NSG 107 -Review for Fluids and Electrolytes

NSG 107 -Review for Fluids and Electrolytes

NSG 107 -Review for Fluids and Electrolytes

Review for fluids and electrolytes

Fluids maintain body temperature, transport nutrients, gases, wastes.

Body fluid compartments

Intracellular, extracellular, intravascular, interstitial compartments

Third-spacing- sequestration of trapped extracellular fluid in actual or potential body space or movement of fluid from intravascular compartment to interstitial tissue or other body space;

Diagnostic Findings: hemoconcentration, CVP normal, blood counts borderline

Administer albumin infusion, IV diuretic

Edema Excess accumulation of fluid in interstitial tissue; generalized edema referred to as anasarca

Infants and older adults at higher risk- for fluid-related problems

Obesity-Fat cells do not contain water, so people with a higher percentage of fat cells have a lower percentage of water, higher risk for fluid issues

Diffusion passive transport of molecules from an area of higher concentration to an area of lower concentration

OSMOSIS: movement of substance from low to high concentration; IV fluids use this process

FILTRATION: The movement of fluids through capillaries

Active transport: requires energy for a solute to move against a concentration gradient; solutes move from an area of lower concentration to an area of higher concentration. Ex. sodium–potassium pump

Passive transport is a movement of substances across cell membranes without need of energy input.

Maintaining fluid and electrolyte balance

Kidneys, adrenal glands play major role; If the kidneys don’t work properly, the body has great difficulty controlling fluid balance

Several hormones affect fluid balance, among them a water retainer called antidiuretic hormone (ADH). Antidiuretic hormone from pituitary gland regulates extracellular fluid by regulating amount of water reabsorbed by kidneys

ADH regulates fluid balance as follows:

1. Low blood pressure (volume) or increased serum osmolality is sensed by the hypothalamus which signals the pituitary gland.
2. The pituitary gland secrets ADH into the blood stream causing the kidneys to retain water
3. Water retention increases blood Pressure (volume) and decreases serum osmolality
4. Release of ADH, which in turn increases the kidneys’ reabsorption of water. The increased reabsorption of water results in more concentrated urine.

A Decrease in serum osmolality, or increase blood volume, stops the release of ADH and less water is reabsorbed, making the urine less concentrated, this process is ongoing

The renin-angiotensin-aldosterone has 3 functions: to maintain a proper blood pressure/blood flow, (2) to maintain the right concentration of sodium (Na+) in the blood, and finally, (3) to maintain the right amount of water in the blood.

Low blood pressure/blood flow is sensed by the Juxtaglomerular apparatus in the kidney

This is because a decrease in Na+ reduces the amount of water in the blood, thus the blood will have a lower pressure. (This follows osmosis, which states that water will diffuse to areas that have highly concentrated solutes.)
In response to the lower pressure, the glomerulus releases the hormone renin into the blood stream. Renin then moves to the liver, to convert angiotensinogen to angiotensin I. Angiotensin I travels to the lungs where the Angiotensin Converting Enzyme (ACE), converts Angiotensin I to Angiotensin II.

If blood flow to the kidneys diminishes, i.e. a patient who’s hemorrhaging, or if the amount of sodium reaching the glomerulus drops, the juxtaglomerular cells secrete more renin. The renin causes vasoconstriction and a subsequent increase in blood pressure.

Angiotensin II can constrict blood vessels, increasing blood pressure; Angiotensin II also stimulates the adrenal glands to produce the hormone Aldosterone.

Aldosterone stimulates the reabsorption of sodium (Na+) in the distal convoluted tubules; Increasing sodium reabsorption means that water and chloride (Cl-) will follow, thus increasing blood volume.

Increases in blood volume may also trigger the release of a hormone known as Atrial Natriuretic Hormone; which inhibits the release of Aldosterone, keeping the body’s water and sodium levels at the homeostatic levels. This is known as a negative feedback loop.

 

Natriuretic peptides: ANP and BNP increases urine production when released

Fluid Volume Deficit

Dehydration occurs when fluid intake of the body is insufficient to meet fluid needs of body

Hypovolemia The most common form of dehydration, caused by fluid loss from the body= low blood volume; causes: severe vomiting and diarrhea, severely draining wounds, and profuse diaphoresis (sweating)

Hypovolemia can also occur with third spacing, Causes: burns, liver cirrhosis, and extensive trauma.

The body initially attempts to compensate for fluid loss by a number of mechanisms, if the cause is not resolved dehydration occurs

In hypovolemia, aldosterone initiates active transport forces Na+ from the distal tubules and  collecting ducts back into the bloodstream, more water is reabsorbed and blood volume expands.

Isotonic dehydration: water and electrolytes are lost in equal proportions

Hypotonic dehydration: electrolyte loss exceeds water loss

Hypertonic dehydration: water loss exceeds electrolyte loss

Thirst= the simplest mechanism for maintaining fluid balance; occurs with even small losses of fluid; Loss of body fluids or eating highly salty foods increases ECF osmolality, drying out mucous membranes in the mouth and stimulating the thirst center in the hypothalamus.

