fluid & electrolyte acid -base balance ppt.pptx

fluid and electrolyte balance is a dynamic process that is crucial for life and homeostasis .
fluid occupies almost 60% of the weight of an adult
body fluid is located in two fluid compartments, and electrolytes.

1. FLUID , ELECTROLYTE , AND ACID – BASE BALANCES CH:KALAVATHI FACULTY GCN MNCL

2. INTRODUCTION: An electrolyte imbalance occurs when certain mineral levels in your blood get too high or too low. Symptoms of an electrolyte imbalance vary depending on the severity and electrolyte type, including weakness and muscle spasms. A blood test called an electrolyte panel checks levels .

3. Definitions : Fluid Balance : The human body maintains fluid balance through mechanisms such as osmoreceptors in the hypothalamus that sense changes in osmolality. Hormones like antidiuretic hormone (ADH) and aldosterone play crucial roles in regulating water reabsorption and sodium retention in the kidneys, respectively. Understanding these mechanisms is essential for managing conditions like dehydration and fluid overload in clinical settings. .

4. Fluid balance State in which the volume of water and the electrolytes are within the normal limits and there is a normal distribution of fluids in the intracellular and extracellular environment in the body Homeostasis : A self regulating process by which the stability of the internal environment is maintained while adjusted to changing external conditions. Extracellular fluid : The fluid outside the cell. It is 30% of the total body water. It forms 20% of the body weight in an adult.

5. Intracellular fluid : The fluid within cells. It makes up 70% of the total body water. It forms 40% of the body weight in an adult . Dehydration : It is the loss of water from the body. Can result from diarrhoea , vomiting, less fluid intake and excessive sweating .

6. OSMOSIS : The solvent passes from an area of lesser concentration to an area of greater concentration through a semipermeable membrane .

7. DIFFUSION : The solute particles move from an area of higher concentration to an area of lesser concentration

8. FILTRATION Filtration is any of various mechanical, physical or biological operations that separates solids from fluids by adding a medium through which only the fluid can pass. The fluid that passes through is called the filtrate

9. ACTIVE TRANSPORT Active transport unlike diffusion involves moving solutes and ions across a cell membrane from an area of lower concentration to an area of higher concentration.

10. Acid-Base Balance : The body maintains a delicate pH balance through buffering systems, respiratory regulation (CO2 elimination), and renal regulation (bicarbonate excretion/reabsorption ). Acidosis and alkalosis can disrupt normal cellular function and organ systems . Acidosis : Hydrogen ion concentration (pH) below 7.35 . Alkalosis : Hydrogen ion concentration (pH) above 7.45 .

11. Electrolyte Balance : Electrolytes such as sodium, potassium, calcium, and magnesium are vital for cellular function, neuromuscular activity, and maintaining acid-base balance. The kidneys, under the influence of hormones like aldosterone and parathyroid hormone (PTH), regulate electrolyte levels by adjusting reabsorption and excretion rates . MAJOR ELECTROLYTES Extracellular- Na, Cl, HCO3 Intracellular- K, Mg, Ca, proteins

12. ELECTROLYTES Electrolyte is body fluids are active chemicals Cations : Positive charge Anions : Negative charge CATIONS : Sodium , Potassium, Magnesium and Hydrogen ions ANIONS: Chloride , Bicarbonate, Phosphate, Sulfate

13. Electrolytes are: Help maintain homeostasis Regulate  Cardiac & neurological function  Oxygen delivery  Acid-base balance etc .

14. FLUID REGULATION MECHANISMS Maintaining Homeostasis The thirst center : The thirst center in the hypothalamus stimulates or inhibits the desire for a person to drink . Kidneys : They are the primary regulator of Regulation of Electrolytes Most of the electrolytes enter the body through dietary intake body fluids and electrolyte balance. The kidneys control the re-absorption of water from plasma filtrate and ultimately the amount excreted as urine.

15. The Renin-Angiotensin-Aldosterone system : The RAA system controls fluid volume, in which when the blood volume decreases, blood flow to the renal juxtaglomerular apparatus is reduced, there by activating the RAA system . Atrial natriuretic peptide: The heart also plays a role in correcting overload imbalances, by releasing ANP from the right atrium .

16. Antidiuretic hormone : ADH regulates the amount of water the kidney tubules absorb and is released in response to low blood volume or in response to an increase in the concentration of sodium and other solutes in the intravascular fluids. Aldosterone : Increases the sodium release to the bloodstream and potassium excretion in the urine.

17. ACID,BASE,AND SALTS Acid : An acid is a type of compound that contains hydrogen ions . Base : A base or alkali is a compound that contains hydroxyl ions . Salt : A salt is a combination of a base and an acid and is created when the positive ions of a base Important salts : The body contains several important salts like sodium chloride, potassium chloride, calcium chloride, calcium carbonate, calcium phosphate, and sodium phosphate .

18. Review of Physiological Regulation of Fluid, Electrolyte and Acid-Base Balances Normal Fluid Intake and Output Daily intake: An adult human at rest takes appropriately 2500 ml of fluid daily . Approximate levels of intake include fluids 1200 ml, foods 1000 ml, and metabolic products 30 ml . Daily output: Daily output should be approximately equal to intake. Normal output occurs as urine, breathing, perspiration and feces .

19. FLUID AND ELECTROLYTE IMBALANCE : Fluid and electrolyte balance is a dynamic process that is crucial for life It plays an important role in homeostats Imbalance may result from many factors, and it is associated with the illness WATER DISTRIBUTION Water constitutes : 60 % total body weight 40 % intracellular (2/3rd of total) 20 % extracellular (1/3rd of total) 15 % interstitial (3/4th of ECF) 5 % intravascular ( 1/4th of ECF)

20. FACTORS AFFECTING FLUID, ELECTROLYTE AND ACID-BASE BALANCE: 1.Fluid Balance: Intake vs. Output Kidney Function Hormonal Regulation 2.Electrolyties Balance 3.Acid-Base Balance pH Regulation

21. Buffer Systems Respiratory Regulation Renal Regulation 4.External Influences Illness Environmental Factors Diet Kidney problems Medications

22. Fluid Balance: Intake vs. Output: The balance between fluid intake (from drinking and eating) and output (urine, sweat, feces) is critical. Factors affecting intake include thirst, dietary habits, and fluid losses through sweating and breathing. Kidney Function: The kidneys regulate fluid balance by adjusting urine volume and concentration based on hydration status. Hormonal Regulation: Hormones such as antidiuretic hormone (ADH) and aldosterone help regulate water reabsorption in the kidneys, influencing fluid balance.

23. Electrolyte Balance: Sodium (Na+): The main extracellular cation, sodium balance is crucial for maintaining osmotic pressure and water balance. Potassium (K+): Important for cellular function, especially nerve and muscle function. Calcium (Ca2+), Magnesium (Mg2+), Chloride (Cl-), Phosphate (PO43-): Other electrolytes essential for various cellular processes. Factors influencing electrolyte balance include dietary intake, renal function, hormonal regulation (e.g., aldosterone for sodium and potassium), and acid-base status.

24. Acid-Base Balance: pH Regulation: The body tightly regulates pH (acid-base balance) to maintain homeostasis. The normal pH range in blood is 7.35-7.45. Buffer Systems: Buffers in the blood, such as bicarbonate-carbonic acid, phosphate, and protein buffers, help resist changes in pH. Respiratory Regulation: The lungs regulate pH by excreting CO2, which affects carbonic acid levels in the blood. Renal Regulation: The kidneys excrete hydrogen ions (acidic) and reabsorb bicarbonate ions (basic), contributing to long-term pH balance.

