10. Fluid and electrolytes.pptx by Ravindra seervi Rav

RAVINDRA SEERVI
B.SC NURSING STUDENT
2ND SEMESTER

1. By Dr . Howaida Saati Kozier & Erb's Fundamentals of Nursing , Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc . All Rights Reserved

2. Learning Outcomes 1. Discuss the functio n, distribution, movement , and regulation of fluids and el ectrolytes in the body. 2. Identify factors affecting normal body flu id, electrolyte . 4 . Discuss the risk factors for and the causes and effects of fluid, and electrolyte imbalances . 5. Collect assessment d ata related to the client's fluid and electrolyte status .

3. Learning Outcomes 6. Identify examples of nursing diagnoses , outcomes , and interventions for clients with altered fluid, and electrolyte balance . 7. Teach clients measures to maintain fluid and electr olyte . 8. Implement measures to correct imbalances of fluids and electrolytes . 9. Evaluate the effect of nursing interventions on the client 's fluid , electrolyte .

4. Introductio n ● Homeostasi s ● Balance depends on several physiologic processes that regulat e fluid intake and output ● Diseases and daily factors ca n create imbalances such as excessi ve temperatures or vigorous activity and use of diuretics .

5. ● 60% of healthy adult weight ● Fat tissue free of water ● Muscle tissue has significant amount of water . Body Fluids and Electrolytes Water

6. ➢ Within cell ➢ About 2 /3 adult body fluid ➢ Vital to cel l functioning ➢ Medium for metaboli c processes ✓ Outside cell ✓ 1/3 body fluid ✓ Intravascular or plasma ✓ Within vascular system Distribution of Body Fluids Intracellular ( ICF ) Extracellular ( ECF )

7. Distribution of Body Fluids g u l r ents ✓ Interstiti al - Surrounds c ells ✓ Lymph and transcellu lar fluid ( About 5% ) ✓ Carries ox ygen and nutrients to , an d waste away , from cel ls 70 kg epres ng id hi lu g f wei ody lt T L in an ad ure 52–1 40 Fi

8. ● Cations, anions ● Vary from one b ody compartment to another ● Usually measured in milliequivalents ( mEq ) Composition of Body Fluid ➢ ICF ● Potassium , magnesium , phosphate , sulfate ● ECF ● Mostly sodium , chloride , and bicarbonate Fluids ● Contain oxygen , nu trients, waste p roducts, and ions . Electrolytes

9. ✓ Crystalloids -( salts that dissolve readily into true solutions ). ✓ Colloids – ( substances such as large protein molecules that do not readily dissolve into true solutions) ● Solvent – ( is the component of a solution that can dissolve a solute ) Movement of Body Fluids and ● Selectively per meable ● Varying degrees of ease of movement ● Solutes - ( substances dissolved in a liquid ). Electrolytes

10. ● Osmolality : ● It is determined by the tota l solute concentration within a fluid c ompartment. ● It is measured as parts of solute per kilogram of water. ● It is reported as milliosmoles per kilogram (mOsm/ kg ) . Movement o f Body Fluids and Electrolytes

11. Solutions: ● Isotonic – ● Solution has the same osmolality as ECF . (E.g. Normal saline , 0.9% sodium chloride ) ● Hypertonic – ● Solution have a higher osmolality than ECF . ( E.g. 3 % sodium chloride ) ● Hypotonic – ● Solution have a Lo wer osmolality than ECF. ( E.g. 0.45% sodium chloride ) Movement o f Body Fluids and Electrolytes

12. Movement o f Body Fluids and Electrolytes Solutions:

13. ● Fluid intake ● 2,500 mL/day (fluids and food) ● Thirst mechanism ● Fluid output ● Urine ● Feces ● Insensible fluid loss ● Skin and lungs ● Obligatory losse s Total losses is 1,300 mL / day approximately. See TABLES 52– 1,2 Average Daily Fluid Intake and outpu t P.1312 Regulating Body Fluids

14. ● Maintaining homeostasis: ● Kidneys ● Hormones ● Antidiuretic hormone (ADH) ● Renin - angiotensin - aldosterone sy stem ● Atrial natriuretic factor Regulating Body Fluids

