Lecture 2a
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Lecture 2A. Fluid & electrolytes (Chapter 7) Integumentary System (chapters 44-46). Homeostasis. The body’s tendency to maintain a state of physiologic balance in constantly changing conditions. Body Fluids. Volume Electrolyte composition pH.

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Lecture 2A

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Lecture 2A

Fluid & electrolytes (Chapter 7)

Integumentary System (chapters 44-46)


Homeostasis

  • The body’s tendency to maintain a state of physiologic balance in constantly changing conditions.


Body Fluids

  • Volume

  • Electrolyte composition

  • pH


What is the primary component of body fluid?

  • Red blood cells

  • White blood cells

  • Electrolytes (i.e. sodium, potassium, calcium, etc.)

  • Water

  • Oxygen


Water

  • 60% of body weight is water

  • Elderly 

  • 45 – 50% of body weight is water


Water in & out

  • Water intake and output should be about equal.

  • Average daily intake/output

    • 2500 mL

  • Table 7-1 pg 101


Electrolytes

  • Substances that dissociate in solution to form ions.

  • Ion =

    • Electrically charged particle


Function of Electrolytes

  • Regulate water

  • Neuro-muscular activity


Key electrolytes

  • Sodium (Na)

    • 135-145 mEq/L

  • Potassium (K+)

    • 3.5 – 5.3 mEq/L

  • Calcium (Ca)

    • 4.5 – 5.5 mEq/L

  • Magnesium (Mg)

    • 1.5 – 2.4 mEq/L

  • Chloride (Cl-)

    • 95 – 105 mEq/L


Distribution of Body Fluid

  • Intracellular fluid (ICF)

    • Fluid inside the cells

    • 40% of body weight

  • Extracellular fluid (ECF)

    • Outside of cells

    • 20% body fluid

    • Where?

      • Interstitial fluid

        • Between the cells

      • Intravascular fluid

        • In the blood vessels

      • Transcellular

        • Body fluids


Body Fluid Movement

  • Compartments separated by selectively permeable membranes

  • 4 ways to move

    • Osmosis

    • Diffusion

    • Filtration

    • Active transport


Osmosis

  • Water moves from an area of lower solute concentration to an area of higher solute concentration


Osmosis

  • Water moves towards a higher solute concentration


Isotonic solution

  • Have the same concentration of solutes as plasma


Hypertonic solution

  • Have a great concentration of solutes than plasma


Hypotonic solution

  • Have a lower concentration of solutes than plasma


Diffusion

  • Solutes move from an area of high solute concentration to an area of low solute concentration


Filtration

  • Water & Solutes move across membranes driven by fluid pressure

  • Figure 7-6 pg 104


Active transport

  • Allows molecules to move into areas of high solute concentration but requires cellular energy

    • Adenosine triphosphate or ATP


In osmosis what moves, and how?

  • Water moves from an area of high solute concentration to an area of low solute concentration

  • Water moves from an area of low solute concentration to an area of high solute concentration

  • Solutes moves from an area of high solute concentration to an area of low solute concentration

  • Solute moves from an area of low solute concentration to an area of high solute concentration


In Diffusion what moves, and how?

  • Water moves from an area of high solute concentration to an area of low solute concentration

  • Water moves from an area of low solute concentration to an area of high solute concentration

  • Solutes moves from an area of high solute concentration to an area of low solute concentration

  • Solute moves from an area of low solute concentration to an area of high solute concentration


Nrs. Dx: Fluid Volume Deficit

  • AKA:

    • Dehydration


Common Causes of Fluid Volume Deficit

  • GI fluid loss

  • Excess urine output

  • Hemorrhaging

  • Inadequate fluid intake


S&S of Fluid Volume Deficit

  • Fatigue

  • Alt. mentation

  • BP?

    • Postural hypotension

  • Pulse?

    • Tachycardia

    • Weak

  • Weight?

    • loss

  • Skin

    • Dry

    • Poor turgor

  • Urine output

    • Decreased

    • Dark


Lab Test for Fluid Volume Deficit

  • Serum osmolality

    • h

  • Hematocrit

    • h

  • Urine specific gravity

    • h


Nursing Plan: Fluid Volume Deficit

  • I&O

    • <30 mL / hr REPORT!

  • Vital Signs

    • BP

      • i

    • Pulse rate

      • h

    • Pulse strength

      • i


Nursing Plan: Fluid Volume Deficit

  • Assess urine

    • Color

      • Dark

    • Specific gravity

      • Weight of urine compared to a drop of distilled water

      • h = FVD


Nursing Plan: Fluid Volume Deficit

  • Daily weight

    • Same…

      • Time

      • Scale

      • Clothing

    • FVD 

      • i wt


Nursing Plan: Fluid Volume Deficit

  • Assess mental status & breath sounds

  • Assess skin

    • Dry

    • Turgor

    • Warm

  • Assess mucus membranes

    • Moist


Nursing Plan: Fluid Volume Deficit

  • PUSH FLUIDS!!!

