fluid and electrolyte imbalance in msn.pptx

urinary tract infection according to msn in nursing its complications etiology sign symptoms, nursing diagnosis and nursing interventions and its nursing management

1. Start

2. Submitted To : Vijay Bhardwaj ( Sir ) Nursing Tutor GCON Alwar Submitted By : Mayank Vyas [ 33 ] B.Sc. Nursing III Sem Batch 2022-23 Fluid’s & Electrolyte Imbalance Govt. College of Nursing, Alwar Subject: Medical Surgical Nursing Topic: Date: 25.09.2024

3. Learning Objectives Body fluids introduction Types of fluids Regulation of body fluids / Fluid movement in body Homeostasis Types of fluid imbalances Electrolytes Electrolyte, their types & their balance imbalances Nursing management of these conditions

4. Every part of your body needs water to function. When you are healthy, your body is able to balance the amount of water that enters or leaves your body. Water is the major body component, accounting 60% of the adult body weight. 2/3rd of the water is with in the cells. (intracellular fluid) 1/3rd of body water is outside the cells(extracellular fluid). Balance of fluid and electrolyte is a important/vital process for survival (Homeostasis) whenever human body falls ill, the balance of fluid and electrolyte gets disturbed. Sometimes this imbalance becomes crucial and fatal. 4 Introduction

5. 5

6. 6 Extracellular space (ECF): fluid outside the cells: one third of body fluid belongs to ECF. It is further divided into three parts  Intravascular space (fluid within blood vessels): it contains plasma, near by 3 litres out of 6 litres blood volume made up of plasma. Interstitial space (fluid that surrounds cells): it contains 11 to 12 litres in adult. Lymph's are interstitial fluid. Transcellular space: This fluid contains smallest amount of fluid of ECF, which are cerebrospinal, synovial, pericardial, sweat, intraocular, pleural fluid and digestive secretions.  

7. Regulation Of Body Fluids Hydrostatic Pressure, Osmotic Pressure decides the direction of fluid movement. Movement can be identified as: Fluid Movement Active transport: Sodium potassium pump, potassium hydrogen pump, co-transport of sodium and glucose Passive transport: Osmosis, diffusion, filtration Vascular transport: Endocytosis-pinocytosis (Cell Drinking) and phag o cytosis and exocytosis

8. Some terms to understand Osmosis Diffusion Osmolarity Osmotic pressure Oncotic pressure or Colloid Osmotic pressure Hydrostatic pressure Homeostasis Dehydration Overhydration Hypovolemia Hypervolemia Oedema Hypotonic, Hypertonic, Isotonic Solutions

9. Presentation Title 10

10. Homeostasis is a self-regulating process by which biological systems maintain stability while adjusting to charging external conditions. Homeostasis is maintained by different systems: Kidney function Heart and blood vesicle/vesicle function Lung function   Pituitary functions Anti Diuretic Hormone (ADH) Adrenal function Parathyroid function Baroreceptor Renin-angiotensin-aldosterone system   Osmoreceptor Natriuretic peptides Released by Heart [ Opposition of RAAS ] Homeostasis

11. Types of fluid imbalances 12 2 major types Hypervolemia Hypovolemia

12. Fluid Imbalances A fluid imbalance is the condition occurring when the patient lose more water or fluid than the body can take in. Or when the patient takes more water and fluid, excrete less from the body At border level, fluid imbalance is represented by two : Hypovolemia Hypervolemia

13. Hypovolemia It is also known as True Volume depletion. In medical terminology hypovolemia or fluid volume disturbances are often confused with dehydration. Hypovolemia refers to a state of combined salt and water loss. This will lead to reduction of ECF volume, whereas dehydration refers to only water loss alone, with increased serum sodium level. In hypovolemia, the loss of salt and water may be renal or non-renal in origin.

14. Etiology Renal Cause : Excessive urinary Na-Cl and water loss . Many drugs such as natriuretic, antibiotic trimethoprim and pentamidine. Tubulointerstitial injury in nephritis. Non Renal Cause : Vomiting Diarrhoea Sweating Decreased intake of fluid Third space fluid shift (Fluid shift to Non-Functional Space Like interstitial space or Peritoneal cavity)

15. Presentation Title 16 Patho-physiology

16. Signs & symptoms Fatigue Weakness Thirst Postural dizziness Oliguria Cyanosis Abdominal or chest pain Confusion or obtundation Any associated electrolyte imbalance will add other sign and symptoms as per involvement.

