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

Lecture 2A

Fluid & electrolytes (Chapter 7)

Integumentary System (chapters 44-46)


Homeostasis

Homeostasis

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


Body fluids

Body Fluids

  • Volume

  • Electrolyte composition

  • pH


What is the primary component of body fluid

What is the primary component of body fluid?

  • Red blood cells

  • White blood cells

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

  • Water

  • Oxygen


Water

Water

  • 60% of body weight is water

  • Elderly 

  • 45 – 50% of body weight is water


Water in out

Water in & out

  • Water intake and output should be about equal.

  • Average daily intake/output

    • 2500 mL

  • Table 7-1 pg 101


Electrolytes

Electrolytes

  • Substances that dissociate in solution to form ions.

  • Ion =

    • Electrically charged particle


Function of electrolytes

Function of Electrolytes

  • Regulate water

  • Neuro-muscular activity


Key electrolytes

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

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

Body Fluid Movement

  • Compartments separated by selectively permeable membranes

  • 4 ways to move

    • Osmosis

    • Diffusion

    • Filtration

    • Active transport


Osmosis

Osmosis

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


Osmosis1

Osmosis

  • Water moves towards a higher solute concentration


Isotonic solution

Isotonic solution

  • Have the same concentration of solutes as plasma


Hypertonic solution

Hypertonic solution

  • Have a great concentration of solutes than plasma


Hypotonic solution

Hypotonic solution

  • Have a lower concentration of solutes than plasma


Diffusion

Diffusion

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


Filtration

Filtration

  • Water & Solutes move across membranes driven by fluid pressure

  • Figure 7-6 pg 104


Active transport

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

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

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

Nrs. Dx: Fluid Volume Deficit

  • AKA:

    • Dehydration


Common causes of fluid volume deficit

Common Causes of Fluid Volume Deficit

  • GI fluid loss

  • Excess urine output

  • Hemorrhaging

  • Inadequate fluid intake


S s of fluid volume deficit

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

Lab Test for Fluid Volume Deficit

  • Serum osmolality

    • h

  • Hematocrit

    • h

  • Urine specific gravity

    • h


Nursing plan fluid volume deficit

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 deficit1

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 deficit2

Nursing Plan: Fluid Volume Deficit

  • Daily weight

    • Same…

      • Time

      • Scale

      • Clothing

    • FVD 

      • i wt


Nursing plan fluid volume deficit3

Nursing Plan: Fluid Volume Deficit

  • Assess mental status & breath sounds

  • Assess skin

    • Dry

    • Turgor

    • Warm

  • Assess mucus membranes

    • Moist


Nursing plan fluid volume deficit4

Nursing Plan: Fluid Volume Deficit

  • PUSH FLUIDS!!!

    • #1 water

    • Variety

    • Available

    • Appealing

    • Intravenous fluids (I.V.)


Nursing plan fluid volume deficit5

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

Nrs. Dx: Fluid Volume Excess

  • Usually due to sodium & water retention

  • AKA

    • Hypervolemia


Common causes of fluid volume excess

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

S&S of Fluid Volume Excess

  • BP

    • h

    • Hypertension

  • Pulse rate

    • h

    • Tachycardia

  • Pulse strength

    • Full bounding pulse


S s of fluid volume excess1

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

Lab tests for Fluid Volume Excess

  • Serum osmolarity

    • i

  • Hematocrit

    • i

  • Specific gravity of urine

    • i


Interdisciplinary care for fluid volume excess

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

Nursing Plan: Fluid Volume Excess

  • Baseline weight

  • Baseline vital signs

  • Monitor

    • I&O

    • VS

    • Skin turgor

    • Edema


Nursing plan fluid volume excess1

Nursing Plan: Fluid Volume Excess

  • Report

    • Dizziness

    • Orthostatic hypotension

    • Tachycardia

    • Muscle cramping


Nursing plan fluid volume excess2

Nursing Plan: Fluid Volume Excess

  • Monitor labs

    • K*

    • Glucose

    • Notify MD for abnormal


Nursing plan fluid volume excess3

Nursing Plan: Fluid Volume Excess

  • Administer meds per MD order

  • Fluid restrictions

  • Sodium restrictions


Nursing plan fluid volume excess4

Nursing Plan: Fluid Volume Excess

  • Provide

    • Oral hygiene

    • Rest

    • Elevate feet

    • Semi-fowler position


Nursing plan fluid volume excess5

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

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

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

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

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

  • Fluid volume deficit

  • Fluid volume excess


Sodium imbalance

Sodium Imbalance

  • What is the chemical sign for sodium?

    • So

    • Sa

    • S

    • N

    • Na


What is the normal serum sodium level

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 imbalance1

Sodium imbalance

  • Sodium and fluid volume frequently go together.


Hyponatremia

Hyponatremia

  • Low serum sodium level

    • < 135 mEq/L


Common causes of hyponatremia

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

S&S of Hyponatremia

  • Anorexia

    • N/V

    • Diarrhea

  • H/A

  • Mental changes

  • Convulsions

  • Coma


Lab tests hyponatremia

Lab Tests: hyponatremia

  • Serum electrolyte levels

    • < 135 mEq/L


If a client has hyponatremia what do they need

If a client has hyponatremia, what do they need?