    • #1 water

    • Variety

    • Available

    • Appealing

    • Intravenous fluids (I.V.)


Nursing Plan: Fluid Volume Deficit

  • Educate

    • I&O

    • Avoid sun/heat

    • Vomiting 

      • Small frequent sips

      • Tea, ginger ale, flat cola

    • Caffeine & sugar 

      • urination

    • If diarrhea 

      • drink fruit juice or bouillon not just water


Nrs. Dx: Fluid Volume Excess

  • Usually due to sodium & water retention

  • AKA

    • Hypervolemia


Common causes of Fluid Volume Excess

  • Renal failure

  • Heart failure

  • Too much water intake

  • Too much sodium intake

  • Medications


S&S of Fluid Volume Excess

  • BP

    • h

    • Hypertension

  • Pulse rate

    • h

    • Tachycardia

  • Pulse strength

    • Full bounding pulse


S&S of Fluid Volume Excess

  • Respiratory

    • Rate

      • h

    • Cough

    • Dyspnea

  • Weight

    • h

  • Edema

    • Excess fluid in the body tissues


Lab tests for Fluid Volume Excess

  • Serum osmolarity

    • i

  • Hematocrit

    • i

  • Specific gravity of urine

    • i


Interdisciplinary Care for Fluid Volume Excess

  • Medications

    • Diuretics

  • Fluid restriction

    • Rx by MD

  • Sodium restriction

  • Action:

    • Increase water excretion

    • “Water pills”


Nursing Plan: Fluid Volume Excess

  • Baseline weight

  • Baseline vital signs

  • Monitor

    • I&O

    • VS

    • Skin turgor

    • Edema


Nursing Plan: Fluid Volume Excess

  • Report

    • Dizziness

    • Orthostatic hypotension

    • Tachycardia

    • Muscle cramping


Nursing Plan: Fluid Volume Excess

  • Monitor labs

    • K*

    • Glucose

    • Notify MD for abnormal


Nursing Plan: Fluid Volume Excess

  • Administer meds per MD order

  • Fluid restrictions

  • Sodium restrictions


Nursing Plan: Fluid Volume Excess

  • Provide

    • Oral hygiene

    • Rest

    • Elevate feet

    • Semi-fowler position


Nursing Plan: Fluid Volume Excess

  • Educate (about diuretics)

    • Increase urine

    • Take in AM

    • Change position slowly

    • Weight daily

    • Decrease salt

    • h potassium

    • Report to MD


With fluid Volume deficit you would expect the blood pressure to be what?

  • Increased (hypertension)

  • Decreased (hypotension)


Why are respiratory problems common with Fluid Volume deficit?

  • The blood flows to the feet

  • There is no blood to circulate the oxygen

  • Increased respiratory rate causes a decreases in effective breathing

  • It is not common with fluid volume deficit, it is common with fluid volume excess


Why are respiratory problems common with Fluid Volume excess?

  • Excess fluid pools into the lungs

  • The blood does not circulate as well

  • Oxygen can not be carried in watery blood

  • Peripheral edema causes their feet to swell


Kidney failure usually leads to which of the following nursing diagnosis?

  • Fluid volume deficit

  • Fluid volume excess


Sodium Imbalance

  • What is the chemical sign for sodium?

    • So

    • Sa

    • S

    • N

    • Na


What is the normal serum sodium level

  • 135 – 145 mEq/L

  • 13 – 15 mEq/L

  • 3.5 – 5.3 mEq/L

  • 35 – 45 mEq/L

  • Uh, what??


Sodium imbalance

  • Sodium and fluid volume frequently go together.


Hyponatremia

  • Low serum sodium level

    • < 135 mEq/L


Common causes of hyponatremia

  • Water retention

    • Kidney disease

    • Heart disease

    • Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

  • Sodium loss

    • Vomiting

    • Diarrhea

    • diuretics


S&S of Hyponatremia

  • Anorexia

    • N/V

    • Diarrhea

  • H/A

  • Mental changes

  • Convulsions

  • Coma


Lab Tests: hyponatremia

  • Serum electrolyte levels

    • < 135 mEq/L


If a client has hyponatremia, what do they need?

  • More Sodium

    • Foods high in sodium

    • IV fluids

  • Less water

    • diuretics


Hypernatremia

  • High serum sodium levels

    • > 145 mEq/L


Common Causes of Hypernatremia

  • Water loss

    • Not drinking

    • Sweating

    • Diarrhea

    • Diabetes

  • Sodium retention

    • Tube feedings without water

    • IV with Na


S&S of hypernatremia

  • Thirst

  • Alt. mental status

  • Dry mucous membranes

  • Postural hypotension

  • Skin

    • Hot, dry


Interdisciplinary Care:Hypernatremia

  • Increase water

    • Push fluids

    • IV

    • SLOWLY!