17. Diagnostic Test Symptoms that point to volume loss (such as diarrhoea, vomiting, bleeding, etc., Skin and weight assessment. Like weight loss, decreased jugular venous pressure, diminished skin turgor , dry oral mucosa membrane. Serum electrolyte changes Diagnostic Test

18. Nursing Management The Therapeutic goals in hypovolemia are to restore and replace outgoing fluid losses For mild Hypovolemia can be treated with oral hydration and resumption of a normal maintenance diet. severe hypovolemia requires intravenous hydration Intake output assessment. Record vitals regularly. Diagnostic Test

19. Hypervolemia Also termed as fluid volume excess. Hypervolemia happens as expansion of the ECF. This occurs as caused by abnormal retention of water and Na+ (generally sodium and water present in same ratio).

20. Etiology Basically hypervolemia may occur due to two simple processes First, is if administered too much of fluid and second if failed to excrete fluid. Compromised regulation of fluid movement and excretion: Few conditions such as cirrhosis, decreased plasma protein, heart failure, renal disorder lymphatic or venous obstruction may cause hypervolemia Excessive ingestion of fluids or foods containing sodium: Increased antidiuretic hormone (ADH) and aldosterone:

21. Presentation Title 22

22. Signs & symptoms Weight gain Oedema (decreased production of plasma proteins, lymphatic obstruction, decreased absorption of interstitial fluid, increased capillary permeability) Ascites Elevated CVP (Central venous pressure) Increased blood pressure Shortness of breath Increased respiratory rate Increased urine output

23. Diagnostic Test The Blood Urea Nitrogen (less than 8 mg/dL) and haematocrit levels (less that 45%) tend to decrease from haemodilution. Specific gravity also decreases (less than 1.01) because of increased level of urine output. Plasma osmolality less than 275 mOsm/kg Serum osmolality increases. Diagnostic Test Complications :- Congestive heart failure

24. Nursing Management: Immediate treatment goat is to support breathing and restore normal fluid volume an osmolality Pharmacological treatment: Diuretics Nitro-glycerine to vasodilate High fowl er position Monitor ECG and use O2 mask or nasal catheter Dialysis Diet therapy: Fluid restriction, salt restriction. Diagnostic Test

25. Electrolyte Na + : most abundant electrolyte in the body. Mainly Extracellular cation.. K + : essential for normal membrane excitability for nerve impulse. Mainly intracellular cation. Cl - : regulates osmotic pressure and assists in regulating acid-base balance.   Electrolytes These are active chemicals (cations and anions) present in body fluid. These chemicals unite in varying combinations and because of this, these always measure in mEq/L.

26. Ca 2+ : usually combined with phosphorus to form the mineral salts of bones and teeth, promotes nerve impulse and muscle contraction/relaxation Mg 2+ : plays role in carbohydrate and protein metabolism, storage and use of intracellular energy and neural transmission. Important in the functioning of the heart, nerves, and muscles.

27. Introduction Electrolyte imbalance is an abnormality in the concentration of electrolytes in the body.  Electrolytes play a vital role in maintaining  homeostasis within the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Two Types of imbalances Primary and Secondary E.g. For Secondary are Hypomagnesemia etc.

28. Normal electrolyte values Sodium: 135-145 mEq/L Potassium: 3.5-5 mEq/L Calcium: 8.5 – 10.2 mg/dL Chloride: 98-107 mEq/L Magnesium: 1.5-2.5 mEq/L

29. Major electrolyte imbalances Hyponatremia (sodium deficit < 130mEq/L) Hypernatremia (sodium excess >145mEq/L) Hypokalemia (potassium deficit <3.5mEq/L) Hyperkalemia (potassium excess >5.1mEq/L) Hypocalcemia (calcium deficit <8.5mg/dL) Hypercalcemia (calcium excess <10.2mg/dL) Chloride imbalance (<98mEq/L or >107mEq/L) Magnesium imbalance (<1.5mEq/L or >2.5mEq/L)

30. Hyponatremia Definition: Com m o n ly defi n ed a s a serum Na+ concentration <135 mEq/L. Hyponatremia represents a relative excess of water in relation to sodium. It is the most common electrolyte disorder . Sodium is not lost from the body but leaves the intravascular space and moves into the interstitial tissue (Third space).

