NSG 321

FLUID AND ELECTROLYTES

Fluid Volume Deficit (dehydration)
Deficit of water and electrolytes in extracellular fluid
Hypovolemia
Dehydration
Young and old susceptable
Causes Signs and Symptoms Management
oss of body fluids
Decreased inta!e
Diabetes insipidus
"drenal insufficiency
#rd spacing shift
wt loss
Decreased s!in turgor$ dry
mucous membranes
%rine output&#'cc(hr
)ea!$ rapid pulse
Hypotension
Hct elevated$ *%+ elevated
,ncrease fluid inta!e$ watch for
impaired swallowing
, - .
)atch for fluid overload
/urn fre0uently
Daily wt1
/hird2Space 3luid Shift
Shift in fluids into potential body spaces or into interstitial spaces
Deficit in extracellular volume
Causes4 Severe burns$ bowel obstruction$ pancreatitis
)eight loss does not occur and fluid loss cannot be measured
Fluid Volume Exce !fluid o"e#lo$d% o"e#&'d#$tio()
5xcess of water and sodium in extracellular fluid
Hypervolemia
.verhydration
Causes Signs and Symptoms Management
6enal failure$ CH3$ cirrhosis
of liver$ Cushing7s syndrome
.ver2administration of +a
8
2
containing ,9 fluids
High inta!e of +a
8
foods or
medications
)eight gain
:eripheral edema
Distended nec! - peripheral
veins
ungs;crac!les - whee<es
"scities
*ounding$ full pulse
Decreased *%+ - Hct
6estrict +a
8
inta!e - fluids
5levate H.* - feet
*edrest or lying down
, - .
Daily wt1
/urn fre0uently
Diuretics
Hemodialysis
ELECTROLYTES
:age =
Sodium
+ormal range >#?2>@A m50(
Chief electrolyte of extracellular fluid
+ervous tissue cells and muscles tissue cells
+a2B pump
6egulates volume of body fluid
Hyponatremia (&>#? m50() Hypernatremia (C>@A m50()
Causes4 loss of +a or too much plain water
S - S4 muscles cramps$ muscles twitching$
+-9$ confusion leading to sei<ures
which can lead to death
/x4 replace +a either oral or ,9D water
restriction
Causes4 profuse sweating$ heatstro!e$ not
enough water inta!e
S-S4 increased body temperature$ tongue
dry(swollen$ thirsty
,f severe;disorientation$
hallucinations
/x4 Hypotonic or isotonic non2saline
infusions
*ot$ium
+ormal range #1A 2 A1' m50(
MaEor cation of intracellular fluid
/ransmission of electrical impulsesD i1e1$ nerve$ heart$ s!eletal$ intestinal$ - lung tissue
"cid2base balance 2 exchange with H
8
Hypo!alemia (&#1A m50() Hyper!alemia (CA1' m50()
Causes4 Diarrhea$ vomiting$ diuretics$
dehydration$ metabolic al!alosis$
hyperaldostonism$ magnesium
depletion$ insulin hypersecretion
S-S4 Muscle wea!ness - leg cramps$
increase sensitivity to digitalis$
5BF changes Gflat / - S/
depressed
/x4 6eplacement with meds - diet
Causes4 salt substitutes$ metabolic acidosis$
tissue trauma$ renal failure$
hypoaldostonism$$ "ddison7s disease
S-S4 flaccid muscles$ paralysis$ slow heart
rate$ 5BF changes;pea!ed /
waves$ absent : waves
/x4 ,f severe;,9 calcium glucontate
Bayexalate enema$ +a*icarb$ ,9
insulin - hypertonic dextrose
:age #
C$lcium
6ange H1' 2 >'1A mg(d
Most abundant electrolyte in body1 HHI in bone - teeth1 Close lin! between calcium
and phosphorus;inversely associated ( Ca :h or Ca2 :h )
+ecessary for nerve impulse - blood clotting
Strength of muscle contractions
