Fluid & Electrolyte Imbalance
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Transcript of Fluid & Electrolyte Imbalance
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Fluid & Electrolyte ImbalanceFluid & Electrolyte Imbalance
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Fluid ImbalanceFluid Imbalance
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Fluid Volume DeficitFluid Volume Deficit(Hypovolemia, Isotonic Dehydration)(Hypovolemia, Isotonic Dehydration)
Common Causes– Hemorrhage– Vomiting – Diarrhea– Burns– Diuretic therapy– Fever– Impaired thirst
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Clinical ManifestationsClinical ManifestationsSigns/Symptoms
– Weight loss– Thirst– Orthostatic changes in pulse rate and bp– Weak, rapid pulse– Decreased urine output– Dry mucous membranes– Poor skin turgor
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Treatment/Interventions (FVD) Treatment/Interventions (FVD) Fluid Management
– Diet therapy – Mild to moderate dehydration. Correct with oral fluid replacement.
– Oral rehydration therapy – Solutions containing glucose and electrolytes. E.g., Pedialyte, Rehydralyte.
– IV therapy – Type of fluid ordered depends on the type of dehydration and the clients cardiovascular status.
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Nursing ImplicationsNursing Implications
Monitor postural heart rate and bp when getting patients out of bed
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Fluid Volume Excess Fluid Volume Excess
Common Causes:– Congestive Heart Failure– Early renal failure– IV therapy– Excessive sodium ingestion
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Clinical ManifestationsClinical Manifestations
Signs/Symptoms– Increased BP– Bounding pulse– Venous distention– Pulmonary edema
Dyspnea Orthopnea (diff. breathing when supine) crackles
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Treatment/Interventions Treatment/Interventions
Drug therapy– Diuretics may be ordered if renal failure is not
the cause.Restriction of sodium and saline intake
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Electrolyte ImbalanceElectrolyte Imbalance
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Hypokalemia (<3.5mEq/L)Hypokalemia (<3.5mEq/L)
Pathophysiology – – Decrease in K+ causes decreased excitability of
cells, therefore cells are less responsive to normal stimuli
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Hypokalemia (<3.5mEq/L)Hypokalemia (<3.5mEq/L)Contributing factors:
– Diuretics– Shift into cells– Digitalis– Water intoxication– Corticosteroids– Diarrhea– Vomiting
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Hypokalemia (<3.5mEq/L)Hypokalemia (<3.5mEq/L)
Interventions– Assess and identify those at risk– Encourage potassium-rich foods– K+ replacement (IV or PO)– Monitor lab values– D/c potassium-wasting diuretics– Treat underlying cause
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Hyperkalemia (>5.0mEq/L)Hyperkalemia (>5.0mEq/L)
Pathophysiology – An inc. in K+ causes increased excitability of cells.
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Hyperkalemia (>5.0mEq/L)Hyperkalemia (>5.0mEq/L)
Contributing factors:– Increase in K+ intake– Renal failure– K+ sparing diuretics– Shift of K+ out of the cells
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Hyperkalemia (>5.0mEq/L)Hyperkalemia (>5.0mEq/L)Interventions
– Need to restore normal K+ balance:– Eliminate K+ administration– Inc. K+ excretion
Lasix Kayexalate (Polystyrene sulfonate)
– Infuse glucose and insulin– Cardiac Monitoring
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Hyponatremia (<135mEq/L)Hyponatremia (<135mEq/L)Contributing Factors
– Excessive diaphoresis– Wound Drainage– NPO– CHF– Low salt diet– Renal Disease– Diuretics
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Hyponatremia (<135mEq/L)Hyponatremia (<135mEq/L)Assessment findings:
– Neuro - Generalized skeletal muscle weakness. Headache / personality changes.
– Resp.- Shallow respirations– CV - Cardiac changes depend on fluid volume– GI – Increased GI motility, Nausea, Diarrhea
(explosive)– GU - Increased urine output
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Hyponatremia (<135mEq/L)Hyponatremia (<135mEq/L)Interventions/Treatment
– Restore Na levels to normal and prevent further decreases in Na.
– Drug Therapy – - IV therapy to restore both fluid and Na. If
severe may see 2-3% saline. – Administer osmotic diuretic (Mannitol) to excrete
the water rather than the sodium.– Increase oral sodium intake and restrict oral
fluid intake.