Causes of fluid volume deficits

Hemorrhage, Excessive perspiration, Hyperventilation, Prolonged fever, vomiting, and diarrhea

End-stage renal failure, Diabetes insipidus

DEHYDRATION Assessment Findings:

INITIAL SYMPTOM THIRST, Rapid weak pulse and low B/P, dizziness, fatigue, weakness, irritability, delirium, decreased tear formation, dry skin, and dry mucous membranes.

Dehydration= poor skin turgor or tenting, increased body temperature because body unable to cool through perspiration. Temperature may not appear elevated in elderly because of lower normal body temp. Urine output decreases, urine becomes concentrated as water is conserved. Dehydration should be considered in any adult with a urine output of less than 30 mL per hour. Urine may appear darker because it’s less diluted, constipation occurs.

NSG 107 -Review for Fluids and Electrolytes

Dehydration Treatment- determine cause (such as diarrhea or decreased fluid intake), replace lost fluids— orally for mild to moderate (if patient is alert and oriented) or I.V. for severe dehydration. Type of fluid depends on patient’s cardiac assessment and current labs.

• Nursing Management: 8 to 10 glasses water/day; avoid caffeine beverages; restrict sodium
• Diagnostic Findings: Lab values may serum sodium >145 mEq/ L; urine specific gravity greater than 1.030, elevated Hct and blood cell counts
• Weight is the most reliable indicator of fluid loss or gain. A loss of 1 to 2 pounds or more per day suggests water loss rather than fat loss.

Average fluid intake

Adult: 2500 mL/day (Range: 1800 to 3600 mL/day) Think 2-3 liters per day (2000ml-3000ml)

Fluid Volume Deficit Symptoms

Thirst, Tachycardia, Hypotension, Tachypnea, Oliguria, poor skin turgor, Dry skin, dry Mucous membranes, Decreased bowel sounds, Constipation, Lethargy to coma state

Interventions=

Cultural Considerations Muslims who celebrate Ramadan fast for 1 month from sunup to sundown. Fasting may include not taking fluids and medications during daylight hours. Therefore, the nurse may need to alter times for medication administration, including intramuscular medication. Special precautions may need to be taken to prevent dehydration in Muslim patients.

Fluid excess 0r overhydration=

Fluid excess causes=

Conditions that cause Fluid excess: renal failure, heart failure, and the syndrome of inappropriate antidiuretic hormone (SIADH)

Fluid excess Types:

Isotonic overhydration- 

Causes: –

Hypertonic overhydration–

Causes: 

Hypotonic overhydration-

Causes: –

Fluid excess symptoms- 

Complications=

Interventions

…

Diagnostic Findings: 

Electrolyte imbalances occur as deficits and/or excess; accompanied by fluid changes

Causes

• Deficits: administration of IV fluids, vomiting, diarrhea, diuretics
• Excess: orally consumed, parenteral administration of electrolytes, kidney failure, endocrine dysfunction, crushing injuries, burns

Priority electrolytes imbalances: sodium, potassium, calcium, magnesium

Sodium– Functions: maintains normal nerve and muscle activity, regulates osmotic pressure, preserves acid–base balance; Most of the sodium in the body (about 85%) is found in blood and lymph fluid; Sodium is dissolved in the blood; Sodium attracts and holds water, so the sodium in the blood helps maintain the liquid portion of the blood. Sodium attracts and holds water, too much sodium, may cause a person to retain extra water, increasing the blood volume.

NA+ helps keep fluid inside and outside the body‘s cells

Normal 135mEq/L-145 mEq/L

Too little or too much sodium in the body can affect the neuro system specifically nerve and muscle function.

Hyponatremia, can cause muscle spasms, cramps, headache, irritability, restlessness, nausea and fatigue.

Hypernatremia can cause lethargy, restlessness, increased deep tendon reflexes, muscle spasticity and seizures.

The kidneys are responsible for controlling sodium concentrations and retain sodium when your levels are low and excrete sodium in the urine when levels are high; people with kidney problems may be more susceptible to dangerous changes in sodium levels due to kidney dysfunction; Sodium is also lost in sweat.

Hyponatremia= 

Causes= 

S/S= 

  

Interventions

…

NSG 107 -Review for Fluids and Electrolytes

Hypernatremia Serum sodium level exceeds 145 mEq/L

Hypernatremia implies a deficit of total body water relative to total body Na and is generally not caused by an excess of sodium, but rather by due to unreplaced water that is lost from the gastrointestinal tract (Vomiting or diarrhea), skin (Sweating), or the urine (Diabetes insipidus)

Check the patient’s vital signs; fever, tachycardia, decreased blood pressure, and orthostatic hypotension are characteristic of hypernatremia and compare with prior.