Helps with 9itamin *>= absorptionD use stimulated by 9itamin D
:arathyroid hormone regulates Ca4 increased calcitonin (by thyroid)2 decreased Ca
Hypocalemia (&H1' mg(d) Hypercalemia (C>'1A mg(d
Causes4 "l!alosis state$ hyperphosphatemia$
hypomagnesemia$ vit$ D deficiency$
hypothyroidism$ pancreatitis$
osteoporosis
S-S4 numbness$ tingling of fingers$ muscle
cramps$ tetany$ hyperactive deep
tendon reflex$ positive Chvo!te!7s
- /rousseau7s sign
/x4 parenteral Ca salts$ diet
Causes4 arge amounts of vit1 D$ Ca2
containing antacids$ thia<ide
diuretics$ bone tumors$ immobility$
renal failure$ hyperparathyroidism
S-S4 muscle wea!ness$ tiredness$ lethargy$
anorexia$ +-9$ constipation$
polyuria$ polydipsia$ hypoactive
deep tendon reflexes$ cardiac arrest
/x4 treat cause$ ,9 fluids (+SS)$
calcitonin$ ,9 phosphate$ increase
fluids - bul! in diet$ watch for dig1
toxicity
+$,(eium
6ange >1# 2 =1> m50(
Cation found in cells
helps intracellular level of B
8
"ctivator for en<yme system
"ffects CH. - protein metabolism
"ffects neuromuscular function
"cts on peripheral C9 system to produce vasodilation
Hypomagnesemia (& >1# m50() Hypermagnesemia (C=1> m50()
Causes4 alcoholism$ diabetic !etoacidosis$ +F
suction$ diarrhea$ fistula
S-S4 +euromuscular irritability (increased
reflexes)$ sei<ures$ positive
Chvoste!7s - /rousseau7s signs
Cardiac;increased heart rate$
increased dig toxicity
ow potassium and calcium levels
/x4 diet$ ,9 mag sulfate
Causes4 end2stage renal disease$ increased use
of antacids - laxatives
S-S4 :eripheral vasodilation;flushing -
s!in warmth$ decreased *: -
respirations
Hypoactive deep tendon reflexes
/x4 HemodialysisD loop diuretics and
J+S$ ,9 Ca gluconate
:age @
*&o-&o#ou
6ange #1' 2 @1A mg(d
"nion in cell
Helps with acid2base balance
Helps with 9itamin * effectiveness$ CH. metabolism
Critical to nerve - muscle function
:rovides structural support to bone and teeth1
:hosphorous level decreases with age
Hypophosphatemia (&#1' mg(d) Hyperphosphatemia (C@1A mg(d)
Causes4 respiratory al!alosis$ phosphate2
binding antacids$ recovery phase of
burns$ malnourishment
S-S4 parasthesis$ muscle wea!ness$ muscles
pain - tenderness
/x4 prevention
Causes4 renal failure$ large inta!e of mil! or
9it D$ hypoparathyroidism$
hyperthyroidism
S-S4 short termtetany - hypocalemia$
long2termCa deposits in Eoints$
!idneys
/x4 correct underlying problem$ low
phosphorous diet
C&lo#ide
6ange HK 2 >'? m50(
Chief extracellular anion
Foes with sodium
Decreased chloridedecreased potassium
Helps with acid2base balance
,nverse relationship with *icarbonate
Hypochloremia (&HK m50() Hyperchloremia (C>'? m50()
Causes4 decreased sodium - potassium levels$
metabolic al!alosis
S-S4 Hyperexcitability of muscles$ cardiac
dysrhythmias
/x4 ,9 of J +SS or +SS$ diet
Causes4 increased sodium$ metabolic acidosis
/x4 treat underlying cause
,9 of lactated 6ingers solution$
diuretics
Acid./$e
"cids G H
8
ions released 6egulation of H
8
"l!ali (or base) G /raps H
8
ions >1 *uffer system
=1 6espiratory control
No#m$l V$lue0
pH L1#A2L1@A
:a.= K'2>'' mm Hg
:aC.= #A2@A mm Hg
*icarbonate =>2=K m50(
#1 6enal control