Nsg care with Fluid & Electrolyte imbalance.pptx

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1. Care of the patient with Fluid and Electrolyte Imbalance Abhishek A. Joshi Nursing Tutor GCON,Bhavnagar

2. If You Don’t Fight for What You want, THEN… Don’t Cry for What You Lost.! Thought of the Day

3. Introduction Terminology Fluid and Electrolytes Homeostasis and Fluid balance Factors affecting Fluid & Electrolyte imbalance Importance of Electrolytes in Human body Nursing Care and Management Quiz Content

4. Fluid and electrolyte balance is essential for health. Many factors, such as illness, injury, medication, surgery and treatments, can disrupt the patient's fluid and electrolyte balance . Even a patient with a minor illness is at risk for fluid and electrolyte imbalance . The nurse continuously serves and evaluates patient's progress. Hence , she is most logically accountable for assessing and reporting real or potential fluid and electrolyte disturbances. Introduction

5. Very minor changes in patient's behaviour such as slight restlessness, twitching or a change in breathing patterns may be an early sign of imbalance. A knowledgeable nurse can recognize these minor changes, report them accurately and manage the situation effectively. Adults requires at least 40 ml/Kg fluid per day. Example - A man with weight of 60 kg, requires at least 2400 ml fluid per day. Cont..

6. Shall we learn some basic Terminologies about Fluid & Electrolytes ?

7. Diffusion: the process by which solutes move from an area of higher concentration to one of lower concentration; does not require expenditure of energy Osmosis: the process by which fluid moves across a semipermeable membrane from an area of low solute concentration to an area of high solute concentration; the process continues until the solute concentrations are equal on both sides of the membrane . Active transport: physiologic pump that moves fluid from an area of lower concentration to one of higher concentration; active transport requires adenosine triphosphate (ATP) for energy . Terminology (Terms)

8. Osmolarity : the number of osmoles, the standard unit of osmotic pressure per liter of solution. It is expressed as milliosmoles per liter ( mOsm /L); describes the concentration of solutes or dissolved particles . Osmolality: the number of osmoles (the standard unit of osmotic pressure) per kilogram of solution. Expressed as mOsm /kg. Used more often in clinical practice than the term osmolarity to evaluate serum and urine. In addition to urea and glucose, sodium contributes the largest number of particles to osmolality. Cont..

9. Hypertonic solution: a solution with an osmolality higher than that of serum . Hypotonic solution: a solution with an osmolality lower than that of serum . Isotonic solution: a solution with the same osmolality as serum and other body fluids . pH Value: A concentration of Hydrogen ion in Blood Steam, it shows the potentials of Hydrogen. it's regulated by Buffers. Cont..

10. Homeostasis: “ it is the process through which bodily equilibrium is maintained” The body is designed to maintain a constant maintenance of internal environment like body fluid compositions, temperature, blood pressure, blood glucose level; etc. Fluid Balance: The amount of water coming into the body each day must equal the amount of water eliminated from the body over the same period of time. If not, the body will have either a net water gain or net water loss. Homeostasis & Fluid Balance

11. 1) Water Sources: Drinking water Water contained in food Metabolism to CO2 & H2O 2) Water Loses: Urinary loss Fecal loss Sweat loss Pathological Loss Water Sources & water Loses

12. Age Stress Diaphoresis Renal Disease Dehydration Hormones Lifestyle Factors affecting Fluid & Electrolyte imbalance

13. Body fluids contain certain substances which dissociate and carry electrical changes and are known as electrolytes . Natural minerals in food become electrolytes or ions in the body through digestion and metabolism. Electrolytes are usually measured in milli equivalents per litter ( mEq /L) or on milligrams per decilitre (mg/dl ). There is many electrolytes plays an important roles in human body are as belows . Importance of Electrolytes

14. There is a mainly Two types of ions… ( i ) Cations Sodium (Na+) Potassium (K+) Calcium ( Ca2 +) Magnesium ( Mg2 +) (ii) Anions: Chloride (Cl-) Bicarbonate ( HCO3 -) Phosphate (PO) Electrolytes

15. is the most abundant cation (90%) in ECF . Na ions are the major contributors in maintaining water balance. Nerve impulses transmission & Muscles contraction. Regulation of acid base balance. Participation in cellular chemical reaction. Regulator of ECF volume influences ICF volume. Essential electrolyte in Sodium – Potassium pump. Normal Value : 135 to 145 mEq /L (a) Sodium:

