1. Chapter 76 Disorders in Fluid and Electrolyte Balance

2. Fluids and Electrolytes Balance
A normal balance between the body’s fluids and electrolytes, and acids and bases must exist for a person to be healthy.
Homeostasis
Dynamic process by which the body constantly adjusts to internal and external stimuli
Disrupted by abnormalities of fluid levels and electrolyte content

3. Diagnostic Tests Basic metabolic panel (BMP)
Comprehensive metabolic panel (CMP)
Hematologic tests of the complete blood count (CBC), clotting factors, and liver function tests (LFTs)
Arterial blood gas (ABG) evaluations
Urine and other body fluids

4. Common Medical Treatment
Electrolyte excess
Oral or rectal medication to draw electrolytes out of the body through the gastrointestinal system.
Oral or intravenous (IV) medications may draw fluids or certain electrolytes from the body for elimination through the urinary system.
Electrolyte deficit
Specific electrolytes may be added to a large- volume infusion or given in a smaller volume via intermittent infusion.

5. Nursing Process Data collection Planning and implementation
Teaching the client and family
Treating edema
Monitoring daily fluid balance
Administering medications
Assisting with mouth and Skin care
Evaluation

6. Question Is the following statement true or false?
The nurse is responsible for notifying the primary healthcare provider of significant changes in laboratory values.

7. Answer
True
Although laboratory personnel may have highlighted or noted critical values, the nurse is generally responsible for notifying the primary healthcare provider of significant changes in laboratory values or of critical laboratory values.
Critical values are those laboratory levels that are considered serious or life threatening.
The nurse documents that the laboratory values have been reported.

8. Fluid Volume Excess
Excessive retention of water and sodium in the ECF.
Possible causes
Increased fluid intake, decreased urine output
Excess ingestion of sodium
Physical disorders that result in a decreased ability of the heart to pump effectively
Stress from surgery or other physical trauma that causes aldosterone and antidiuretic hormone (ADH) production, resulting in sodium and water retention

9. Fluid Volume Excess (Cont’d)
Edema: Local or generalized clinical manifestation of many disorders involving FVE
Congestive heart failure, thrombophlebitis, liver cirrhosis
Poor lymphatic drainage
Inflammation
Physical stress
Low protein levels
Sodium retention

10. Fluid Volume Excess (Cont’d)
Dependent edema
Sacral edema
Pitting edema
Nonpitting edema
Pulmonary edema

11. Fluid Volume Deficit Deficiency of fluid and electrolytes in the ECF.
Dehydration: Decreased volume of water; does not occur without electrolyte changes
Possible causes
Inadequate fluid intake and starvation
Loss of body fluids
Prolonged fever
Inability of the body to conserve and reuse water by concentrating the urine

12. Electrolyte Functions
Potassium (K)
Major electrolyte in intracellular fluid (ICF)
Controls cellular osmotic pressure and activates enzymes
Regulates acid–base balance and maintains nerve and muscle function
Influences kidney function and sugar uptake

13. Electrolyte Functions (cont’d)
Sodium (Na)
Major electrolyte in extracellular fluid (ECF)
Influences distribution of water
Maintains acid–base balance and nerve function
Calcium (Ca)
Major component of bones and teeth
Affects permeability of cell membranes and nerve function.
Blood coagulation, maintenance of heartbeat

14. Electrolyte Functions (cont’d)
Magnesium (Mg)
May be needed in activation of enzymes
Aids in some neuromuscular functions
Chloride (Cl)
Plays a key role in acid–base balance
Helps to maintain water balance
Phosphorus (P) and Phosphate (PO4)
Component of bone
Involved in most metabolic processes

15. Electrolyte Imbalance
EXCESS
DEFICIENCY
Potassium (K)
Hyperkalemia
Hypokalemia
Sodium (Na)
Hypernatremia
Hyponatremia
Calcium (Ca)
Hypercalcemia
Hypocalcemia
Magnesium (Mg)
Hypermagnesemia
Hypomagnesemia
Chloride (Cl)
Hyperchloremia
Hypochloremia
Phosphorus (P) and Phosphate (PO4)
Hyperphosphatemia
Hypophosphatemia

16. Imbalances in Older Adults
Decreased renal and respiratory functioning
Thirst mechanisms are depressed; deliberate limitation of fluid intake.
Regular medications affect renal and cardiac function and fluid balance; routine procedures induce serious fluid volume deficits.
Subtle or atypical signs of disturbances; skin turgor is a less valid observation of dehydration.
Self-medication with enemas, laxatives, or remedies, such as baking soda.

17. Question Is the following statement true or false?
In elderly individuals, the thirst sensation may be heightened.

18. Answer
False
In some individuals, especially the elderly, the thirst sensation may be diminished or depressed.
Individuals with impaired sensations, altered mental status, or communication difficulties may be unable to perceive, communicate, or respond to thirst.
Thirst is also a major symptom of hypernatremia.

19. Acid-Base Balance: Acidosis
When the blood is more acidic than normal
Metabolic acidosis
Deficit in bicarbonate ions (HCO3+) or an excess in hydrogen ions (H+)
Respiratory acidosis
Increase in carbon dioxide in the blood

20. Acid-Base Balance: Alkalosis
When the blood is more basic than normal, because of a loss of body acids or excessive retention of alkaline substances
Metabolic alkalosis
Excess of bicarbonate, often owing to excess bicarbonate antacid administration or a loss of acids
Respiratory alkalosis
Deficit of plasma CO2 usually caused by hyperventilation

21. Question Is the following statement true or false?
A simple treatment for respiratory acidosis is for the client to breathe into a paper bag.

22. Answer
False
A simple treatment for respiratory alkalosis, usually caused by hyperventilation, is for the client to breathe into a paper bag, thereby retaining needed CO2 in the body. The client rebreathes his or her own CO2, thus replacing the CO2 needed by the body.

23. End of Presentation