25. Factors affecting acid-base balance include respiratory function (rate and depth of breathing affect CO2 levels), kidney function (acid secretion and bicarbonate reabsorption), and metabolic processes (production of acids and bases from cellular metabolism ).

26. External Influences : ILLNESS: When a person is sick, especially if the illness involves Whiting, diarrhea, or fever, he is at greater risk for fluid and electrolyte imbalance. These factors cause body to lose water. If a large amount of water is lost from the body, the result is dehydration. This would obviously alter the fluid balance of the body, because electrolytes are dissolved in body fluids, It can also alter the electrolyte concentrations.

27. Water can be replenished by drinking, but sometimes when the person is sick it can be difficult to drink enough water to replenish what is lost . Stress and alcohol consumption also affect fluid, electrolyte and acid-base balance as the person may not consume adequate fluids and electrolytes . Trauma causes release of intracellular potassium which is an extremely dangerous imbalance .

28. ENVIRONMENTAL FACTORS: Various environmental factors such as temperature, humidity, radiation, and atmospheric pressure affect mainly sweating and urinary water loss, while physical exercise causes DIET : The fluid and electrolyte balance in the body is affected by the diet because the foods and beverages a person takes provide fluid and electrolytes

29. people with conditions like anorexia nervosa , which is an eating disorder characterized by self-starvation, or bulimia, vomiting , can develop an imbalance. Retention of sodium causes fluid retention and imbalance. Same way excessive loss of sodium is associated with decreased volume of body fluid. Fluid Volume Deficit results from loss of body fluids and occurs more rapidly with decreased fluid intake Fluid volume excess may be related to a simple fluid overload or diminished function of the homeostatic mechanisms responsible for regulating fluid balance.

30. KIDNEY PROBLEMS: The kidneys are important regulators of fluid and electrolyte balance in the body. The kidneys have the ability to excrete excess water and electrolytes through the urine. They can also retain water or electrolytes if their levels drop too low. Thus, the kidneys help maintain a balance between daily consumption and excretion of electrolytes and water . If kidney problems develop due to infection, inflammation, or trauma, the kidneys' ability to maintain fluid and electrolyte balance can be thrown off.

31. Medications : There are certain medications that could lead to electrolyte imbalances when taken against the physician's orders Maintaining fluid, electrolyte, and acid-base balance is essential for overall health, and the body

32. DIAGNOSIS Physical examination : Physical examination is necessary to observe the signs and symptoms of the imbalances Laboratory studies : BUN (Blood Urea Nitrogen): BUN may be decreased in fluid volume excess[FVE] due to plasma dilution . Hematocrit : Hematocrit levels in fluid volume deficiency[FVD] are greater than normal because there is a decreased plasma volume .

33. Serum electrolyte levels : Measurement of electrolyte levels should be performed to check for presence of an imbalance . ECG : ECG changes can also contribute to the diagnosis of fluid and electrolyte imbalance . ABG analysis : ABG analysis may reveal acid-base imbalances.

34. MEDICAL MANAGEMENT Treatment of fluid and electrolytes imbalances needs accuracy to avoid consequences that can result in complications . Isotonic electrolyte solutions : These solutions are used to treat the hypotensive patient with FVD because they expand plasma volume . Accurate Intake and Output : Accurate and frequent assessments of Intake and Output should be performed when therapy should be slowed or increased to prevent volume deficit or overload.

35. Dialysis: Hemodialysis or peritoneal dialysis is performed to remove nitrogenous wastes and control potassium and acid-base balance, and to remove sodium and fluid . Nutritional therapy : Treatment of fluid and electrolyte imbalances should involve restrictions or enforcement of the concerned electrolyte.

36. DRUG THERAPY AVP (Arginine Vasopressin) receptor agonists: These are new pharmacologic agents that treat hypernatremia by stimulating free water excretion . Diuretics : To decrease fluid volume in FVE, diuretics are administered . IV Calcium Gluconate : If serum potassium levels are dangerously elevated, it may be necessary to administer IV Calcium Gluconate . Calcitonin : Calcitonin can be used to lower the serum calcium level and is particularly useful for patients with heart disease or heart failure who cannot tolerate large sodium loads.

37. FLUID VOLUME DEFICIT/HYPOVOLEMIA/ DEHYDRATION Fluid volume deficit (FVD) is a state or condition where the fluid output exceeds the fluid intake. It occurs when the body loses both water and electrolytes from the ECF in similar proportions. Common sources of fluid loss are the gastrointestinal tract, polyuria, and increased perspiration.. Fluid volume deficit may be an acute or chronic condition managed in the hospital, outpatient center, or home setting.

38. DEHYDRATION: The most common cause of dehydration in young children is severe diarrhea and vomiting. Older adults naturally have a lower volume of water in their bodies, and may have conditions or take medications that increase the risk of dehydration. HYPOVOLEMIA It also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. this may be due to either a loss of both salt and water or a decrease in blood volume. hypovolemia refers to the loss of extracellular fluid

39. CAUSES Abnormal losses through the skin, GI tract or kidneys . Decrease in intake of fluid (e.g., inability to intake fluid due to oral trauma) Bleeding Diarrhoea Diuresis Abnormal drainage Increased metabolic rate (e.g., fever, infection )

40. Blood loss - accidents, trauma, bleeding Burns Excessive perspiration Decreased production of ADH RISK FACTORS: Vomiting Diarrhoea GI suctioning Sweating Decreased intake,

41. Nausea Inability to gain access to fluids Adrenal insufficiency Osmotic diuresis Hemorrhage Coma Burns Ascites and liver dysfunction

42. SIGNS AND SYMPTOMS Weak rapid pulse Loss of weight and loss of skin turgor Thirst Decreased urine output-oliguria (less than 30 ml per hour ) Postural hypotension Dry mucous membrane Decreased body temperature

43. Altered sensorium Increased specific gravity of urine . Increased blood urea level flattened neck veins Decreased or delayed capillary refill Cool , clammy skin Muscle weakness, and cramps.

44. MANAGEMENT Treat the cause/correct the cause . Replace fluids via intravenous route (according to the degree of fluid loss ) Provide concentrated fluids Correct electrolytes imbalance

45. FLUID VOLUME EXCESS Fluid Volume Excess is also termed as hypervolemia. It refers to the excessive accumulation of fluids in the body. Body fluids, like blood and water, are important to keep your organs functioning People with heart and kidney conditions and people who are pregnant often experience hypervolemia. The exact rate of occurrence is unknown because mild cases of hypervolemia resolve on their own, while severe cases are often a symptom of an underlying condition

46. CAUSES: Inability of kidneys to excrete urine - Chronic kidney disease Excessive Sodium intake /retention . Heart failure Cirrhosis of liver Cushing syndrome Excessive unwise infusion of I/V fluids Hormonal changes and pregnancy

47. SIGNS AND SYMPTOMS Crackles and wheeze in the lungs Dyspnea Ascites Decreased blood urea nitrogen ( BUN) Decreased hematocrit Distended neck veins Bounding pulse due to excessive blood volume Edema

48. Bloating in the stomach. Mild discomfort like cramping or a headache. Quick weight gain . Severe symptoms of hypervolemia : High blood pressure. Shortness of breath . Heart failure

49. MANAGEMENT Treatment for hypervolemia varies depending on the cause but focuses on reducing the amount of fluid in the body. Diuretics Reducing the amount of salt in the diet. Limiting the amount of fluid intake. Dialysis or paracentesis: to remove excess fluid from the body. Rest

50. ELECTROLYTES IMBALANCE An electrolyte imbalance occurs when certain mineral levels in your blood get too high or too low. Symptoms of an electrolyte imbalance vary depending on the severity and electrolyte type, including weakness and muscle spasms. A blood test called an electrolyte panel checks levels.