16. Most of the sodium comes from the dietary intake. Sodium particularly in Mustard, Cheese, Bread, Cereal, Table salt. Daily allowance for sodium is 500 mg. Sources of Sodium

17. Potassium is the primary intracellular cation. Potassium is very important in the human body along with Sodium. It's regulates the water balance and the acid base balance in blood and tissues. Potassium plays a vital role in “Sodium - potassium pump.” Potassium is also very important in cellular biochemical reactions and energy metabolism. The normal potassium serum level is 3.5 to 5.0 mEq /L. (b) Potassium:

18. Normally Potassium is supplied in food. Potassium rich diet includes Bananas, Potatoes, Orange, Lentils, Tomatoes etc. Daily requirement : 3400 mg/day. Sources of Potassium

19. Calcium is stored in bone, plasma and body cells. 99% of Calcium is located in Bone and only 1% Calcium is in ECF . Approx. 50% calcium in the plasma is bound to protein and other is free ionized calcium. Responsible for construction, formation and maintenance of bone and teeth. It is vital component in blood clotting system and also helps in wound healing. it’s essential for muscle contraction. Normal level of Ca in adult is 8.5 to 10.0 mg/dl. (c) Calcium:

20. The main source of calcium is dairy products. Other sources of calcium includes green leafy vegetables, pease , lentils etc. Daily requirement: 2500 mg/day. Sources of Calcium

21. About 50 to 60% of body Mg is contained within ECF compartment and only 1% Mg contained in ICF . Mg is vital to many intracellular processes including enzyme reactions and synthesis of proteins/Nucleic acid. It’s essential ion for neuromuscular transmission and cardiovascular function. The normal serum Magnesium level is 1.6-2.6 mg/dl. (d) Magnesium:

22. Magnesium is obtained through the diet. Green vegetables, grains, nuts, meat and seafood. Daily requirement: 400-420 mg/day. Sources of Magnesium

23. Chloride is major anion found in the fluid outside of cells and in the blood. Acts with sodium and maintain the osmotic pressure of the blood. Vital role in the body acid base balance. Essential for the production of HCL (Hydrochloric acid). The normal serum range is 98-108 mEq /L. (a) Chloride:

24. Most phosphate 95% is found in bones and about 14% is in ICF and only 1% is in ECF . PO is essential to intracellular processes such as the production of ATP (Adenosine Phosphate). Is vital for RBC function and O2 delivery to tissues. Promotes Neuromuscular action and participates in carbohydrate metabolism. Normal Value 2.5-4.5 mg/dl. (b) Phosphate:

25. Phosphate is ingested in the diet, absorbed in the jejunum and excreted by the kidneys. A relationship exist b/w Po and Ca+, when one increase the other decrease. Daily requirement 700 mg/day. Sources of Phosphate

26. Bicarbonate found in ECF and ICF . Bicarbonate working as a buffer and maintain a pH level in body as well as maintain acid base balance. Normal pH level of Blood is 7.35-7.45. If pH level bellows 7.35, its called Acidosis. If pH level of blood above 7.45, it’s called Alkalosis. Bicarbonate ion Normal level is 22-26 mEq /L. (b) Bicarbonate:

27. Assessment: Health History Physical Assessment Diagnostic Test Management: Fluid Management Dietary Management Nursing Management Nursing Care

28. QUIZ

29. Q.1 The normal Blood pH level is……???

30. Q.2 : the process by which fluid moves across a semipermeable membrane from an area of low solute concentration to an area of high solute concentration is called?

31. Q.3 Mr . Ali’s pH value is 8.2, that condition called?

32. 1. PEE VEE ; ‘‘ FUNDAMENTALS OF NURSING ’’ SECOND EDITION;PUBLISHED BY JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LIMITED;NEW DELHI ; 2. LOTUS PUBLISHERS; ‘‘A TEXT BOOK OF NURSING FOUNDATIONS ’’ EDITION;EDITED BY CELESTINA FRANCIS & KRITIKA MISRA ; P.NO . 340 TO 352. 3 . WEBPAGE; WWW.WIKIPEDIA.COM : THE TOPIC OF “NURSING CARE WITH THE PATIENT OF FLUID & ELECTROLYTE IMBALANCE” BY DR KIRAN SADHU. Bibliography