Lecture 2A Fluid & electrolytes (Chapter 7) Integumentary System (chapters )

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? A.Red blood cells B.White blood cells C.Electrolytes (i.e. sodium, potassium, calcium, etc.) D.Water E.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) – 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? A.Water moves from an area of high solute concentration to an area of low solute concentration B.Water moves from an area of low solute concentration to an area of high solute concentration C.Solutes moves from an area of high solute concentration to an area of low solute concentration D.Solute moves from an area of low solute concentration to an area of high solute concentration

In Diffusion what moves, and how? A.Water moves from an area of high solute concentration to an area of low solute concentration B.Water moves from an area of low solute concentration to an area of high solute concentration C.Solutes moves from an area of high solute concentration to an area of low solute concentration D.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 –  Hematocrit –  Urine specific gravity – 

Nursing Plan: Fluid Volume Deficit I&O – <30 mL / hr REPORT! Vital Signs – BP  – Pulse rate  – Pulse strength 

Nursing Plan: Fluid Volume Deficit Assess urine – Color Dark – Specific gravity Weight of urine compared to a drop of distilled water  = FVD

Nursing Plan: Fluid Volume Deficit Daily weight – Same… Time Scale Clothing – FVD   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 –  – Hypertension Pulse rate –  – Tachycardia Pulse strength – Full bounding pulse

S&S of Fluid Volume Excess Respiratory – Rate  – Cough – Dyspnea Weight –  Edema – Excess fluid in the body tissues

Lab tests for Fluid Volume Excess Serum osmolarity –  Hematocrit –  Specific gravity of urine – 

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 –  potassium – Report to MD

With fluid Volume deficit you would expect the blood pressure to be what? A.Increased (hypertension) B.Decreased (hypotension)

Why are respiratory problems common with Fluid Volume deficit? A.The blood flows to the feet B.There is no blood to circulate the oxygen C.Increased respiratory rate causes a decreases in effective breathing D.It is not common with fluid volume deficit, it is common with fluid volume excess

Why are respiratory problems common with Fluid Volume excess? A.Excess fluid pools into the lungs B.The blood does not circulate as well C.Oxygen can not be carried in watery blood D.Peripheral edema causes their feet to swell

Kidney failure usually leads to which of the following nursing diagnosis? A.Fluid volume deficit B.Fluid volume excess

Sodium Imbalance What is the chemical sign for sodium? A.So B.Sa C.S D.N E.Na

What is the normal serum sodium level A.135 – 145 mEq/L B.13 – 15 mEq/L C.3.5 – 5.3 mEq/L D.35 – 45 mEq/L E.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? A.Pt B.P C.Po D.K E.Sa

What is the normal serum potassium level? A.1.5 – 5.1 mEq/L B.2.5 – 5.2 mEq/L C.3.5 – 5.3 mEq/L D.4.5 – 5.4 mEq/L E.None of the above

Lab tests for Hypokalemia Serum electrolytes – K+

Hypokalemia Low potassium levels – < 3.5 mEq/L

Common Causes of Hypokalemia 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? A.Increased sodium levels B.Decreased sodium levels C.Increased potassium levels D.Decreased potassium levels E.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 Plan At 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  Dietary 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’s sign – 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 –  BP –  

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 A.Parathyroid B.Pituitary C.Adrenal D.Ovaries E.Testis

S&S of Hypercalcemia Muscle weakness  reflexes Confusion Dysrhythmias BP –  Urine output – 

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 Lab tests: – Serum Calcium levels – PTH – ECG

Interdisciplinary care Hypercalcemia 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