51. Sodium Deficit: Hyponatremia Excess : Hypernatremia Potassium Deficit: Hypokalemia Excess : Hyperkalemia Calcium Deficit : Hypocalcemia Excess : Hypercalcemia

52. HYPONATREMIA Hyponatremia is the most common type of electrolyte imbalance . DEFINITION: Hyponatremia is defined as a sodium concentration of less than 135 mmol /L (135 mEq /L), with severe hyponatremia being below 120 mEq /L.

53. CAUSES : Using diuretics Drinking too much alcohol Untreated diarrhea Taking certain medications GI LOSS: diarrhoea, vomiting, Ng suction RENAL LOSS: Diuretics, adrenal insufficiency, a wasting renal disease SKIN LOSS: Burns, wound drainage

54. Hypovolemic Hyponatremia: Causes: Loss of sodium and water (e.g., diarrhea, vomiting, diuretic use). Euvolemic Hyponatremia: Causes: Syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypothyroidism, adrenal insufficiency, psychogenic polydipsia. Hypervolemic Hyponatremia: Causes: Heart failure, liver cirrhosis, nephrotic syndrome.

55. Clinical Manifestations Neurological Symptoms: Headache, confusion, lethargy, seizures (especially in severe cases ). Dizziness, coma. Gastrointestinal Symptoms: Nausea, vomiting, abdominal cramps . Musculoskeletal Symptoms: Weakness, muscle cramps, Muscular twitching. Cardiovascular Symptoms: Hypotension, tachycardia (due to volume depletion in hypovolemic hyponatremia ).

56. Skin :Dry skin, and edema . May be absent, mild or severe. Mild symptoms include A decreased ability to think, Headaches, Nausea, Poor balance, Anorexia, Vomiting,

57. Diagnosis: Serum Sodium Levels: Confirm hypernatremia with laboratory tests. Severity categorization: Mild: 145-149 mEq /L Moderate: 150-154 mEq /L Severe: >155 mEq /L

58. TREATMENT Treat / correct the underlying cause. correction with 3% normal saline is only recommended in those with significant symptoms. Sodium replacement administration of sodium by mouth who eat and drink. Lactated ringers solution (0.9% sodium chloride) is prescribed

59. Limiting water intake. Adjusting or stopping medications, or adding newer medications. Adding salt to your diet . Medications: Consider using vasopressin receptor antagonists (e.g., tolvaptan ) in select cases under close monitoring to increase free water excretion. Diuretics: Use loop diuretics cautiously to promote sodium and water excretion, under monitoring of electrolyte levels .

60. Nursing Considerations : History: Assess for factors predisposing to inadequate water intake or excessive sodium intake, recent illnesses (e.g., fever, diarrhea), medications (e.g., diuretics ). Physical Examination: Check for signs of volume status (e.g., skin turgor, mucous membranes), neurological status (e.g., mental status changes, seizures), and vital signs.

61. Patient Education: Educate patients and caregivers about the importance of fluid restriction, medication compliance, and monitoring symptoms. Assessment: Monitor neurological status, vital signs, and intake/output closely . Complications : Severe hyponatremia can lead to cerebral edema, seizures , and coma if not corrected appropriately.

62. HYPERNATREMIA DEFINITION: Hypernatremia is defined as an elevated concentration of sodium in the blood, typically when serum sodium levels exceed 145 mEq /L . Causes of Hypernatremia: Inadequate Water Intake: Prolonged inability to access water (e.g., impaired thirst sensation, inability to communicate water needs ).

63. Excessive Water Loss: Increased insensible losses (e.g., fever, burns). Gastrointestinal losses (e.g., diarrhea, vomiting). Renal losses (e.g., diabetes insipidus, osmotic diuresis). Excessive Sodium Intake: Rarely occurs from excessive sodium ingestion without adequate water intake . Increased serum sodium concentration

64. Clinical Manifestations: Neurological Symptoms: Thirst, restlessness, irritability, confusion, lethargy, seizures, Thirst, Hallucinations. Musculoskeletal Symptoms: Weakness, muscle cramps, Twitching. Cardiovascular Symptoms: Hypotension, tachycardia (due to volume depletion in severe cases),Increased BP and pulse. Elevated body temperature, Restlessness, pulmonary edema,

65. MANAGEMENT Gradual lowering of the sodium level by the infusion of a hypotonic electrolyte solution 0.3% sodium chloride Diuretics also may be prescribed to treat the sodium gain Hypernatremia involves correcting the fluid and sodium balance in the body. Treat the underlying condition that is causing the increased blood sodium levels.

66. Administer intravenous fluids such as 0.45% NaCl or 5% dextrose in water (D5W) cautiously to correct hypernatremia over 48-72 hours . Nursing Considerations: Patient Education: Educate patients and caregivers about the importance of adequate fluid intake, signs of dehydration, and compliance with prescribed treatment. Assessment: Monitor neurological status, vital signs, and fluid balance closely to detect and manage complications promptly.

67. Complications: Severe hypernatremia can lead to neurological sequelae, including Seizures, coma, and permanent brain damage if not corrected promptly .

68. HYPOKALEMIA Hypokalemia refers to a lower-than-normal level of potassium in the blood, typically defined as a serum potassium level below 3.5 mEq /L .. Normal potassium levels are between 3.5 and 5.0. mmol /L Potassium is crucial for maintaining proper function of cells, nerves, and muscles, including the heart muscle

69. CAUSES OF HYPOKALEMIA INCLUDE Causes of Hypokalemia: Gastrointestinal Losses: Vomiting, diarrhea, nasogastric suctioning. Use of laxatives or enemas. Renal Losses: Diuretic therapy (especially loop and thiazide diuretics like furosemide and steroids). Renal tubular acidosis. Hyperaldosteronism, Dialysis, Diabetes insipidus,

70. Intracellular Shift: Alkalosis (shifts potassium into cells). Insulin therapy (promotes cellular uptake of potassium). Inadequate Intake: Prolonged fasting or inadequate dietary intake Hypomagnesemia, and not enough intake of potassium in the diet.

71. Clinical Manifestations: Muscle Weakness: Especially in the legs and may progress to paralysis, Muscle weakness, Leg cramps , Paresthesia , Reflexes. Cardiac Arrhythmias: Particularly ventricular arrhythmias, Low potassium also increases the risk of an abnormal heart rhythm, which is often too slow and can cause cardiac arrest.

72. Fatigue and Malaise: Generalized weakness and fatigue, Anorexia, Constipation: Due to smooth muscle dysfunction, Abdominal distention, and hypoactive Polyuria and Polydipsia: Due to renal tubular dysfunction

73. Diagnosis: Serum Potassium Levels: Confirm hypokalemia with laboratory tests. Severity categorization: Mild: 3.0-3.5 mEq /L Moderate: 2.5-2.9 mEq /L Severe: <2.5 mEq /L Electrocardiogram (ECG): Assess for characteristic changes such as flattened T waves, U waves, and ST segment depression. Severe hypokalemia can lead to prominent U waves and potentially lethal arrhythmias.

