Fluid and Electrolytes, and Acid Base Balances and Imbalances Ppt Powerpoint Presentation slides-Medical Slideshow Fluid, Electrolyte, and Acid Base Imbalances

Fluid and Electrolytes, and Acid Base Balances and Imbalances

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Slide 1 :

Fluid and Electrolytes, and Acid Base Balances and Imbalances Nur 105 Adult Health

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Learning Objectives/Outcomes Define Key Terms associated with fluids, electrolytes and acid base balances. Describe the assessment findings for a balance and imbalance fluid, electrolytes and acid base. Develop a nursing care plan to maintain fluid and electrolyte homeostasis. Describe the nursing interventions in maintaining fluid and electrolyte homeostasis. Evaluate the effectiveness of nursing interventions to promote fluid and electrolyte balance.

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Homeostatis-Fluid and Electrolytes 60% of body consists of fluid Intracellular space Extracellular space Electrolytes are active ions: positively and negatively charged

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Hydrostatic Pressure

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Regulation of Body Fluid Compartments Osmosis is the diffusion of water caused by fluid gradient. Diffusion is the movement of a substance from area of higher concentration to one of lower concentration. Active Transport is the movement of substance across permeable membrane and gradient; requires energy and pump. Ex. Sodium/potassium pump

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Regulation of Body Fluid Compartments (cont’d) Filtration is the movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure Osmolality reflects the concentration of fluid that affects the movement of water between fluid compartments by osmosis Osmotic pressure is the amount of hydrostatic pressure needed to stop the flow of water by osmosis

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Osmolarity Isotonic – same solute concentration; equal; no movement across membrance Hypertonic/hyperosmotic – greater osmotic pressure (concentration); water pulled into fluid to equalize. Hypotonic/hypo-osmotic – lesser osmotic pressure (concentration); water pulled out of fluid to equalize.

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Sodium-Potassium Pump Sodium concentration is higher in ECF than ICF Sodium enters cell by diffusion Potassium exits cell into ECF

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Gains and Losses Gain – solid foods, drinks; thirst center Loss -water and electrolytes move in a variety of ways; sensible and insensible. Kidneys Skin Lungs GI tract

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Developmental ConsiderationsElderly Skin elasticity impaired 45% to 50% of body weight in older adults is water; loss of muscle mass and reduced ratio of lean to total body weight; Sites for skin turgor are: forehead sternum Abdomen Renal, Muscular, Neurologic, Endocrine

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Electrolytes Major cation for extracellular fluid – Sodium Major cation for intracellular - Potassium Cations Calcium,phosphorus, magnesium

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Fluid Volume Disturbances Fluid Volume Deficit (Hypovolemia) Fluid Volume Excess (Hypervolemia)

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Pitted edemaFluid overload

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Fluid Imbalances Fluid Deficits Isotonic – fluid and lytes loss equally; decline in circulating blood volume Hypertonic – fluid loss exceeds loss of lytes Hypotonic – lytes loss exceeds loss of water Fluid Excess Isotonic (CHF) – Only ECF is expanded Hypertonic –rare – excessive Na+ intake; fluid shifts from ICF to ECF Hypotonic – water intoxication; life threatening; fluid moves in ICF and all compartment expands

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Nursing Process - Assessment Physical exam Assess skin elasticity (tenting), edema, skin dryness, mucous membrance, conjunctiva, VS -Increase respiratory rate in response to hypoxia Altered mental status – confusion, lethargic, etc. Neuromuscular assessment of muscle tone and strength, movement, coordination, and tremors. Cardiovascular – orthostatic hypotension Renal - weight loss, I &O. Lab data – hemoconcentration (elevated hemoglobins, hematocrits, glucose, protein, blood urea

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Intervention for Fluid Imbalance Dehydration Oral fluid replacement ORT – special formula IV Therapy Check closely for fluid overload, check vital signs, pulse rate and I&O Drug Therapy Depends on cause: antiemetic, antidiarrhea, antibiotic Other Treatment based on problems Drug therapy-dysrhythmias Oral care, artificial tears, salivart

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Fluid Imbalance - Overhydration Isotonic Overhydration Hypotonic Overhydration – water intoxication; fluid moves into ICF Hypertonic Overhydration – fluid pulled from ICS ICS ICS ECS ECS ++ ++ + ++ ++ + shrink swell

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Fluid Overload - Interventions Drug therapy – osmotic diuretics first, then loop diuretic such as Lasix Weights, I&O, serum electrolytes, EKG Check IV fluids hourly Assessment of cardiopulmonary, renal, mental, skin VS every 4 hours and prn; I&O qshift and prn Diet Therapy – restrict fluid and sodium

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Electrolyte Imbalances Hypo and Hypernatremia (Na+) Hypo and Hyperkalemia (K+) Hypo and Hypercalcemia (Ca+) Hypo and Hypermagnesemia (Mg+) Hypo and Hyperphosphatemia (Phos+) Hypo and Hyperchloremia (Cl-)

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ElectrolytesBasic Principles in Treatment Electrolyte Deficits Treatment Drug Supplements Foods Assess complications Remove cause Electrolyte Excess Treatment Antagonist Hydration Omit foods or medications high in lytes Assess complications Remove the cause

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Sodium Electrolyte Imbalances135-145 mEq/L Hyponatremia Assess mental, muscle weakness, GI distress, hypovolemia; VS Replace Na+ slowly; saline IV infusions; If excess fluid, mannitol Check ADH levels Monitor electrolytes if Na+ K+ Diet therapy Hypernatremia Assess mental status, muscle twitching and irregular muscle contractions, VS, BP in hypovolemia; BP with bounding pulses in hypervolemia If fluid loss, hypotonic IV fluids; If fluid and Na+ loss, isotonic IV fluid Restrict Na+,