15. Table 52-3, (P .1315) ● Sodium (Na + ) ● Potassium ( K + ) ● Calcium (Ca 2+ ) ● Magnesium (Mg 2+ ) ● Chloride ( Cl - ) ● Phosphate ( PO 4 - ) ● Bicarbonate ( HCO 3 - ) ● Electrolytes important for: ➢ Maintaining fluid balance ➢ Contributi ng to acid–base regulation ➢ Facilitating enzyme reactions ➢ Transmitt ing neuromuscular reaction s electrolytes Regulating

16. ● Age ● Sex and body siz e ● Environmental temperature ● Lifestyle ● Diet ● Exercise ● Stress ● Alcohol consumption Factors Affecting Bo dy Fluid, Electrolyte

17. Disturban ces in Fluid Volume and Electrolyte ✓ Renal disease ✓ Cardiovascula r disease ✓ Diabetes mellitus, cancer, COPD ✓ Confusion leading to poor fluid intake ✓ Vomiting , diarrhea , nasogastric suctioning ✓ Burns ✓ Medications ( diureti cs)

18. ➢ Hypovolemia ➢ Isotonic loss of wat er and electrolytes ➢ Third space syndrome ➢ Fluid in area not readily acces sible as ECF Basic Types ✓ Isotonic: ● Loss or gain of water and electrolytes in equal proportions ✓ Osmolar: ● Loss or gain of only water ● Osmolalit y of serum is altered. Fluid volume deficit Fluid Imbalanc es

19. Fluid Imbala nces ● Fluid volume excess ● Isotonic gain of water and electrolytes ● Edema ● Pitting edema

20. Fluid volu me excess Furosemide: Therapeutic effects include: ● Diuresis ,( excretion of water , sodium , chloride , potassiu m, magnesium, hydrogen , and calcium ) and lowering BP ● Client and fami ly teaching ● Weigh yourself daily , and repo rt weight gain or loss of more than 3 pounds in 1 day to your primary care provider. ● Some form of potassium supplementation may be needed. ● Eat diet high in potassium. ● Make position changes fr om lying to sitting and sitting to standing slowly in order to minimize dizziness ( Orthosta tic hypotensi on) .

21. Fluid Imbalances Dehydration Overhydrati on ● Hypo - osmolar gain of only water , leaving low serum osmolality an d low serum sodium levels ● Hyperosmolar loss of only water , leaving the client with excess sodium

22. Electrolyte Imba lances (table 52-6, P1322) Sodium (135–145 mEq/ L) ● Hypernatremia ● Hyponatremia

23. Electrolyte Imbal ances (table 52-6, P132 2) Calcium : ● 5.0 mg / dL ( serum ioni zed) ● Hypocalcemia ● 8.5–10.5 mg / dL ( total serum) ● Hypercalcemi a Potassium : ● 3.5–5 mEq/L ● Hypokalemia ● Hyperkalemia

24. Potassium may be given i ntravenously for severe hypokalemia . ● It must always be diluted appropriately and never be given IV push . ● Potassium that is to be given IV should be mixed i n the pharmacy and double - checked prior to administra tion by two nurses . ● The usual concentration of IV potassium is 20 t o 40 mEq/L. Be Alert

25. Phosphate: • 2.5–4.5 mg / dL • Hypophosphatem ia • Hyperphosphate mia Electrolyte Imbal ances (table 52-6, P132 2) ● 1.5–2.5 mEq/L ● Hypomagnesemia ● Hypermagnesemia Magnesium: Chloride: ● 95–108 mEq/L ● Hypochloremi a ● Hyperchloremia

26. Hypocalcemia

27. Nursing Management

28. ● Chronic diseases ● Acute conditions ● Medications ● Treatments ● Age ● Very old or very young ● Inability to access food and fluids Assessing ● Skin ● Mucus membranes ● Eyes ● Fontanels (infants) ● Cardiovascular system ● Respiratory system ● Neurologic Physical examination Nursing histo ry

29. ● Daily weights ● Vital signs ( Pulse , & Bp ) . ● Fluid intake/output ● Record intake of all of the followin g: ● Oral fluids / Tube feedings / irrigations ● Parenteral feedings / IV medications ● Record output of all of the following: ● Urinary output / Vomitus and liqu id feces ● Tube drainage / Wound and fis tula drainage Assessing Clinical meas urements

30. ● Serum electrolytes ● Complete blood count ( CBC ) ● Hematocrit ( Hct ) information ● Osmolarity ● Urine specific gravity ● Urine pH Assessing Laboratory tests

31. ● Deficient Fluid Volume ● Excess Fluid Volum e ● Risk for Imbalanced Fluid Volume ● Risk for Deficient Fluid volume ● Impaired Gas Exchange What are the Nursing Diagnosi ng For Fluid and electrolytes imbalan ces ?