74. Treatment of Hypokalemia: Oral Potassium Replacement: Potassium Chloride ( KCl ): Given orally to replenish potassium levels. Dosage: Depends on the severity of hypokalemia and individual patient needs. Common doses range from 20-80 mEq per day divided into multiple doses to avoid gastrointestinal irritation. Intravenous Potassium Replacement: Indication: For severe symptomatic hypokalemia or when oral intake is not feasible. Caution: Must be administered cautiously and under continuous cardiac monitoring due to the risk of cardiac arrhythmias and vein irritation .

75. Potassium levels that are only slightly below the normal range can be managed with changes in the diet . Lower levels of potassium require replacement with supplements either taken by mouth or given with significant intravenously. Magnesium replacement may also be required . Minor cases of hypokalemia may be treated with oral potassium

76. Trying to increase potassium intake through the diet . For example, some of the following foods are high in potassium : Dried fruits Nuts Spinach Potatoes Bananas Avocados Bran cereals However, oral supplements of potassium for a period are usually needed as well, unless the hypokalemia is very mild.

77. Nursing Considerations : History: Assess for risk factors such as recent illnesses (e.g., vomiting, diarrhea), medication history (especially diuretics), dietary habits, and symptoms. Physical Examination: Check for signs of muscle weakness or paralysis, cardiac irregularities (e.g., irregular pulse, palpitations), and gastrointestinal symptoms .

78. Patient Education: Educate patients on the importance of potassium-rich foods (e.g., bananas, oranges, potatoes), adherence to prescribed medications, and monitoring for signs of hypokalemia. Assessment: Monitor potassium levels, symptoms, ECG changes, and fluid balance closely during treatment

79. Complications: Severe hypokalemia can lead to life-threatening cardiac arrhythmias, muscle paralysis, and respiratory failure if not corrected promptly .

80. HYPERKALEMIA Hyperkalemia refers to an elevated concentration of potassium in the blood, typically defined as a serum potassium level above 5.0 to 5.5 mEq /L. Potassium is crucial for various physiological processes, including maintaining proper electrical activity in the heart and normal neuromuscular function.

81. Causes of Hyperkalemia: Impaired Renal Excretion: Acute or chronic kidney disease. Medications affecting potassium excretion (e.g., potassium-sparing diuretics, ACE inhibitors, NSAIDs ). Hypoaldosteronism and Rhabdomyolysis. Excessive Potassium Intake: High dietary potassium intake or potassium supplements.

82. Rapid infusion of potassium-containing intravenous fluids Excessive Potassium Intake: High dietary potassium intake or potassium supplements. Rapid infusion of potassium-containing intravenous fluids Pseudo hyperkalemia: Potassium release from cells during blood sampling or handling (e.g., hemolysis).

83. Clinical Manifestations: Cardiac Symptoms: Palpitations, irregular heartbeats (arrhythmias), potentially progressing to cardiac arrest. Muscular Symptoms: Weakness, paralysis (especially in severe cases). Gastrointestinal Symptoms: Nausea, vomiting, abdominal cramping. Neurological Symptoms: Tingling sensations, numbness

84. Treatment of Hyperkalemia: Stabilization and Immediate Measures: Cardiac Monitoring: Continuously monitor ECG for changes and signs of arrhythmias. Calcium Gluconate or Calcium Chloride: Administer intravenously to stabilize cardiac cell membranes and protect against arrhythmias. Calcium does not lower potassium levels but protects the heart from the effects of hyperkalemia

85. Enhanced Potassium Excretion: Diuretics: Loop diuretics (e.g., furosemide) may be used to increase potassium excretion in patients with adequate urine output and renal function. Sodium Bicarbonate: Corrects acidosis, which can help shift potassium back into cells . Potassium Removal from the Body: Kayexalate (Sodium Polystyrene Sulfonate): Administered orally or rectally to exchange sodium for potassium in the intestines, promoting potassium excretion

86. Hemodialysis : Reserved for severe hyperkalemia refractory to other treatments or in patients with acute kidney injury or renal failure. Prevention of Recurrence: Identify and manage underlying causes of hyperkalemia (e.g., adjust medications, treat renal disease). Educate patients on dietary potassium restriction and avoidance of high-potassium foods.

87. HYPOCALCEMIA Low calcium levels in the blood serum is referred as Hypocalcemia. The normal range is 8.5-10.5 mg/dl with levels less than 8.5 mg/dl defined as hypocalcemia . CAUSES Hypoparathyroidism Primary Hypoparathyroidism Secondary Hypoparathyroidism Vitamin D Deficiency

88. Alkalosis Renal failure Pseudo hypoparathyroidism Hypomagnesemia Pancreatitis Certain rare genetic disorders Certain medications:  bisphosphonates ,  corticosteroids ,  rifampin ,  calcitonin ,  chloroquine

89. Hypoparathyroidism: Primary Hypoparathyroidism: Reduced secretion of parathyroid hormone (PTH) due to damage or removal of parathyroid glands during surgery. Secondary Hypoparathyroidism: Reduced PTH secretion due to underlying conditions (e.g., autoimmune diseases). Vitamin D Deficiency: Insufficient dietary intake or inadequate sunlight exposure leading to decreased vitamin D production or absorption.

90. Acute Pancreatitis: Can lead to precipitation of calcium with fatty acids, reducing ionized calcium levels. Chronic Kidney Disease: Impairs the activation of vitamin D and decreases renal calcium reabsorption. Magnesium Deficiency: Impairs PTH secretion and decreases responsiveness of target tissues to PTH. Alkalosis: Shifts calcium from ionized to protein-bound form, reducing the biologically active ionized calcium levels.

91. SIGNS AND SYMPTOMS Neuromuscular Irritability: Tetany (muscle cramps, spasms ), paresthesias (tingling, numbness), hyperactive reflexes . Cardiovascular : Prolonged QT interval, arrhythmias (especially in severe cases ), cardiac arrest. Gastrointestinal : Abdominal cramps, diarrhea . Neurological : Seizures (in severe cases ). Confusion.

92. Irritability Bronchospasm Chvostek's sign is the twitching of the facial muscles in response to tapping over the area of the facial nerve . Trousseau's sign is characterized by the occurrence of carpopedal spasm caused by inflating the blood-pressure cuff to a level above systolic pressure for 3 minutes

93. TREATMENT The treatment of hypocalcemia involves addressing the underlying cause and replenishing calcium levels to restore normal physiological function . Calcium Replacement: Oral Calcium Supplements: Calcium Carbonate or Calcium Citrate: Given orally to increase calcium levels in patients with mild to moderate hypocalcemia. Dosage: Typically prescribed based on the severity of hypocalcemia and individual patient needs. Common doses range from 500 mg to 2,000 mg of elemental calcium per day.

94. Intravenous Calcium Salts: Calcium Gluconate or Calcium Chloride: Administered intravenously for severe or symptomatic hypocalcemia when oral intake is not feasible or when rapid correction is needed. Administration: Infused slowly to minimize the risk of cardiac arrhythmias and other complications .

95. Vitamin D Supplementation: Calcitriol (Active Vitamin D): Mechanism: Enhances intestinal absorption of calcium and promotes bone mineralization. Indications: Used in hypocalcemia due to vitamin D deficiency or impaired vitamin D activation. Dosage: Prescribed based on serum vitamin D levels and severity of hypocalcemia .

