fluid and electrolyte part 1 posted today

Chapter 14Fluid and Electrolytes: Balance and Disturbance : 

Chapter 14Fluid and Electrolytes: Balance and Disturbance

Fluid and Electrolyte Balance : 

Fluid and Electrolyte Balance Necessary for life and homeostasis Nursing role is to help prevent and treat fluid and electrolyte disturbances

Fluid : 

Fluid Approximately 60% of the typical adult is fluid Varies with age, body size, and gender Younger people and men generally have higher % of body fluid Intracellular fluid Extracellular fluid (ECF) Intravascular Interstitial Transcellular “Third spacing”: loss of ECF into a space that does not contribute to equilibrium

Osmosis- During osmosis, water molecules naturally travel from hypotonic areas to hypertonic areas. : 

Osmosis- During osmosis, water molecules naturally travel from hypotonic areas to hypertonic areas. Movement of fluid from and area of lower solute concentration to an area of higher solute concentration

Intravenous Solution Review : 

Intravenous Solution Review Isotonic Extracellular volume replacement Concentration of ECF = ICF Hypotonic Pulls water into the cells and rehydrates the cells Hypertonic Pulls water from the cells into the vascular space to maintain circulating blood volume

Routes of Gains and Losses : 

Routes of Gains and Losses Gain Dietary intake of fluid and food or enteral feeding Parenteral fluids Loss Kidney: urine output Skin loss: sensible and insensible losses Lungs GI tract Other

Osmolality/Osmolarity : 

Osmolality/Osmolarity Osmolality is reported as millisomoles per kilgram of water (mOsm/kg) Osmolarity is measured in milliosmoles per liter Normal serum osmolality is 275 to 300 mOsm/kg Normal urine osmolality is 250 to 900 mOsm/kg Normal urine specific gravity 1.010 – 1.025

You just ate 4 bags of potato chips so what would you expect? : 

You just ate 4 bags of potato chips so what would you expect? THIRST ?increase. Sensation of thirst is decreased in the elderly putting them at increase risk of dehydration ADH ? Increase. Result in water reabsorption OSMOLALITY ? Increase. Measure of solutes per kilogram.solutes in plasma-sodium, glucose, bun ALDOSTERONE ? Decrease. Aldosterone is a hormone that causes the tubules of the kidneys to retain sodium and water. This increases the volume of fluid in the body, and drives blood pressure up. Many drugs, such as spironolactone, lower blood pressure by blocking the aldosterone receptor. Aldosterone is part of the renin-angiotensin system. URINE OUTPUT ? decrease

You decide to drink 5 gallons of water so what do you expect ? : 

You decide to drink 5 gallons of water so what do you expect ? THIRST ? Decrease ADH ?decrease OSMOLALITY ? decrease BLOOD VOLUME ? Increased the amount of fluid in the blood URINE OUTPUT ? increased

Elderly consideration : 

Elderly consideration More prone to dehydration The sensitivity of the thirst mechanism decreases in older adults put patient at risk for fluid deficit and hyperosmolality. Fat cells contain less water than an equivalent volume of lean tissue Elderly less body water content assess skin turgor forhead or stermum

Fluid Volume Imbalances : 

Fluid Volume Imbalances Fluid volume deficit (FVD): hypovolemia Fluid volume excess (FVE): hypervolemia

Fluid Volume Deficit : 

Fluid Volume Deficit Loss of extracellular fluid exceeds intake ratio of water, and electrolytes are lost in the same proportion as they exist in normal body fluids Dehydration refers to loss of water alone with increased serum sodium level May occur in combination with other imbalances Causes: fluid loss from vomiting, diarrhea, GI suctioning, sweating, decreased intake, and inability to gain access to fluid Risk factors: diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, and third space shifts

FLUID VOLUME DEFICIT : 

FLUID VOLUME DEFICIT Compensatory mechanisms include: Increased sympathetic nervous system stimulation with an increase in heart rate & cardiac contraction; thirst; plus release of ADH & aldosterone Severe case may result in hypovolemic shock or prolonged case may cause renal failure

Fluid Volume Deficit (cont.) : 

Fluid Volume Deficit (cont.) Manifestations: rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural hypotension, rapid and weak pulse, increased temperature, cool and clammy skin due to vasoconstriction, thirst, nausea, muscle weakness, and cramps Laboratory data: elevated BUN in relation to serum creatinine, increased hematocrit, and possible serum electrolyte changes Medical management: provide fluids to meet body needs Oral fluids IV solutions: see Table 14-4

Fluid Volume Deficit—Nursing Management : 

Fluid Volume Deficit—Nursing Management Monitor intake and output (I&O) Monitor for symptoms: skin turgor, oral mucosa, urinary output (UO), and mental status Initiate measures to minimize fluid loss Provide oral care Administer oral fluids Administer parenteral fluids

NURSING MANAGEMEMT OF FVD : 

NURSING MANAGEMEMT OF FVD Monitoring I&O on a regular schedule depending on the patient If urine output is below 30 mL / hr. notify the physician May check urine specific gravity q 8hrs. >1.025 indicate concentrate urine. <1.010 dilute urine Weigh patient daily at the same time & recognize that a change of 2.2 lbs. represents a loss of 1000 mL Monitor skin turgor, oral membranes, lab Monitor vital signs for increase HR, decrease b/p

Fluid Volume Excess : 

Fluid Volume Excess Due to fluid overload or diminished homeostatic mechanisms Risk factors: heart failure, renal failure, and cirrhosis of the liver Contributing factors: excessive dietary sodium or sodium-containing IV solutions Manifestations: edema; distended neck veins; abnormal lung sounds (crackles); tachycardia; increased BP, pulse pressure, and CVP; increased weight; increased UO; shortness of breath; and wheezing Medical management is directed at the cause, restriction of fluids and sodium, and the administration of diuretics

Fluid Volume Excess—Nursing Management : 

Fluid Volume Excess—Nursing Management Take I&O and daily weights; assess for lung sounds, edema, and other symptoms; monitor responses to medications such as diuretics Promote adherence to fluid restrictions and patient teaching related to sodium and fluid restrictions Monitor and avoid sources of excessive sodium; include medications Promote rest Use semi-Fowler’s position for orthopnea Provide skin care and positioning/turning

Electrolyte Imbalances : 

Electrolyte Imbalances Sodium: hyponatremia and hypernatremia Potassium: hypokalemia and hyperkalemia Calcium: hypocalcemia and hypercalcemia Magnesium: hypomagnesemia and hypermagnesemia Phosphorus: hypophosphatemia and hyperphosphatemia