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Fluids and Electrolytes

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Presentation on theme: "Fluids and Electrolytes"— Presentation transcript:

1 Fluids and Electrolytes
Nancy Lin, RN, MS

2 SLOs Compare and contrast common electrolyte imbalances in pediatric and adult client populations. Examine medications and treatments used to correct fluid and electrolyte imbalances for pediatric and adult clients. Examine the plan of care for pediatric and adult clients experiencing electrolyte disturbances. Utilize the nursing process to help pediatric and adult clients manage problems with fluid, electrolyte, and acid-base imbalances.

3 Water Content Of The Body

4 Water Balance in Infants
Infants & young children Greater need for water More vulnerable to alterations Infants have greater & more rapid water loss Water & electrolyte disturbances occur more frequently & more rapidly Children adjust less promptly to these alterations

5 Water Balances in Infants
Body Surface Area (BSA) BSA of premature neonate 5x more than older child or adult, 2-3x more in newborn Longer GI tract in infancy source of relatively greater fluid loss

6 Water Balances in Infants
Metabolic Rate Higher in infancy Greater production of metabolic wastes Kidney Function Immature at birth Inability to concentrate or dilute urine More likely to become dehydrated or overhydrated

7 Water Balances in Infants
Fluid Requirements Ingest & excrete greater amount of fluid/kg of body weight Maintenance requirements include both water & electrolytes

8 Dehydration in Children
Common causes: Gastroenteritis (most common) n/v/d Diabetic ketoacidosis Extensive burns

9 Assessing for Dehydration in Children
Earliest detectable sign: __________________ Skin & mucous membranes Fontanels Extremities Skin elasticity Capillary refill Sensorium (irritability to lethargy) Heart rate Eyes Urine output BP

10 Nursing Responsibilities in Children with Dehydration
Assessment Accurate I&O 1 gm wet diaper weight = 1 ml urine Oral rehydration management Parenteral fluid therapy

11 Water Intoxication in Children
Can occur during Acute intravenous (IV) water overloading Feeding of incorrectly mixed formula Excess water ingestion Manifestations: Irritability Somnolence HA Vomiting Diarrhea Seizures

12 Gerontologic Considerations in Fluid & Electrolyte Balance
Structural changes in kidneys Hormonal changes Loss of subcutaneous tissue Reduced thirst mechanism

13 Fluid and Electrolyte Imbalances
Extracellular Fluid Volume (ECF) Imbalances Fluid volume deficit (hypovolemia) Treatment Fluid volume excess (hypervolemia)

14 Sodium Plays a major role in ECF volume and concentration
Generation and transmission of nerve impulses Acid–base balance

15 Sodium Imbalances: Hypernatremia
Elevated serum sodium Causes hyperosmolality cellular dehydration Primary protection Manifestations

16 Nursing Management Hypernatremia
Treat underlying cause If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline Diuretics Reduce level gradually

17 Sodium Imbalances: Hyponatremia
Results from loss of sodium-containing fluids or from water excess Manifestations

18 Nursing Management Hyponatremia
Caused by water excess Fluid restriction is needed Severe symptoms (seizures) Give small amount of IV hypertonic saline solution (3% NaCl)

19 Self Assessment Implementation of nursing care for the patient with hyponatremia includes a. fluid restriction. b. administration of hypotonic IV fluids. c. continue to monitor the patient. d. increased water intake for patients on nasogastric suction.

20 Chloride Primary anion in ECF (nl: 95-108 mEq/L)
Combines w/Na to create neutrality Assists in reabsorption of Na in kidney Essential for reabsorbing hydrogen ion to buffer alkalosis Lost through vomiting, excessive sweating Normally excreted in urine

21 Potassium Major ICF cation Necessary for Sources
Transmission and conduction of nerve and muscle impulses Maintenance of cardiac rhythms Acid–base balance Sources

22 Potassium Imbalances: Hyperkalemia
High serum potassium caused by Massive intake Impaired renal excretion Shift from ICF to ECF Common in massive cell destruction Burn, crush injury, tumor lysis

23 Hyperkalemia in Acidosis
As blood [H+] rises in cases of acidosis, more H+ ions are pumped intracellularly in exchange for K+ ions that are pumped extracellularly to maintain electrical neutrality.

24 Potassium Imbalances: Hyperkalemia
Clinical manifestations

25 Nursing Implementation: Hyperkalemia
Eliminate oral and parenteral K intake Increase elimination of K Force K from ECF to ICF by IV insulin or sodium bicarbonate Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV

26 Nursing Implication Hyperkalemia
CBIGKD “see big kid” Calcium chloride or gluconate Bicarbonate Insulin Glucose Kayexalate Dialysis

27 Potassium Imbalances: Hypokalemia
Low serum potassium caused by Abnormal losses of K+ via the kidneys or gastrointestinal tract Magnesium deficiency Metabolic alkalosis

28 Potassium Imbalances: Hypokalemia (cont'd)
Clinical manifestations

29 Potassium Imbalances Hypokalemia
Clinical Manifestations: “SUCTION”

30 Potassium Imbalances Hypokalemia
“SUCTION” Skeletal muscle weakness U wave Constipation Toxic effects of digoxin Irregular, weak pulse Orthostatic hypotension Numbness (paresthesia)

31 Nursing Management Hypokalemia
KCl supplements orally or IV Should not exceed 10mEq/hr To prevent hyperkalemia and cardiac arrest

32 Nursing Diagnoses Hyperkalemia & Hypokalemia

33 ECG changes associated with alterations in potassium status

34 Calcium Obtained from ingested foods
Inverse relationship with phosphorus Blocks sodium transport Stabilizes cell membrane