96. Ergocalciferol ( Vitamin D2) or Cholecalciferol (Vitamin D3): Mechanism: Precursors converted to active vitamin D in the liver and kidneys. Indications: Used in chronic vitamin D deficiency to restore calcium balance. Dosage: Prescribed based on serum vitamin D levels and response to therapy

97. Magnesium Replacement: Magnesium Sulfate or Magnesium Oxide: Mechanism: Corrects concurrent magnesium deficiency, which can impair parathyroid hormone (PTH) secretion and responsiveness. Indications: Used when hypocalcemia is associated with magnesium deficiency. Dosage: Adjusted based on serum magnesium levels and clinical response

98. Nursing Interventions: Oral/IV Calcium Replacement: Calcium Gluconate: Given IV for acute severe hypocalcemia or when oral intake is not feasible. Calcium Carbonate or Citrate: Given orally for mild to moderate hypocalcemia. Vitamin D Supplementation: Calcitriol (active form of vitamin D): Given orally or IV to enhance calcium absorption and bone mineralization .

99. Magnesium Replacement: Correct magnesium deficiency to restore PTH function and improve calcium levels. Seizure Precautions: Implement seizure precautions for patients at risk of seizures due to hypocalcemia. Patient Education: Educate patients on the importance of calcium and vitamin D-rich foods (e.g., dairy products, leafy green vegetables) and adherence to prescribed medications.

100. Monitoring: Regularly assess serum calcium levels, symptoms, and response to treatment to guide adjustments in therapy . Complications: Severe Tetany: Including laryngospasm and respiratory compromise. Cardiac Arrhythmias: Especially in severe hypocalcemia.

101. Hypercalcemia It refers to an elevated level of calcium in the blood, typically defined as a total serum calcium level greater than 10.5 mg/dl (or ionized calcium greater than 5.6 mg/dl ). Causes of Hypercalcemia : Primary Hyperparathyroidism : Most common cause, due to excessive parathyroid hormone (PTH) secretion leading to increased calcium release from bones

102. Malignancy : Cancer cells can release substances that increase calcium levels (e.g., parathyroid hormone-related protein, PTHrP ). Hypercalcemia of Malignancy : Direct bone metastases can cause bone breakdown and release of calcium . Hyperthyroidism : Increases bone turnover and can lead to hypercalcemia. Granulomatous Diseases : Such as sarcoidosis, where granulomas produce 1,25-dihydroxy vitamin D leading to increased intestinal absorption of calcium.

103. Excessive Calcium and Vitamin D Intake: Including supplements . Thiazide Diuretics: Can decrease urinary calcium excretion . Immobilization : Prolonged immobility can increase bone resorption.

104. Clinical Manifestations: Neuromuscular: Weakness, fatigue, lethargy, confusion, depressed reflexes, and in severe cases, coma. Gastrointestinal: Anorexia, nausea, vomiting, constipation, abdominal pain. Renal: Polyuria, polydipsia, nephrolithiasis (kidney stones), renal insufficiency. Cardiovascular: Hypertension, shortened QT interval, and in severe cases, arrhythmias.

105. TREATMENT The treatment of hypercalcemia depends on the severity of the condition, the underlying cause, and the presence of symptoms. Here's an overview of the treatment strategies commonly used in clinical practice: 1. Fluid Hydration: Purpose: Increases renal calcium excretion and helps prevent renal complications like nephrolithiasis. Method: Administer isotonic saline (0.9% NaCl ) intravenously to maintain adequate hydration status.

106. 2. Pharmacological Interventions : Calcitonin: Mechanism : Inhibits bone resorption and enhances renal calcium excretion . Administration : Usually given intramuscularly or subcutaneously for rapid onset of action . Indications : Used for acute management or when rapid reduction of calcium levels is required . .

107. Bisphosphonates : Mechanism : Inhibit osteoclastic bone resorption, reducing calcium release from bones . Examples : Pamidronate and zoledronic acid are commonly used intravenously . Indications : Effective for hypercalcemia due to malignancy or primary hyperparathyroidism

108. Glucocorticoids : Mechanism : Inhibit calcium absorption from the gastrointestinal tract and promote renal excretion . Indications : Used in hypercalcemia associated with granulomatous diseases like sarcoidosis . Loop Diuretics (e.g., Furosemide ): Mechanism : Increase renal calcium excretion by promoting diuresis . Indications : Used in conjunction with hydration to prevent fluid overload and manage hypercalcemia.

109. Treatment of Underlying Cause: Primary Hyperparathyroidism: Surgical removal of the parathyroid gland (parathyroidectomy) may be necessary. Malignancy: Targeted therapy, chemotherapy, or radiation therapy to reduce calcium release from tumor cells. Other Causes: Addressing the underlying condition contributing to hypercalcemia (e.g., discontinuing calcium and vitamin D supplements, treating hyperthyroidism).

110. Dialysis: Indication: Reserved for severe hypercalcemia refractory to other treatments or in patients with renal failure who are unable to excrete excess calcium effectively. 5. Patient Monitoring and Supportive Care: Monitor Serum Calcium Levels: Regularly assess to guide treatment adjustments. Cardiovascular Monitoring: Monitor for signs of arrhythmias or hypertension. Neurological Assessment: Assess for changes in mental status or neuromuscular symptoms. Hydration Status: Ensure adequate fluid intake to prevent dehydration and promote urinary calcium excretion.

111. Nursing Considerations: Patient Education: Educate patients on the importance of medication adherence, dietary restrictions (if applicable), and signs and symptoms of recurrent hypercalcemia . Monitor Vital Signs: Especially for signs of hypertension and changes in heart rate and rhythm. Encourage Hydration: Increase oral fluid intake unless contraindicated (e.g., heart failure).

112. Monitor Electrolytes: Especially potassium levels, as hypercalcemia can lead to hypokalemia . Medication Administration: Administer prescribed medications such as loop diuretics (e.g., furosemide) to increase calcium excretion .

113. Long-Term Management: Follow-Up: Regular follow-up to monitor calcium levels and assess for recurrence or complications. Prevention: Address underlying risk factors (e.g., encourage smoking cessation, monitor calcium and vitamin D intake) to prevent recurrence of hypercalcemia .

114. Complications: Renal Stones: Due to increased urinary calcium excretion. Cardiac Arrhythmias: Particularly in severe cases. Neurological Impairment: Coma or seizures in extreme cases.

115. A CID-BASE IMBALANCES Acid-base imbalances occur when the body's mechanisms for maintaining pH homeostasis fail, leading to conditions of either acidosis or alkalosis. These imbalances can be categorized as either respiratory or metabolic, depending on their origin .

116. The normal values for arterial blood gases (ABG) components are essential for assessing a patient’s acid-base status. Here are the typical reference ranges for pH, Pa CO ₂, and HCO ₃⁻ pH : Normal range: 7.35 to 7.45pH below 7.35 indicates acidemia . pH above 7.45 indicates alkalemia .

117. Pa CO₂ (Partial Pressure of Carbon Dioxide): Normal range: 35 to 45 mm Hg Pa CO ₂ below 35 mmHg suggests respiratory alkalosis ( hypo capnia ). Pa CO ₂ above 45 mmHg suggests respiratory acidosis (hypercapnia ). HCO ₃⁻ (Bicarbonate ): Normal range: 22 to 26 m Eq /LHCO₃⁻ below 22 m Eq /L indicates metabolic acidosis. HCO ₃⁻ above 26 m Eq /L indicates metabolic alkalosis.

