80 mmHg O 2 Sat 90% March 17, 2011

Scenario 7:

Scenario 7 Mrs. B; a patient with emphysema, comes to ER and complains of SOB, an increased amount of expectorant, and general malaise. Assess her A.B.G. values pH 7.23 PCO 2 48 mmHg HCO 3 15 mEq /L PO 2 60 mmHg O 2 sat 85% March 17, 2011

Nursing diagnoses related to fluid and acid-base imbalances:

Nursing diagnoses related to fluid and acid-base imbalances March 17, 2011

Nursing Diagnoses:

Nursing Diagnoses Fluid volume deficit Fluid volume excess Risk for fluid volume imbalance Risk for fluid volume deficit Impaired gas exchange Impaired skin integrity related to dehydration Acute confusion related to electrolyte imbalance March 17, 2011

Scenario:

Scenario Mr. X a known Diabetic for 5 years was admitted to the medical ward with H/O nausea and vomiting for 1 day, weakness, headache and difficulty breathing on exertion. He also reported that he had not taken his insulin for one week as he was on fasting with the lord. The nurse who assessed him this morning reported poor skin turgur, sunken eyes, a GMR reading of 22 mmol /L and a urine dip stick reading of glucose 4+ and Ketones 4+. Laboratory serum potassium and sodium were 3.1 mEq /L and 130 mEq /L respectively. ABG result was pH 7.27, PCO 2 36 mmHg, HCO 3 18 mEq /L, PO 2 80 mmHg and O 2 Sat 90%. March 17, 2011

Slide 36:

Assessment Nursing Diagnosis Pt. Outcome Interventions Rationale March 17, 2011

References:

References Morton, P. G., & Fontaine, D. K. (2009). Critical care nursing: A holistic approach . Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Shipton , S., Walker, H., Kozier , B., & Berman, A. (2000). Fundamentals of nursing: Concepts, process, and practice : instructor's guide . Upper Saddle River, N.J: Prentice Hall Health . March 17, 2011