31. Hypovolemic hyponatremia Develops a s s o d i um and f r ee w ater a r e l o st and / or replaced by inappropriately hypotonic fluids Etiology Sodium can be lost through renal or non-renal routes Hyponatremia mainly occurs due to imbalances of water instead of sodium. Low urine sodium occurs as kidney retains sodium to compensate for non-renal fluid loss like vomiting, diarrhea.

32. GI losses - Vomiting, Diarrhea, fistulas, pancreatitis Excessive sweating Third spacing of fluids- ascites, peritonitis, pancreatitis, and burns Cerebral salt- wasting syndrome- traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial surgery Renal Loss- Acute or chronic renal insufficiency , Diuretics

33. Presentation Title 34

34. Complication In acute hyponatremia , sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death. Can Cause Intracellular edema, or cerebral edema. Diagnostic evaluation Blood tests. Urine tests .

35. Medical management Determine cause. If fluid volume excess, intake of fluids will be restricted to allow the sodium to regain balance. We should administer sodium lactate, RL or isotonic solution (0.9% NaCl).

36. Nursing management Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and gastrointestinal status of the client. Monitor Vital signs & CVP (central venous pressure) Weigh client daily.   Neck and peripheral vein distention, pitting edema, and dyspnea. Auscultate lung and heart sounds. Monitor intake and output. Monitor infusion rate of parenteral fluids closely

37. Hypernatremia is an electrolyte imbalance and is indicated by a high level of sodium in the blood. The normal adult value for Na is 135-145mEq/L. It implies a deficit of total body water relative to total body Na+, caused by water intake being less than water losses Hypernatremia

38. Impaired thirst: e.g.- Primary hypodypsia Excessive Na+ retention Excessive salt intake Hyperventilation Obstructive Uropathy Heavy exercise, exertion Drugs such – steroids, certain blood pressure lowering medicines. Administration of hypertonic enteral feedings with out adequate water supplements. Less intake Causes

39. Correct water deficit We should administer sodium lactate, RL or isotonic solution (0.9% NaCl). Management

40. Presentation Title 41

41. Cerebral bleeding Cerebral edema Subarachnoid hemorrhage Permanent brain damage Death due to brain shrinkage Complications

42. Nursing concern Fever, tachycardia, decreased blood pressure, Poor skin turgor; flushed skin color; dry mucous membranes and a rough, dry tongue Tremors, seizures, and rigid paralysis Safety measures for the patient

43. Hypokalaemia Meaning- Hypoka l emia i s a ser u m potassi u m l evel less than 3.5 mEq /L It is described as potassium deficit Etiology Decreased potassium intake Increased losses or shifts in intracellular and extracellular distribution. GI - Prolonged diarrhea, Vomiting, Excessive use of laxatives

44. Renal • Diuretic therapy • Urinary loss in congestive heart failure • Hypomagnesaemia Primary or secondary hyperaldosteronism Cushing's syndrome or disease Large doses of corticosteroids

45. Presentation Title 47

46. Cardiac dysfunction (Ventricular asystole or fibrillation) Muscles paralysis-paralytic ileus, flaccid paralysis Cardiac or respiratory arrest ECG changes (flattened T wave, prominent U wave. ST depression and prolonged PR interval) Cardiac monitoring is necessary   Complications

47. Serum potassium levels less than 3.5 mEq/L ECG changes- flat/inverted T waves, depressed ST segment, elevated U wave Metabolic alkalosis Urinary potassium excretion test exceeding 20 mEq/day Laboratory & diagnostic findings

48. Management Medical management Determining & correcting the cause of the imbalance. Extreme hypokalemia requires cardiac monitoring Pharmacological management Oral potassium replacement - mild hypokalemia. (irritating to gastric mucosa -with Glass of water or juice) . IV for moderate or severe hypokalemia Can be given in doses of 10 to 20 mEq/ hour diluted

49. Nursing assessment Identify ECG changes. Observe for dehydration Observe for neuromuscular - fatigue and muscular weakness. Complications Heart problems Paralysis

50. Hyperkalaemia Hyperkalemia is an Elevated potassium level over 5.0 mEq/L. In older people risk of hyperkalemia is more due to decrease in renin and aldosterone

