FLUIDS AND ELECTROLYTES

PYRAMID POINTS Maintaining fluid and electrolyte balance Description of the common fluid and electrolyte imbalances Causes of common fluid and electrolyte imbalances Assessment of common fluid and electrolyte imbalances Treatment and evaluation of response to treatment for common fluid and electrolyte imbalances

MAINTAINING FLUID AND ELECTROLYTE BALANCE DESCRIPTION Homeostasis is a term that indicates the relative stability of the internal environment Concentration and composition of body fluids must be nearly constant

MAINTAINING FLUID AND ELECTROLYTE BALANCE DESCRIPTION In the client, when one of the substances—fluids or electrolytes—is deficient, it must be replaced either normally by the intake of food and water or by therapy such as IVs and/or medications When the client has an excess of fluid or electrolytes, therapy is directed towards assisting the body to eliminate the excess

MAINTAINING FLUID AND ELECTROLYTE BALANCE Kidneys Play a major role in controlling all types of balance in fluid and electrolytes Adrenal glands Through the secretion of aldosterone, the adrenal glands also aid in controlling extracellular fluid volume by regulating the amount of sodium reabsorbed by the kidneys Antidiuretic hormone (ADH) ADH from the pituitary gland regulates the osmotic pressure of extracellular fluid by regulating the amount of water reabsorbed by the kidney

FLUID VOLUME DEFICIT DESCRIPTION Dehydration in which the body’s fluid intake is not sufficient to meet the body’s fluid needs The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit

FLUID VOLUME DEFICIT CAUSES Isotonic dehydration Inadequate intake of fluids and solutes Fluid shifts between compartments Excessive losses of isotonic body fluids Hypertonic dehydration Conditions that increase fluid loss such as excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage renal failure, and diabetes insipidus

FLUID VOLUME DEFICIT CAUSES Hypotonic dehydration Chronic illness Excessive fluid replacement (hypotonic) Renal failure Chronic malnutrition

FLUID VOLUME DEFICIT ASSESSMENT Cardiovascular Thready, increased pulse rate Decreased blood pressure and postural hypotension Flat neck and hand veins in dependent positions Diminished peripheral pulses

FLUID VOLUME DEFICIT ASSESSMENT Respiratory Increased rate and depth of respirations Neuromuscular Decreased central nervous system activity from lethargy to coma Fever Renal Decreased urinary output Increased specific gravity

FLUID VOLUME DEFICIT ASSESSMENT Integumentary Dry and scaly skin Poor turgor, tenting present Dry and fissured mouth, paste-like coating present

FLUID VOLUME DEFICIT ASSESSMENT Gastrointestinal (GI) Decreased motility and diminished bowel sounds Constipation Thirst

FLUID VOLUME DEFICIT ASSESSMENT Hypotonic dehydration Skeletal muscle weakness Hypertonic dehydration Hyperactive deep tendon reflexes Increased sensation of thirst Pitting edema

FLUID VOLUME DEFICIT IMPLEMENTATION Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and GI status Prevent further fluid losses and increase fluid compartment volumes to normal ranges Provide oral rehydration therapy if possible; IV fluid replacement if the dehydration is severe

FLUID VOLUME DEFICIT IMPLEMENTATION Generally, isotonic dehydration is treated with isotonic fluid solutions; hypertonic dehydration with hypotonic fluid solutions; and hypotonic dehydration with hypertonic fluid solutions Administer medications as prescribed to correct the cause Administer oxygen as prescribed Monitor electrolyte values and prepare to administer medication to treat an imbalance if present

FLUID VOLUME EXCESS DESCRIPTION Fluid intake or fluid retention exceeds the body’s fluid needs Also called overhydration or fluid overload The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload

FLUID VOLUME EXCESS CAUSES Isotonic overhydration Poorly controlled IV therapy Renal failure Long-term corticosteroid therapy Hypertonic overhydration Excessive sodium ingestion Rapid infusion of hypertonic saline Excessive sodium bicarbonate therapy

FLUID VOLUME EXCESS CAUSES Hypotonic overhydration Early renal failure Congestive heart failure Syndrome of inappropriate antidiuretic hormone Poorly controlled IV therapy Replacement of isotonic fluid loss with hypotonic fluids Irrigation of wounds and body cavities with hypotonic fluids

FLUID VOLUME EXCESS ASSESSMENT Cardiovascular Bounding, increased pulse rate Peripheral pulses full Elevated blood pressure; decreased pulse pressure Elevated central venous pressure Distended neck and hand veins Engorged venous varicosities

FLUID VOLUME EXCESS ASSESSMENT Respiratory Increased respiratory rate Shallow respirations Dyspnea Moist crackles on auscultation

FLUID VOLUME EXCESS ASSESSMENT Neuromuscular Altered level of consciousness Headache Visual disturbances Skeletal muscle weakness Paresthesias

FLUID VOLUME EXCESS ASSESSMENT Integumentary Pitting edema in dependent areas Skin pale and cool to touch GI Increased motility

FLUID VOLUME EXCESS ASSESSMENT Isotonic overhydration Liver enlargement Ascites Hypotonic overhydration Polyuria Diarrhea Nonpitting edema Dysrhythmias Projectile vomiting

FLUID VOLUME EXCESS IMPLEMENTATION Monitor cardiovascular, respiratory, neuromuscular, integumentary, and GI status Administer diuretics; osmotic diuretics are typically prescribed first to prevent severe electrolyte imbalances Restrict fluid and sodium intake Monitor I&O and weight Monitor electrolyte values and prepare to administer medication to treat an imbalance if present