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Implementation - Dietary

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Potassium Electrolyte Imbalances3.5 - 5.5 mEq/L Hypokalemia Hand grasp weak, hyporeflexia, muscle weakness, shallow respirations, pulse thready and weak, dysrhythmia, lethargic, confusion, coma, GI hypoactivity; VS, EKG changes; fiber and fluids Administer K+ oral or IV, monitor lab work, Hyperkalemia EKG changes, paresthesia, GI motility Stop K+ - oral or IV; Administer K+ excreting diuretics (lasix) and Kayexlate; dialysis if severe K+ ; insulin administration

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Implementation - Dietary

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Electrolyte Imbalances Hypocalcemia Causes: Vitamin D deficiency S/S: Numb and tingling fingers and circumoral region, muscle cramps Hypercalcemia Causes: osteoporosis, prolonged immobilization S/S: decreased muscle tone, weakness, lethargy, kidney stones

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Calcium Electrolyte Imbalances Hypocalcemia Trousseau’s and Chvosteck’s signs, vs, heart rate up or down, weak, thready pulse, active bowel sounds Administer Calcium gluconate, foods high in calcium, assess for injury Seizure precautions Hypercalcemia Heart rate and blood pressure; severe hypercal-slow heart rate, dysrhythmias VS, EKG – T wave, QT interval Homan’s sign Lethargic, confusion, muscle weakness, coma deep tendon reflexes without paresthesia Renal calculi; I&O, strain urine; bowels sounds Discontinue calcium oral or IV drugs (antacids);adm. Saline IV, Lasix diuretics, calcium binders, NSAID, dialysis

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Acid-Base Balances PH 7.35-7.45 Acids/Bases – hydrogen ion Buffer Systems – promote balance Bicarbonate/ Carbonic acid Alkalosis – above 7.45 Acidosis – below 7.35

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Sources of Acids and Biccarbonate Ions Acids Carbon dioxide Fatty acids and ketoacids Anaerobic – lactic acid and ketoacids Impaired cells Bicarbonate Breakdown of carbonic acid, intestinal absorption, pancreatic production, movement of cellular bicarbonate in ECF and kidney reabsorption of bicarbonate

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Acid Base Regulatory Mechanisms Chemical Acid-Base Control Bicarbonate and phosphate Respiratory Acid Base Control Carbon dioxide Renal Acid Base Control Bicarbonate, acids, ammonium

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Biological Compensation Respiratory Metabolic disorders – Diabetes, acute renal failure carbon dioxide retained or excreted Renal In lung disorders – COPD Formation of acids or bicarbonate reabsorbed or excreted Arterial Blood Gases (ABGs)

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AcidosisMetabolic and Respiratory Overproduction of Hydrogen Ions Underelimination of Hydrogen Ions Underproduction of Bicarbonate Ions Overelimination of Bicarbonate Ions Respiratory Depression Inadequate Chest Expansions Airway Obstruction Reduced Alveolar-capillary diffusion

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Assessment of Acidosis History – age, cause, diet, medications, illness Physical Assessment Lethargic, confusion, coma Muscle weakness, deep tendon reflexes, flaccid paralysis; skin in metabolic - warm, dry, pink (due to vasodilation); skin in respiratory – pale to cyanotic. Heart rate , then in severe cases, heart rate , BP, monitor vs, O2 sat, EKG Mental status – confused, uncooperative Metabolic acidosis – lo bicarbonate; Respiratory acidosis – elevated carbonic acid (CO2)

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Treatment for Acidosis Metabolic Hydration Treat cause – diabetic Ketoacidosis – insulin; antidiarrheal for diarrhea Dialysis – renal failure Monitor VS, EKG Assess for complications Respiratory Oxygen, bronchial dilators, dry pulmonary secretions, breathing exercise, postural drainage Monitor oxygen sat levels, VS, EKG Assess for complications

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AlkalosisMetabolic and Respiratory Metabolic Base Excess Acid Deficit Respiratory Loss of carbonic acid in hyperventilation Anxiety, fear or improper settings on mechanical ventilators Hyperventilation direct stimulation of CNS – fever, metabolic acidosis, drugs - salicylates

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Assessment of Alkalosis Physical Assessment CNS- dizziness, agitation confusion, hyperreflexia, parathesia, Chvostek’s and Trousseau’s signs. Cramps, twitches, charley horses, deep tendon reflexes hyperactive, tetany, weak muscles, poor hand grasp Heart rate , pulse thready, BP Rate and depth of respirations Laboratory Metabolic – elevated bicarbonate Respiratory – low bicarbonate and carbonic acid

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Treatment for Alkalosis Treat the cause Correct electrolyte imbalances; remove if excess or administer if low Hydration Antiemetic for upper GI distress Monitor IV fluids, VS, ABG’s, I&O, oxygen, respiratory and cardiac (EKG) Assess for complications

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Types of IV Solutions Isotonic Hypotonic Hypertonic

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Complications of Intravenous Therapy Systemic Complications Fluid overload Air embolism Septicemia and other infection Local Complications Infiltration and extravasation Phlebitis Thrombophlebitis Hematoma Clotting and Obstruction

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Summary Fluids Intracellular Extracellular Excess or deficit Electrolytes (Major cations and anion

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	SlidesOnline 1 Years ago. Category: other

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Define Key Terms associated with fluids, electrolytes and acid base balances. ..... Normal ph sligh more Define Key Terms associated with fluids, electrolytes and acid base balances. ..... Normal ph slightly alkaline; more H+ more acid, less H+ more base ... less

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