Check the skin and mucous membranes for signs of dehydration (poor skin turgor; flushed skin color; dry mucous membranes and a rough, dry tongue)

Assess the patient for muscle twitching, hyperreflexia, tremors, seizures, and rigid paralysis.

Causes= 

S/S=

Interventions

…

Potassium, along with sodium, the other electrolyte, plays a vital role in regulating the fluid levels in your body. K+ helps to control the amount of water in your body and maintain a healthy blood pH, Potassium helps skeletal and smooth muscles to contract and is need for regular digestive and muscular functioning; if you have excessively high or low potassium levels, an irregular heartbeat can occur; heart arrhythmias are potentially life-threatening.

Normal K+ range is 3.5 mEq/L to 5 mEq/L

Hypokalemia=

Causes-

S/S= 

Interventions: 

Take precautions when administering potassium IV

Maximum infusion rate should be 5 to 10 mEq/hr as prescribed

If client receiving more than 10 mEq/hr, place on cardiac monitor and infuse using IV controller

Instruct client not to take oral potassium supplements, if prescribed, on empty stomach

Instruct client about increasing dietary potassium with foods, such as bananas, oranges, potatoes, meat, raisins, spinach, tomatoes, lima beans, salmon, cod

Hyperkalemia=

Causes= 

S/S:

Interventions: 

Hypocalcemia= 

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Addison’s disease=

Signs & Symptoms of Addison’s Disease Remember the phrase:

Sodium & Sugar low (due to low levels of cortisol which is responsible for retention sodium and increases blood glucose), Salt cravings, Tired and muscle weakness

 Hyperkalemia/hypercalcemia=

Hyperkalemia= 

Calcium= keeps bones and teeth strong, supports skeletal structure and function. plays key roles in cell signaling, blood clotting, muscle contraction and nerve function, activates certain enzymes, transports ions across the cell membrane, send and receives neurotransmitters to communicate with other cells, calcium is also one of the key players in maintaining a regular heartbeat. Calcium may decrease systolic blood pressure in individuals with high blood pressure. Without vitamin D, your body cannot absorb calcium. Caffeine, alcohol and excess sodium can all decrease calcium absorption and/or increase calcium excretion from your body

Hypocalcemia- serum calcium <8.8 mg/dL

Causes: 

Assessment Findings: 

Interventions:

 

Hypercalcemia Serum calcium level exceeds 10 mg/dL

Causes-

Early sign: 

Interventions- 

Treat cause, IV sodium chloride, Lasix, corticosteroids or plicamycin, Calcitonin injection is used to treat Paget’s disease of bone, or high levels of calcium in the blood (hypercalcemia).

Magnesium 

NSG 107 -Review for Fluids and Electrolytes

Hypomagnesemia -Serum magnesium level lower than 1.6 mg/dL

Causes:

Assessment Findings:

Diagnostic Finding:

Treatment:

Interventions:

Hypermagnesemia 

Causes 

S/S=

Interventions-

TIP Not part of review but could be helpful: plays a vital role in the reactions that generate and use ATP, it is required 4 energy-production. Magnesium cations function as cell regulators in hundreds of chemical reactions throughout the body. Magnesium protects our DNA and it helps regulate our electrolyte balance. It affects the conduction of nerve impulses, muscle contraction, and heart rhythms. The sodium-potassium pump is activated by magnesium inside the cell. Magnesium deficiencies impair the sodium-potassium pump, allowing potassium to escape from the cell, to be lost in the urine, potentially leading to potassium deficiency (hypokalemia). Those with hypokalemia rarely respond to treatment when a magnesium deficiency’s present. Magnesium’s role in calcium regulation is pivotal to its role in maintaining heart health. Magnesium is a modulator of calcium, competing with calcium for entrance into cells and keeping many cellular processes in balance. The effect of magnesium on blood vessels is one of dilation, whereas calcium promotes contraction.

 

TIPS:

Hypercalcemia= Renal calculi formation (kidney stones (stoned), Muscular weakness and/or twitches

(Addie likes salt, is hyper for pot (k+), then gets stoned (Ca+), tired and weak,) = salt cravings, hyper K+, hyper Ca+

Cushing’s is opposite of Addison’s

Cushing’s: hyper-secretion of CORTISOL

Cushing’s Disease: caused from an inside source due to the pituitary gland producing too much ACTH (Adrenocorticotropic hormone) which causes the adrenal cortex to release too much cortisol.

Signs & Symptoms of Cushing’s

Remember the mnemonic: “STRESSED” (remember there is too much of the STRESS hormone CORTISOL)

Weight gain, especially in the upper body and around the stomach,  

Electrolytes imbalance: hypokalemia, hypocalcemia

I’ve got a cushie fat tushie, from too many ‘roids and not enough bananas= I am round and chubby from excessive steroids and I am hypokalemic