118. Examples of ABG Interpretation Respiratory Acidosis : pH : < 7.35 Pa CO ₂: > 45 mmHg HCO ₃⁻: Normal (acute) or increased (chronic, due to renal compensation ) Respiratory Alkalosis : pH : > 7.45 Pa CO ₂: < 35 mmHg HCO ₃⁻: Normal (acute) or decreased (chronic, due to renal compensation )

119. Metabolic Acidosis : pH : < 7.35 Pa CO ₂: Normal or decreased (due to respiratory compensation ) HCO ₃⁻: < 22 mEq /L Metabolic Alkalosis : pH : > 7.45 Pa CO ₂: Normal or increased (due to respiratory compensation ) HCO ₃⁻: > 26 mEq /L

120. Types of Acid-Base Imbalances Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

121. RESPIRATORY ACIDOSIS: Respiratory acidosis is a condition characterized by an excess of carbon dioxide (CO₂) in the blood due to inadequate ventilation. This leads to an increase in hydrogen ion concentration, resulting in a decrease in blood pH ( acidemia ). Respiratory acidosis can be divided into 2 types ACUTE CHRONIC

122. CAUSES OF RESPIRATORY ACIDOSIS Acute Respiratory Acidosis : Airway Obstruction : Aspiration, severe asthma, anaphylaxis, Hypoventilation, leading to increased CO₂ levels Central Nervous System Depression : Drug overdose (e.g., opioids, sedatives), head trauma . Neuromuscular Disorders : Myasthenia gravis, Guillain-Barré syndrome . Acute Lung Conditions : Pneumonia, acute respiratory distress syndrome (ARDS), pulmonary edema.

123. Chronic Respiratory Acidosis : Chronic Obstructive Pulmonary Disease (COPD): Chronic bronchitis, emphysema . Obesity Hypoventilation Syndrome : Decreased respiratory drive in obese individuals . Restrictive Lung Disease: Pulmonary fibrosis, severe kyphoscoliosis . Neuromuscular Disorders: Long-standing conditions like muscular dystrophy .

124. Clinical Features Acute Respiratory Acidosis : Rapid onset of symptoms Headache , confusion, drowsiness Dyspnea (shortness of breath), cyanosis Tachycardia , arrhythmias Severe cases may lead to coma and death if untreated Chronic Respiratory Acidosis : Insidious onset, often asymptomatic until severe Fatigue , lethargy Morning headache Memory impairment, personality changes Chronic cough and wheezing (in COPD)

125. Diagnostic Evaluation Arterial Blood Gas (ABG) Analysis : pH : Low ( acidemia ) Pa CO ₂: Elevated(> 45 mmHg ) HCO ₃⁻: Normal in acute cases; elevated in chronic cases due to renal compensation Chest X-ray: To identify underlying lung pathology (e.g., pneumonia, COPD ). Pulmonary Function Tests (PFTs): To assess lung function and identify chronic lung disease . Electrolyte Panel : To check for associated metabolic disturbances.

126. Management Acute Respiratory Acidosis : Airway Management : Ensure airway patency, suction if necessary . Ventilator Support : Non-invasive ventilation (e.g., CPAP, Bi PAP ) or invasive mechanical ventilation in severe cases . Treat Underlying Cause : Bronchodilators for asthma, antibiotics for pneumonia, reversal agents for drug overdose (e.g., naloxone for opioid overdose ).

127. Chronic Respiratory Acidosis : Optimize Medical Management of Underlying Condition : Inhaled bronchodilators, corticosteroids for COPD . Supplemental Oxygen : For hypoxemia, with caution to avoid suppressing respiratory drive in COPD patients . Lifestyle Modifications : Weight loss for obesity hypoventilation syndrome, smoking cessation for COPD .

128. Pulmonary Rehabilitation : Exercise training, education, and support for chronic lung disease patients . Monitoring and Follow-up

129. RESPIRATORY ALKALOSIS Respiratory alkalosis is a condition characterized by a decrease in the partial pressure of carbon dioxide ( Pa CO ₂) in the blood due to excessive ventilation, leading to an increase in blood pH ( alkalemia ). It is the opposite of respiratory acidosis and is typically caused by hyperventilation .

130. Causes of Respiratory Alkalosis Central Nervous System Disorders : Anxiety , panic attacks Pain , fever ,(e.g ., stroke, meningitis ) Hypoxemia : High altitude Pulmonary diseases (e.g., pulmonary embolism, pneumonia, asthma)Severe anemia Drugs and Hormones : Salicylate (aspirin) overdose Progesterone (e.g., during pregnancy ) Mechanical Ventilation : Excessive ventilatory support Incorrect ventilator settings Other Causes : Sepsis Liver disease Hyperthyroidism

131. Diagnostic Evaluation Arterial Blood Gas (ABG) Analysis : pH : Elevated ( alkalemia ) Pa CO ₂: Decreased (< 35 mmHg ) HCO ₃⁻: Normal or slightly decreased (compensatory response by the kidneys ) Electrolyte Panel: Serum Electrolytes: Decreased calcium and potassium levels due to alkalosis . Chest X-ray

132. Pulmonary Function Tests : To identify underlying lung pathology. Additional Tests: Toxicology Screen: For suspected drug overdose. Thyroid Function Tests: If hyperthyroidism is suspected.

133. Clinical Features Light headedness , dizziness Paresthesia (tingling in the extremities ) Palpitations , tachycardia Chest pain or tightness Dyspnea (shortness of breath ) Confusion , agitation Tetany (muscle spasms), Crapo pedal spasm Seizures

134. Management Address Underlying Cause Anxiety and Panic Attacks : Breathing exercises, anxiolytics . Pain or Fever : Analgesics, antipyretics . Hypoxemia : Oxygen therapy, treatment of the underlying pulmonary condition . Drug Overdose : Specific antidotes (e.g., activated charcoal for salicylates ).

135. Correct Ventilator Support: Adjust ventilator settings to avoid hyperventilation in mechanically ventilated patients. Symptomatic Treatment : Rebreathing : Using a paper bag to increase CO₂ levels in acute hyper ventilation. Electrolyte Repletion : Correcting hypokalemia and hypocalcemia if present . Monitor and Reassess : Regular ABG analysis to monitor pH and Pa CO ₂ .

136. Metabolic Acidosis Metabolic acidosis is a condition characterized by a decrease in the body's pH due to an excess of acid or a significant loss of bicarbonate. It results in a lower bicarbonate (HCO₃⁻) concentration in the blood. Metabolic acidosis can arise from various conditions and requires thorough evaluation to identify the underlying cause.

137. Causes of Metabolic Acidosis Metabolic acidosis can be broadly categorized into high anion gap acidosis and normal anion gap acidosis . High Anion Gap Metabolic Acidosis : Ketoacidosis : Diabetes mellitus (diabetic ketoacidosis), alcoholism, starvation . Lactic Acidosis : Shock, sepsis, hypoxia, severe exercise, liver failure . Renal Failure : Chronic kidney disease, acute kidney injury . Toxins/Ingestions : Methanol, ethylene glycol, salicylates (aspirin overdose), propylene glycol .

138. Normal Anion Gap ( Hyperchloremic ) Metabolic Acidosis: Gastrointestinal Bicarbonate Loss : Diarrhea, fistulas . Renal Tubular Acidosis : Distal (type 1), proximal (type 2), hyperkalemic (type 4). Medications : Carbonic anhydrase inhibitors (e.g., acetazolamide).

139. Symptoms and Signs Symptoms: Rapid breathing ( Kussmaul respirations) to blow off CO₂ . Fatigue , weakness . Confusion , lethargy . Nausea , vomiting, abdominal pain . Headache. coma and cardiac arrhythmias . Signs: Tachypnea (rapid breathing ). Dehydration. Hypotension.