32. ● Etiology of other diagnoses : ● Impaired Oral Mucous Membrane ● Impaired Sk in Integrity ● Decreased Cardiac Outpu t ● Ineffective Tissue Per fusion ● Activity Intolerance ● Risk for Injury ● Acute Confu sion What are the Nursing Diagn osing For Fluid and electrolytes imbalances ?

33. ● The client will have : ● Maintain or restore normal fluid bala nce ● Maintain or resto re normal balance of electrolytes ● Prevent associated risks ● Tissue breakdown, decreased cardiac output, confusion , a nd other neurologic signs ● Promoting wellness by providing patient t eaching about fluid and ele ctrolytes balance . Planning

34. ● Explain reason for required i ntake and amount needed ● Establish 24 hour plan for ingesting fluid s ● Identify f luids client likes and use those ● Help clients select foods that become liquid at roo m temperature ● Supply cups, glasses, straws ● Encourage pa rticipation in recording intake ● Enteral fluid and electrolyte replacement ● Fluid intake m odifications ● Facilitating fluid inta ke Implementin g

35. Implementin g ● Enteral fluid and electrolyte replacement ● Fluid intake m odifications ● Restricting fluid intake ● Explain reason and amount of restriction ● Place fluids in small containers ● Offer ice chip s and mouth care ● Teach avoidance of ingesting chewy, salty, or sweet foods or fluids

36. ● Parenteral fluid and elect rolyte replacement ● Intravenous sol utions ● Isotonic / Hypotonic / Hypertonic ● Volume expande rs ● Replace lost blood or plasma ● Enteral fluid and electrolyte repl acement ● Dietary changes ● Oral electrolyte supplements ● Potassium / Calcium / Multivitamins ● Sports drinks o r liquid nutritional supplements Implementin g

37. ➢ Parenteral f luid and electrolyte replacement . ➢ Regulating and monitoring intravenous infusions ● Factors affecting flow rate ● Position of forearm ● Tube position and paten cy ● Height of infusion bottle ● Infiltration or leakage ● Ratio of angiocath to vein size ● Nurse must check ● mL / hr ● Drops / min ( gtt / min ) ● KVO or TKO Implementin g

38. Implementin g ● Enteral flu id and electrolyte replacement ● Changing intravenous container s and tubing ● Change primary set and secondary tubing that rema ins continuously attach ed q 72 h. ● Complications of infu sion therapy ● Infiltrati on ● Coolness of skin a round site, skin blanching, edema near site , leakag e, absence of or pinkish blood return, difference compared to contralate ral limb

39. Implement ing Complications of infusion therapy ● Pain , tenderne ss, skin blanching , edema , temp change or burning at site , tight ness ● Redness at site , wa rmth, able cord along d p eleva ing , p vei sw ● Mechanical , chemical , or bacterial Extravasation Phlebitis below site temperature

40. Evaluating ● Collect data as identified in the plan o f care . ● If desired outcomes are not ac hieved, explore the reasons before modifying the care plan .

41. Summary ● Filtration process occurs when fluids and solutes mo ve together across a membrane from an area of higher pressure to an area of a lowe r pressure ● Infiltration could notice by the nu rse who is caring for patient with Intravenous (IV) therapy and find the IV site could be pale, swollen, and cool. ● Fluid volume excess occurs when asses sing a patient and finds crackles in the lung bases and neck veins distention ● Phlebitis could be detected by the nurse who is assessing the intravenous (IV) cannula for a patient receiving IV fluids and finds red ness at site, warmth, swelling, palpable cord along vein, elevated temperature ● Intravenous medication should be included in the patient intake documentation

42. Source Berman , A. Snyder , S & Frandsen , G . (2015). Kozier and E rb’s Fundamentals of Nursing Concepts , Process and Practice ; 10 th edition . USA : P earson International .