Potassium imbalance

  • What is the chemical sign for potassium?

    • Pt

    • P

    • Po

    • K

    • Sa


What is the normal serum potassium level?

  • 1.5 – 5.1 mEq/L

  • 2.5 – 5.2 mEq/L

  • 3.5 – 5.3 mEq/L

  • 4.5 – 5.4 mEq/L

  • None of the above


Lab tests for Hypokalemia

  • Serum electrolytes

    • K+


Hypokalemia

  • Low potassium levels

    • < 3.5 mEq/L


Common Causes ofHypokalemia

  • GI loss

    • Vomiting

    • Diarrhea

    • Diuretics

    • NPO


S&S of Hypokalemia

  • N&V

  • Anorexia

  • Muscle weakness

  • Dysrhythmias


If a client has Hypokalemia, what do they need?

  • POTASSIUM REPLACEMENT!!

    • Potassium replacement medications


Natural sources of K+

  • Fruits

    • Banana

    • Oranges

    • Cantaloupe

  • Vegetables

    • Carrots

    • Cauliflower

    • Potato


What is Hyperkalemia?

  • Increased sodium levels

  • Decreased sodium levels

  • Increased potassium levels

  • Decreased potassium levels

  • I have no idea!


Hyperkalemia

  • High potassium levels

    • > 5.3 mEq/L


Common causes of Hyperkalemia

  • #1 Renal failure


S&S of Hyperkalemia

  • Dysrhythmias  cardiac arrest

  • N&V / diarrhea

  • Muscle weakness


REMEMBER!!!

  • Both hypokalemia and hyperkalemia affect cardiac function and can result in serious, even fatal dysrhythmias


Lab Tests: Hyperkalemia

  • Serum electrolytes

    • K+

  • ECG

    • Electrocardiogram

  • Renal function

    • BUN

      • Blood Urea Nitrate


HyperKalemia: Interdisciplinary Care

  • Medications

    • Treat the cause

    • Loop diuretics

      • Lasix


Nursing PlanAt risk for injury

  • Monitor

    • K+ levels

    • S&S of K+ imbalance

      • Weakness


Nursing Plan:Decreased Cardiac output

  • Monitor

    • Vital signs

    • Apical pulse

  • Place on cardiac monitor


Calcium (Ca)

  • Hypocalcemia

    • Low serum calcium levels

  • Hypercalcemia

    • High serum calcium levels


Common causes of hYPOCALCEMIA

  • Parathyroidectomy

  • iDietary intake

  • Lack of sun exposure

  • Alcoholics


What’s so bad about not having calcium? Why do we need it anyway?

  • Healthy bones

  • Muscle contraction & relaxation


S&S of hypocalcemia

  • Tetany

    • Group of symptoms that are caused by hypocalcemia

    • Paresthesia

    • Muscle spasms


S&S of Hypocalcemia

  • + Chvostek’ssign

    • Tap facial nerve 

    • Facial spasm


S&S of Hypocalcemia

  • + Trousseau’s sign

    • Occlusion of brachial artery > 3 min.

    • Carpal spasm


S&S of Hypocalcemia

  • Dysrhythmias

  • Cardiac output

    • i

  • BP

    • i


Interdisciplinary Care: Hypocalcemia

  • Diagnostic tests

    • Serum Calcium level

    • PTH

      • Parathyroid Hormone levels


Interdisciplinary Care: Hypocalcemia

  • If a client has a diagnosis of hypocalcemia – what do they need?

  • Calcium replacement!

    • Oral calcium replacement


Natural courses of Calcium

  • Milk

  • Milk products


HYPERCALCEMIA

  • Increased serum calcium levels


Common causes of Hypercalcemia

  • Hyperparathyroidism

  • Some cancers

  • Immobilization

  • Renal failure


What endocrine gland controls the serum calcium level

  • Parathyroid

  • Pituitary

  • Adrenal

  • Ovaries

  • Testis


S&S of Hypercalcemia

  • Muscle weakness

  • i reflexes

  • Confusion

  • Dysrhythmias

  • BP

    • h

  • Urine output

    • h


REMEMBER: Calcium has a sedative effect on neuromuscular transmission

  • HYPERcalcemia decreased neuromuscular excitability, muscle weakness and fatigue

  • HYPOcalcemia increased neuromuscular excitability, muscle twitching, spasms and tetany


Interdisciplinary careHypercalcemia

  • Lab tests:

    • Serum Calcium levels

    • PTH

    • ECG


Interdisciplinary careHypercalcemia

  • Medications

    • Diuretics


Magnesium Imbalance

  • Mg


Hypomagnesemia

  • Low serum magnesium levels


Common Causes of Hypomagnesemia

  • #1 Alcoholism


S&S of Hypomagnesemia

  • Muscle weakness

  • Tetany

    • + Chvostek’s

    • + Troussseau’s

  • Dysrhythmias

    • ECG changes

  • Seizures


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