35 Calcium Functions Balance controlled by Transmission of nerve impulses
Myocardial contractions Blood clotting Formation of teeth and bone Muscle contractions Balance controlled by Parathyroid hormone Calcitonin Vitamin D

36 Calcium Imbalances Hypercalcemia
High serum calcium levels caused by Hyperparathyroidism (two thirds of cases) Malignancy Vitamin D overdose Prolonged immobilization

37 Calcium Imbalances: Hypercalcemia
Manifestations Dec. excitability Skeletal muscle Cardiac muscle Nervous system

38 Nursing Implementation: Hypercalcemia
Excretion of Ca with loop diuretic Hydration with isotonic saline infusion Synthetic calcitonin Mobilization

39 Calcium Imbalances: Hypocalcemia
Low serum Ca levels caused by Decreased production of PTH Acute pancreatitis Multiple blood transfusions Alkalosis Decreased intake

40 Calcium Imbalances: Hypocalcemia
Manifestations Positive Trousseau’s or Chvostek’s sign Laryngeal stridor Dysphagia Tingling around the mouth or in the extremities

41 Nursing Diagnoses Hypocalcemia
Risk for injury Potential complication: fracture or respiratory arrest

42 Nursing Management: Hypocalcemia
Treat cause Oral or IV calcium supplements Not IM to avoid local reactions Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis

43 Phosphate Primary anion in ICF
Essential to function of muscle, red blood cells, and nervous system Deposited with calcium for bone and tooth structure Involved in acid–base buffering system, ATP production, and cellular uptake of glucose Maintenance requires adequate renal functioning

44 Phosphate Imbalances: Hyperphosphatemia
High serum PO43- caused by Acute or chronic renal failure Chemotherapy Excessive ingestion of phosphate or vitamin D Manifestations

45 Nursing Mangement: Hyperphosphatemia
Identify and treat underlying cause Restrict foods and fluids containing PO43- Adequate hydration and correction of hypocalcemic conditions

46 Phosphate Imbalances: Hypophosphatemia
Low serum PO43- caused by Malnourishment/malabsorption Alcohol withdrawal Use of phosphate-binding antacids During parenteral nutrition with inadequate replacement

47 Hypophosphatemia: Manifestations
CNS depression Muscle weakness & pain Dysrhythmias Respiratory failure Cardiomyopathy Diplopia Malaise Anorexia

48 Nursing Management: Hypophosphatemia
Oral supplementation Ingestion of foods high in PO43- IV administration of sodium or potassium phosphate

49 Self Assessment The nurse anticipates that the patient with hyperphosphatemia secondary to renal failure will require a. calcium supplements. b. potassium supplements. c. magnesium supplements. d. fluid replacement therapy.

50 Magnesium 50% to 60% contained in bone
Coenzyme in metabolism of protein and carbohydrates Factors that regulate calcium balance appear to influence magnesium balance Acts directly on myoneural junction Important for normal cardiac function

51 Magnesium Imbalances: Hypermagnesemia
High serum Mg caused by Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present Manifestations

52 Nursing Management: Hypermagnesemia
Prevention Emergency treatment IV CaCl or calcium gluconate Fluids to promote urinary excretion

53 Magnesium Imbalances: Hypomagnesemia
Low serum Mg caused by Prolonged fasting or starvation Chronic alcoholism Fluid loss from gastrointestinal tract Prolonged parenteral nutrition without supplementation Diuretics

54 Hypomagnesemia Manifestations
3 T’s Tremors Twitching Tetany STARVED SZ Anorexia & Arrhythmias Rapid HR Vomiting Emotional lability DTRs (hyperactive)

55 Nursing Management: Hypomagnesemia
Oral supplements Increase dietary intake Parenteral IV or IM magnesium when severe

56

57 Electrolyte Disorders Signs and Symptoms
Excess Deficit Sodium (Na) Hypernatremia Thirst CNS deterioration Increased interstitial fluid Hyponatremia Potassium (K) Hyperkalemia Ventricular fibrillation ECG changes CNS changes Hypokalemia Bradycardia

58 Electrolyte Disorders Signs and Symptoms
Excess Deficit Calcium (Ca) Hypercalcemia Thirst CNS deterioration Increased interstitial fluid Hypocalcemia Tetany Chvostek’s, Trousseau’s signs Muscle twitching CNS changes ECG changes Magnesium (Mg) Hypermagnesemia Loss of deep tendon reflexes (DTRs) Depression of CNS Depression of neuromuscular function Hypomagnesemia Hyperactive DTRs

59 References Adams, M.P., & Urban, C.Q. (2013), Pharmacology : Connections to nursing practice (2nd ed.) Boston: Pearson Education, Inc. Fluids & Electrolytes made Incredibly Easy! 4th edition. (2008). Lippincott Williams & Wilkins. Hockenberry, M.J. & Wilson, D. (2015). Wong’s Nursing care of infants and children (10th ed.). St. Louis, MO: Mosby. Lewis, S., Heitkemper, M. & Dirksen, S. (2014). Medical Surgical Nursing: Assessment and Management of Clinical Problems (9th ed.). St. Louis, MO: Mosby Osborn, K. S., Wraa, C. E., & Watson, A. B. (2010). Medical-Surgical Nursing: Preparation for Practice. Upper Saddle River, NJ: Pearson Touhy, T. & Jett, K. (2014). Ebersole & Hess’ Gerontological Nursing Healthy Aging (4th Ed.) St. Louis: Mosby/Elsevier

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