51. Etiology Retention of Potassium- Renal insufficiency, renal failure, Decreased urine output, potassium sparing diuretics. Excessive release of Cellular Potassium - severe traumatic injuries. Severe burns, severe infection, metabolic acidosis. Excessive IV infusions or Oral administration of potassium. Can cause due to Renal failure (especially the patients whose potassium level increases to infection) or Shifting potassium from intracellular fluid to extracellular fluid

52. R estrict Dietary intake potassium. If due to metabolic acidosis,- correct acidosis with sodium bicarbonate promotes potassium uptake into the cells. Diuretics- Improving urine output decreases elevated serum potassium level Medical management

53. Total serum level of less than 8.5 mg/dl It can result for decreased total body calcium stores or low levels of extracellular calcium with normal amounts of Calcium stored in bones. Hypocalcaemia Etiology Parathyroidectomy Acute Pancreatitis Inadequate dietary intake Lack of sun exposure Lack of weight bearing exercise Drugs: Loop diuretics, calcitonin Hypomagnesemia, alcohol abuse

54. Sign & Symptoms Chvostek’s Sign -is the contraction of the facial muscle that is produced by tapping the facial nerve in front of the ear. Trosseau’s Sign- is a carpal spasm that occurs by inflating a BP cuff on the upper arm to 20mmHg greater than systolic pressure for 2-5 mins. Muscle spasms Laryngospasms Seizures Anxiety Confusion, Psychosis Bronchospasm Diarrhoea Numbness

55. Sign & Symptoms Fatigue Tingling/numbness in fingers Abdominal cramps Palpitations Dyspnea Muscle spasms Cardiac dysrhythmias, decreased cardiac output Convulsions/seizure ECG changes (Prolonged QT Interval and lengthened ST Segment)

56. Pharmacological management IV administration of calcium gluconate or calcium chloride. Vitamin D therapy may be used to enhance calcium absorption Management

57. Hypercalcaemia Serum calcium value greater than 10.2 mg/dl Usually results from increased absorption of calcium from the bones and intestines. It is indicated by calcium level excess in the ECF compartment. Etiology Excessive calcium intake Excessive vitamin D intake Renal failure Hyperparathyroidism Malignancy Hyperthyroidism

58. Presentation Title 66

59. Eliminate calcium administration Drug Therapy Isotonic NaCl (Inc. the excretion of Ca) Diuretics Calcium reabsorption inhibitors (Phosphorus) Cardiac Monitoring Restrict calcium intake In Severe Cases Heart block/sudden death [ ECG changes (Shortened ST segment and QT interval) ] Management

60. Increasing patient mobility and encouraging fluids Encourage to drink 2.8 to 3.8L of fluid daily Adequate fiber in diet is encouraged Safety precaution are implemented Nursing management

61. This is an electrolyte disturbance in which there is an abnormally low level of phosphate in the blood. Hypophosphatemia is defined as: Mild 2-2.5 mg/dL Moderate 1-2 mg/dL Severe < 1 mg/dL Hypophosphatemia

62. Etiology and risk factors Loss or long term lack of intake . Increased growth or tissue repair and recovery from malnourished states. Prolonged and excessive intake of antacids. Increased calcium found in hyperparathyroidism. Phosphate loss occurring in burns and metabolic alkalosis

63. Sign & Symptoms Decreased cardiac and respiratory functions Muscle weakness Brittle bones, bone pain Confusion and seizure Neurologic symptoms such as disorientation, tremors, seizures, confusion occur because of insufficient oxygen delivery by haemoglobin due to ATP deficiency, Cardiomyopathy, Nystagmus (rapid involuntary movement of eyes).

64. Diet and dietary supplementation Total parenteral nutrition is the intervention till the phosphate level become stable Management

65. Presentation Title 73

66.  This is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood, i.e.. sérum phosphate concentration > 4.5 mg/dl Hyperphosphatemia Sign & Symptoms Tachycardia, palpitations and restlessness. Anorexia, nausea, vomiting. Tetany, serious dysrhythmias. All the clinical features of hypocalcemia

67. Etiology Chronic renal failure is one of major cause Excessive usage of a phosphate-saline laxative Hypoparathyroidism Cancer disease Excessive Vitamin D consumption: Increased absorption. of Phosphorus in GI tract Rapid cell catabolism: This process will release cellular phosphorus which will remain in ECF compartment.