140. Diagnostic Evaluation Arterial Blood Gas (ABG) Analysis : pH : Low (< 7.35 ). Pa CO ₂: May be low (respiratory compensation ). HCO ₃⁻: Low (< 22 mEq /L ). Serum Electrolytes : Measure sodium (Na⁺), potassium (K⁺), chloride (Cl⁻), and bicarbonate (HCO₃⁻ ). Anion Gap Calculation : Anion gap = [Na⁺] - ([Cl⁻] + [HCO₃⁻ ]). { Normal anion gap: 8-12 mEq /L .}

141. Additional Tests : Blood Glucose : For diabetic ketoacidosis . Lactate Levels : For lactic acidosis . Renal Function Tests : BUN, creatinine for renal failure . Toxicology Screen : For suspected toxin ingestion . Urine Analysis : To assess renal tubular function . Physical examinations

142. Management Treat the Underlying Cause Diabetic Ketoacidosis : Insulin therapy, fluid and electrolyte replacement . Lactic Acidosis : Address underlying cause (e.g., sepsis, hypoxia), fluids, possible use of bicarbonate in severe cases . Renal Failure : Hemodialysis if indicated, management of electrolyte imbalances . Toxin Ingestion : Specific antidotes (e.g., fomepizole for methanol or ethylene glycol), supportive care, dialysis if necessary

143. Supportive Care: Fluids and Electrolytes : Correct dehydration and electrolyte imbalances . Bicarbonate Therapy : Reserved for severe acidosis (pH < 7.1) or specific conditions; must be used cautiously to avoid complications like hypokalemia or paradoxical acidosis . Monitoring: Regular ABG analysis to monitor acid-base status . Continuous assessment of clinical symptoms and response to treatment.

144. Metabolic Alkalosis Definition Metabolic alkalosis is a disturbance in the body's acid-base balance, resulting in an elevated blood pH due to an increase in bicarbonate (HCO3-) or a loss of hydrogen ions (H+). It is characterized by a pH above 7.45 and a bicarbonate level greater than 26 mEq /L.

145. Causes Loss of Hydrogen Ions : Gastrointestinal Loss : Prolonged vomiting or nasogastric suctioning leading to loss of gastric acid ( HCl ). Renal Loss : Conditions like diuretic therapy (especially loop or thiazide diuretics), hyperaldosteronism, and hypokalemia .

146. Gain of Bicarbonate: Exogenous Administration : Excessive intake of bicarbonate (e.g., antacids or bicarbonate infusions). Metabolic Processes : Chronic conditions like chronic obstructive pulmonary disease (COPD) where chronic hypercapnia can lead to compensatory metabolic alkalosis.

147. Clinical Manifestations Neuromuscular : Muscle twitching , cramps, and tetany due to hypocalcemia , Paresthesia (tingling sensation) and muscle weakness . Central Nervous System : Dizziness , confusion, irritability, and, in severe cases, seizures . Cardiovascular : Arrhythmias , hypotension, and decreased myocardial contractility . Gastrointestinal : Nausea , vomiting, and anorexia.

148. Diagnosis Diagnosis is based on clinical assessment laboratory investigations : Arterial Blood Gas (ABG ): Elevated pH (>7.45 ). Elevated bicarbonate level (>26 mEq /L ). Serum Electrolytes : Low chloride (Cl-) levels in hypochloremic alkalosis . Low potassium (K+) levels in hypokalemic alkalosis . Urine Chloride Levels : Low urine chloride (<10 mEq /L) suggests a cause related to vomiting or diuretics . High urine chloride (>20 mEq /L) suggests mineralocorticoid excess.

149. Management Treatment focuses on addressing the underlying cause and correcting the acid-base imbalance : Correction of Hypovolemia : Administration of isotonic saline (0.9% Na Cl ) to restore fluid volume and promote renal bicarbonate excretion . Correction of Electrolyte Imbalances : Potassium supplementation for hypokalemia .

150. Magnesium supplementation if magnesium deficiency is present. Acidifying Agents : In severe cases, administration of acidifying agents like hydrochloric acid ( HCl ) or ammonium chloride (NH4Cl) may be necessary . Medications: Use of acetazolamide, a carbonic anhydrase inhibitor, can promote renal bicarbonate excretion . Adjustment or discontinuation of causative medications (e.g., diuretics).

151. Nursing Management Nursing care for patients with metabolic alkalosis involves: Monitoring: Regular monitoring of vital signs, ABGs, and electrolytes. Assessing for signs of volume depletion or fluid overload . Patient Education: Educating patients about the proper use of medications, such as avoiding excessive use of antacids.

152. Advising patients on the importance of maintaining electrolyte balance through diet and hydration . Supportive Care: Providing comfort measures for symptoms like muscle cramps or dizziness. Ensuring safety measures to prevent falls or injuries in patients with neuromuscular symptoms.

153. INTRAVENOUS THERAPY The treatment that infuses intravenous solutions, medications, blood, or blood products directly into a vein . In an emergency circumstance or for individuals who are unable to take medications orally, intravenous therapy is an efficient and quick-acting means to provide fluid or medication treatment.

154. Purpose : To supply fluid when clients are unable to take in an adequate volume of fluids orally . To replace the electrolytes and other salts to maintain electrolyte balance . To supplement glucose for maintenance of metabolism . To administer water soluble vitamins and medications . To establish a lifeline in case of emergencies.

155. Hydration: To restore fluid balance in patients who are dehydrated . Electrolyte balance: To correct electrolyte imbalances . Medication administration: To deliver medications directly into the bloodstream for immediate effect . Blood transfusions: To administer blood and blood products . Parenteral nutrition: To provide nutrition to patients who cannot eat or absorb nutrients through the gastrointestinal tract.

156. Types of IV Access Peripheral and central veins are two types of veins. Peripheral IV Lines: Used for short-term access. Inserted into small peripheral veins, usually in the arms or hands. Suitable for fluids, medications, and some blood products .

157. Central Venous Catheters (CVCs): Used for long-term access. Inserted into large veins (e.g., subclavian, jugular, femoral). Types include peripherally inserted central catheters (PICCs), tunneled catheters, and implanted ports. Suitable for medications, chemotherapy, parenteral nutrition, and long-term therapies.

158. Equipment Needed IV Catheter: Different gauges for different purposes (e.g., 18G, 20G, 22G). Tourniquet: To constrict blood flow and make veins more visible. Alcohol swabs or antiseptic solution: For skin disinfection. IV fluids or medication: Depending on the prescription. IV administration set: Tubing that connects the IV bag to the catheter. IV pole or infusion pump: To hold the IV bag and regulate the flow rate. Tape and dressing: To secure the IV catheter .

159. TYPES OF I.V FLUIDS Intravenous (IV) fluids are categorized based on their composition and osmolarity . The three main types of IV fluids are Crystalloid solutions Colloid solutions Blood products .

160. Crystalloid Solutions A crystalloid solution is an aqueous mixture of water and tiny solutes like glucose and electrolytes. The molecules in crystalloids are easily able to traverse semipermeable membranes, allowing them to move through intravascular, intracellular, and extracellular compartments.

161. They are classified based on their tonicity relative to plasma : ISOTONIC HYPOTONIC HYPERTONIC SOLUTIONS .

162. A. Isotonic Solutions: 0.9% Sodium Chloride (Normal Saline): Composition: 154 mEq /L of sodium and chloride . Uses : Fluid resuscitation, dehydration, blood transfusions . Lactated Ringer's (LR): Composition: Sodium, potassium, calcium, chloride, and lactate. Uses: Surgery, burns, acute blood loss, and electrolyte imbalance.