  • More Sodium

    • Foods high in sodium

    • IV fluids

  • Less water

    • diuretics


Hypernatremia

Hypernatremia

  • High serum sodium levels

    • > 145 mEq/L


Common causes of hypernatremia

Common Causes of Hypernatremia

  • Water loss

    • Not drinking

    • Sweating

    • Diarrhea

    • Diabetes

  • Sodium retention

    • Tube feedings without water

    • IV with Na


S s of hypernatremia

S&S of hypernatremia

  • Thirst

  • Alt. mental status

  • Dry mucous membranes

  • Postural hypotension

  • Skin

    • Hot, dry


Interdisciplinary care hypernatremia

Interdisciplinary Care:Hypernatremia

  • Increase water

    • Push fluids

    • IV

    • SLOWLY!


Potassium imbalance

Potassium imbalance

  • What is the chemical sign for potassium?

    • Pt

    • P

    • Po

    • K

    • Sa


What is the normal serum potassium level

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

Lab tests for Hypokalemia

  • Serum electrolytes

    • K+


Hypokalemia

Hypokalemia

  • Low potassium levels

    • < 3.5 mEq/L


Common causes of hypokalemia

Common Causes ofHypokalemia

  • GI loss

    • Vomiting

    • Diarrhea

    • Diuretics

    • NPO


S s of hypokalemia

S&S of Hypokalemia

  • N&V

  • Anorexia

  • Muscle weakness

  • Dysrhythmias


If a client has hypokalemia what do they need

If a client has Hypokalemia, what do they need?

  • POTASSIUM REPLACEMENT!!

    • Potassium replacement medications


Natural sources of k

Natural sources of K+

  • Fruits

    • Banana

    • Oranges

    • Cantaloupe

  • Vegetables

    • Carrots

    • Cauliflower

    • Potato


What is hyperkalemia

What is Hyperkalemia?

  • Increased sodium levels

  • Decreased sodium levels

  • Increased potassium levels

  • Decreased potassium levels

  • I have no idea!


Hyperkalemia

Hyperkalemia

  • High potassium levels

    • > 5.3 mEq/L


Common causes of hyperkalemia

Common causes of Hyperkalemia

  • #1 Renal failure


S s of hyperkalemia

S&S of Hyperkalemia

  • Dysrhythmias  cardiac arrest

  • N&V / diarrhea

  • Muscle weakness


Remember

REMEMBER!!!

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


Lab tests hyperkalemia

Lab Tests: Hyperkalemia

  • Serum electrolytes

    • K+

  • ECG

    • Electrocardiogram

  • Renal function

    • BUN

      • Blood Urea Nitrate


Hyperkalemia interdisciplinary care

HyperKalemia: Interdisciplinary Care

  • Medications

    • Treat the cause

    • Loop diuretics

      • Lasix


Nursing plan at risk for injury

Nursing PlanAt risk for injury

  • Monitor

    • K+ levels

    • S&S of K+ imbalance

      • Weakness


Nursing plan decreased cardiac output

Nursing Plan:Decreased Cardiac output

  • Monitor

    • Vital signs

    • Apical pulse

  • Place on cardiac monitor


Calcium c a

Calcium (Ca)

  • Hypocalcemia

    • Low serum calcium levels

  • Hypercalcemia

    • High serum calcium levels


Common causes of hypocalcemia

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

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

  • Healthy bones

  • Muscle contraction & relaxation


S s of hypocalcemia

S&S of hypocalcemia

  • Tetany

    • Group of symptoms that are caused by hypocalcemia

    • Paresthesia

    • Muscle spasms


S s of hypocalcemia1

S&S of Hypocalcemia

  • + Chvostek’ssign

    • Tap facial nerve 

    • Facial spasm


S s of hypocalcemia2

S&S of Hypocalcemia

  • + Trousseau’s sign

    • Occlusion of brachial artery > 3 min.

    • Carpal spasm


S s of hypocalcemia3

S&S of Hypocalcemia

  • Dysrhythmias

  • Cardiac output

    • i

  • BP

    • i


Interdisciplinary care hypocalcemia

Interdisciplinary Care: Hypocalcemia

  • Diagnostic tests

    • Serum Calcium level

    • PTH

      • Parathyroid Hormone levels


Interdisciplinary care hypocalcemia1

Interdisciplinary Care: Hypocalcemia

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

  • Calcium replacement!

    • Oral calcium replacement


Natural courses of calcium

Natural courses of Calcium

  • Milk

  • Milk products


Hypercalcemia

HYPERCALCEMIA

  • Increased serum calcium levels


Common causes of hypercalcemia

Common causes of Hypercalcemia

  • Hyperparathyroidism

  • Some cancers

  • Immobilization

  • Renal failure


What endocrine gland controls the serum calcium level

What endocrine gland controls the serum calcium level

  • Parathyroid

  • Pituitary

  • Adrenal

  • Ovaries

  • Testis


S s of hypercalcemia

S&S of Hypercalcemia

  • Muscle weakness

  • i reflexes

  • Confusion

  • Dysrhythmias

  • BP

    • h

  • Urine output

    • h


Remember calcium has a sedative effect on neuromuscular transmission

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 care hypercalcemia

Interdisciplinary careHypercalcemia

  • Lab tests:

    • Serum Calcium levels

    • PTH

    • ECG


Interdisciplinary care hypercalcemia1

Interdisciplinary careHypercalcemia

  • Medications

    • Diuretics


Magnesium imbalance

Magnesium Imbalance

  • Mg


Hypomagnesemia

Hypomagnesemia

  • Low serum magnesium levels


Common causes of hypomagnesemia

Common Causes of Hypomagnesemia

  • #1 Alcoholism


S s of hypomagnesemia

S&S of Hypomagnesemia

  • Muscle weakness

  • Tetany

    • + Chvostek’s

    • + Troussseau’s

  • Dysrhythmias

    • ECG changes

  • Seizures


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