68. Mild Hyperphosphatemia Limiting the High Phosphate Foods like Milk and Milk products Moderate Hyperphosphatemia Calcium or Aluminum Products that Promotes The binding And excretion Of phosphate. Severe Renal failure DIALYSIS Management

69. Normal magnesium levels are between 1.46–2.68 mg/dL (0.6-1.1 mmol/L) levels less than 1.46 mg/dL (0.6 mmol/L) defining hypomagnesemia. Hypomagnesemia Sign & Symptoms Myocardial irritability GI changes from decreased contractility Neuromuscular changes Cardiac abnormalities

70. Etiological factors Other electrolyte Imbalances Critically ill and Alcoholics Malnutrition; Mal-absorption Syndromes Pancreatitis Chronic renal Failure Phosphorus in The intestine Medications Like Diuretics Burns

71. Management Oral magnesium replacement in the form of magnesium-containing antacids or parenteral magnesium sulfate. Increase in dietary intake of magnesium IV magnesium sulfate must be administered by an infusion pump

72. Hypermagnesemia Levels greater than 2.68 mg/dl (1.1 mmol/L) defining as hypermagnesemia. This is a rare electrolyte abnormality. Etiology and risk factors Renal insufficiency Excessive use of magnesium-containing antacids or laxatives Administration of potassium sparing diuretics Severe dehydration from ketoacidosis Overuse of IV magnesium sulfate

73. Sign & Symptoms: Decrease in muscle activity Hypotension. ECG changes Drowsiness Severe muscle weakness, lethargy Delayed myocardial conduction

74. Management Decreasing the use of magnesium sulfate. Diuretic increases renal elimination of magnesium. IV calcium may also be used to antagonize the effect of hypermagnesemia. Albuterol has also been used to reduce magnesium levels. The presence of severe respiratory distresses require ventilatory assistance. If renal failure is present, hemodialysis may be necessary

75. Hypochloraemia It is a deficit of chloride. Serum chloride level is less than 97 mEq/l, then considered as hypochloraemia. The major source of chloride is table salt. Chloride helps to maintain acid-balance as a role of buffer in the exchange of oxygen and carbon dioxide in RBC chloride and sodium builds large composition of electrolyte in ECF and maintains serum molality.

76. Sign & Symptoms Agitation Muscle weakness Hypertonicity Hyperactive deep tendon reflexes Tetany Slow and shallow respiration Convulsions Dysthymias (long-term form of depression) Tremors Muscle cramps

77. Management Patient prescribed with sodium chloride 0.9% solution or potassium chloride or ammonium chloride to improve chloride level. Encourage patient to consume foods rich in chloride.

78. Hyperchloremia It is excess of chloride. Hyperchloremia occurs when serum chloride level rises >108 mEq/L. Etiology Increased intake of dietary chloride Increased loss of bicarbonate Metabolic acidosis Diarrheas Renal failure

79. Sign & Symptoms Rapid respiration Lethargy Decreased cardiac output Fitting edema Weakness Tachypnea

80. Management Sodium bicarbonate can be used to treat prompt hyperchloremia. Diuretics can also be used to elimination chloride along with sodium.

81. Dietary Implications in Electrolyte Imbalances The following foods are rich in electrolyte and nurse should give education to the patient to take those food during electrolyte imbalance. Leafy green vegetables: Good sources of calcium and magnesium. Sweet potato, and Potatoes are a good source phosphorus, magnesium and also high in potassium Fruits: Bananas, other fruits are high in potassium. Dairy products: Good sources of calcium and also contain other electrolytes, such as magnesium, sodium and phosphorus. Nuts and seeds: Good source of magnesium al phosphorus. Beans: Kidney beans, and soybeans contain magnesium, potassium, and phosphorus. Table salt and salty foods: Contains 40% sodium an 60% chloride Breakfast cereals: Cereals are fortified with calcium wheat-and oat-based cereals contain magnesium.

82. Conclusion 91 Electrolytes are chemicals in the body that regulate important physiological functions. Electrolyte imbalance causes a variety of symptoms that can be severe. These can be life-threatening if not managed appropriately.

83. Reference’s Brunner & Suddharths Textbook of Medical surgical Nursing Lewis Medical Surgical Nursing Understanding Medical Surgical Nursing Google https://www.ncbi.nlm.nih.gov/books/NBK591820/ https://www.nursebuff.com/nursing-mnemonics-and-memory-aids/ Google https://www.nursebuff.com/nursing-mnemonics-and-memory-aids/ Image’s

84. Thank you