163. 5 % Dextrose in Water (D5W ):[Isotonic] Composition: Dextrose, no electrolytes. Uses: Hypernatremia, provide free water for renal excretion of solutes . B. Hypotonic Solutions: 0.45% Sodium Chloride (Half Normal Saline): Composition: 77 mEq /L of sodium and chloride. Uses: Hypernatremia, intracellular dehydration

164. C. Hypertonic Solutions: 3% Sodium Chloride: Composition : 513 mEq /L of sodium and chloride. Uses: Severe hyponatremia, cerebral edema .

165. Colloid Solutions Colloid solutions contain larger molecules, such as proteins or starches, which remain in the vascular compartment and draw fluid into the bloodstream. Albumin (5% or 20%): Composition: Human albumin protein. Uses: Hypoproteinemia, burns, acute liver failure . Hetastarch : Composition: Synthetic starch. Uses: Volume expansion during hypovolemia.

166. Blood Products Blood products are used for transfusion in patients with significant blood loss or specific deficiencies . Packed Red Blood Cells (PRBCs ): Composition : Concentrated red blood cells . Uses : Anemia, acute blood loss . Fresh Frozen Plasma ( FFP): Composition : Plasma proteins, clotting factors . Uses : Coagulation disorders, liver disease .

167. Platelets: Composition : Concentrated platelets. Uses : Thrombocytopenia, platelet function disorders.

168. CALCULATIONS OF IV FLUID THERAPY The complete volume of fluid to be infused and the precise time for the infusion must be known by the nurse in order to determine IV flow rates . The most common method for prescribing intravenously delivered fluids is based on millilitres per hour . Setting the flow rate, which is measured in drops per minute, allows for the administration of the required volume per hour . Milliliters per hour (mL/h): Calculated by dividing the total infusion volume by the total infusion time in hours.

169. Number of drops per one (1) minute ( gtts /min): Calculated by multiplying the total infusion volume to the drop factor and then dividing by the total infusion time in minutes . Infusion time : Total volume to infuse divided by milliliters per hour being infused .

170. ML per hour fluid calculation: Millilitres per hour = Total infusion volume Total infusion time EXAMPLE: If a patient needs 3,000 mL of saline IV over 6 hours for a correcting dehydration. How many milliliters per hour will you set on a controller ? Where : Total infusion volume (mL) = 3000mL Total infusion time = 6hours Computation : Total infusion volume (3000mL ) / Total infusion time (6hrs ). Answer : 500 mL/hour.

171. Calculating drops per minute ( gtt /min ) IV Drip Rate ( gtt /min) = Total volume(ml) Time(in min) Example : A patient is receiving 400 mL normal saline IV over 4 hours, using tubing with a drop factor of 15 drops/ mL . How many drops per minute should be delivered ? Where: Total infusion volume = 400mL Drop factor 15 gtts /mL Total infusion time = 4 hours or 240 minutes (4 x 60min ) Calculate : Drops/Min=400ml/240min X * 15 = (400ml)/(240min ) 15 Answer : 25 gtts /min. Drop factor( ggt /ml ) X

172. Calculating total infusion time( hr ) Formula: Infusion time = Total volume to be infused Mililiter per hour Example: A client is ordered to receive 500mL of NS at the rate of 60 ml. per hour. Find the total infusion time . Where: Total volume to be infused in mL = 500mL Millilitre per hour being infused = 60mL Calculation : (500ml)/(60ml / h /r ) = 8 hrs Result:8hrs

173. Procedure for Inserting a Peripheral IV Line Preparation: Verify the physician’s order. Gather all necessary equipment. Perform hand hygiene. Explain the procedure to the patient and obtain consent. Site Selection: Choose a suitable vein, usually in the non-dominant arm. Avoid areas with previous IV therapy, inflammation, or infection.

174. Preparation of Site: Apply a tourniquet above the selected site to engorge the vein. Disinfect the site with an antiseptic solution and let it dry . Catheter Insertion:(I V CANULA) Hold the skin taut and insert the catheter bevel up at a 10-30 degree angle. Once blood return is seen, advance the catheter slightly and then thread the catheter into the vein while withdrawing the needle. Release the tourniquet.

175. Securing the Catheter: Attach the IV administration set to the catheter hub. Secure the catheter with tape and apply a sterile dressing. Starting the Infusion: Hang the IV bag on the IV pole and connect it to the administration set. Open the roller clamp to allow fluid to flow and adjust the flow rate as prescribed. Monitor the infusion site and patient for any adverse reactions

176. Care and Maintenance Monitor the IV site: Check for signs of infiltration, phlebitis, infection, or leaking. Change IV site: Rotate the IV site every 72-96 hours or as per hospital protocol. Flush the catheter: Use normal saline to maintain patency and prevent clotting. Document: Record the IV insertion details, site condition, and any patient reactions.

177. MONITORING INTAKE AND OUTPUT Importance of intake and output chart : Monitoring is an important clinical care process that provides the means to determine the progress of the disease and the beneficial as well as detrimental effects of treatment. Monitoring of intake help care givers ensure that the patient has proper intake of fluid and other nutrients. Monitoring of output helps determine whether there is adequate output of urine as well as normal defecation.

178. RESTRICTING FLUID INTAKE Fluid intake is restricted in certain condition to prevent the compication of fluid volume excess and complicated to it . Indications: Congestive heart failure . Kidney disease . Cirrhosis of liver . Increased Intra Cranial Pressure . Hypertension. Fluid volume excess . Pulmonary edema etc.

179. Fluid is highly restricted in severe cases of CHF, ESRD and or Pulmonary eddema . Sodium intake is restricted along with fluid intake to reduce fluid absorption . Monitor Intake and Output chart . Monitor weight same time of every day and record it. It provides changes in the fluid balance.

180. ENHANCING THE FLUID INTAKE Fluid intake may be recommended in several cases of dehydration and hypovolemia. It may be administer combination of electrolytes to achieve homeostasis . Indications: Dehydration. Heat stroke . Profuse seating. Working hard or exercise. Diarrheal disease Fever.

181. Fluid loss by vomiting, hemorrhage, wound drains etc Nursing measures to promote fluid intake: Encourage the client to take plenty of oral liquids. Keep the water available at reach and near visual field to motivate water intake. Assess the client for features of dehydration.

182. If the client has nausea and vomiting, initially restrict the fluid and start with test feeds which includes pieces of ice, followed by sips of water and liquids later on . Maintain intake and output chart . Encourage the client to take frequent sips of water to avoid vomiting and promote tolerance.

183. Complications and Management Infiltration: Fluid leaks into surrounding tissue. Signs: Swelling, pallor, coolness, and pain at the site. Management: Stop the infusion, remove the catheter, elevate the limb, and apply a warm compress. Phlebitis: Inflammation of the vein. Signs: Redness, warmth, swelling, and pain along the vein .

184. Management: Remove the catheter, apply a warm compress, and monitor the site. Infection: Introduction of bacteria at the IV site. Signs: Redness, swelling, warmth, pain, and possibly fever. Management: Remove the catheter, apply a sterile dressing, and notify the healthcare provider. Air Embolism: Air enters the bloodstream. Signs: Sudden shortness of breath, chest pain, and hypotension. Management: Clamp the IV line, place the patient in a left lateral Trendelenburg position, and notify the healthcare provider immediately.

185. Legal and Ethical Considerations Informed consent: Always obtain consent before starting IV therapy. Documentation: Accurately document all aspects of IV therapy.