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Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Contributing Factors– Hyperaldosteronism– Renal failure– Corticosteroids– Increase in oral Na intake– Na containing IV fluids– Decreased urine output with increased urine
concentration
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Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Contributing factors (cont’d):– Diarrhea– Dehydration– Fever– Hyperventilation
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Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Assessment findings: – Neuro - Spontaneous muscle twitches.
Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes
– Resp. – Pulmonary edema– CV – Diminished CO. HR and BP depend on
vascular volume.
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Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
GU – Dec. urine output. Inc. specific gravity
Skin – Dry, flaky skin. Edema r/t fluid volume changes.
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Hypernatremia (>145mEq/L)Hypernatremia (>145mEq/L)
Interventions/Treatment– Drug therapy
.45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.
– Diet therapy Mild – Ensure water intake
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Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)
Contributing factors:– Dec. oral intake– Lactose intolerance– Dec. Vitamin D intake– End stage renal disease– Diarrhea
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Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)
Contributing factors (cont’d):Acute pancreatitisHyperphosphatemiaImmobilityRemoval or destruction of parathyroid gland
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Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)Assessment findings:
– Neuro –Irritable muscle twitches. Positive Trousseau’s sign. Positive Chvostek’s sign.
– Resp. – Resp. failure d/t muscle tetany.– CV – Dec. HR., dec. BP, diminished
peripheral pulses– GI – Inc. motility. Inc. BS. Diarrhea
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Positive Trousseau’s Sign Positive Trousseau’s Sign
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Positive Chvostek’s SignPositive Chvostek’s Sign
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Hypocalcemia (<9.0mg/dL)Hypocalcemia (<9.0mg/dL)
Interventions/Treatment– Drug Therapy
Calcium supplements Vitamin D
– Diet Therapy High calcium diet
– Prevention of Injury Seizure precautions
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Hypercalcemia (>10.5mg/dL)Hypercalcemia (>10.5mg/dL)
Contributing factors:– Excessive calcium intake– Excessive vitamin D intake– Renal failure– Hyperparathyroidism– Malignancy– Hyperthyroidism
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Hypercalcemia (>10.5mg/dL)Hypercalcemia (>10.5mg/dL)Assessment findings:
– Neuro – Disorientation, lethargy, coma, profound muscle weakness
– Resp. – Ineffective resp. movement– CV - Inc. HR, Inc. BP. , Bounding peripheral pulses,
Positive Homan’s sign. Late Phase – Bradycardia, Cardiac arrest– GI – Dec. motility. Dec. BS. Constipation– GU – Inc. urine output. Formation of renal calculi
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Hypercalcemia (>10.5mg/dL)Hypercalcemia (>10.5mg/dL)Interventions/Treatment
– Eliminate calcium administration– Drug Therapy– Isotonic NaCL (Inc. the excretion of Ca)– Diuretics– Calcium reabsorption inhibitors (Phosphorus)– Cardiac Monitoring
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Hypomagnesemia (<1.4mEq/L)Hypomagnesemia (<1.4mEq/L)
Contributing factors:– Malnutrition– Starvation– Diuretics– Aminoglycoside antibiotics– Hyperglycemia– Insulin administration
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Hypomagnesemia (<1.4mEq/L)Hypomagnesemia (<1.4mEq/L)
Assessment findings:*Neuro - Positive Trousseau’s sign. Positive Chvostek’s sign. Hyperreflexia. Seizures*CV – ECG changes. Dysrhythmias. HTN*Resp. – Shallow resp.*GI – Dec. motility. Anorexia. Nausea
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Hypomagnesemia (<1.4mEq/L)Hypomagnesemia (<1.4mEq/L)
Interventions:– Eliminate contributing drugs– IV MgSO4– Assess DTR’s hourly with MgSO4– Diet Therapy
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Hypermagnesemia (>2.0mEq/L)Hypermagnesemia (>2.0mEq/L)
Contributing factors:– Increased Mag intake– Decreased renal excretion
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Hypermagnesemia (>2.0mEq/L)Hypermagnesemia (>2.0mEq/L)
Assessment findings:Neuro – Reduced or weak DTR’s. Weak voluntary muscle contractions. Drowsy to the point of lethargyCV – Bradycardia, peripheral vasodilatation, hypotension. ECG changes.
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Hypermagnesemia (>2.0mg/dL)Hypermagnesemia (>2.0mg/dL)
Interventions– Eliminate contributing drugs– Administer diuretic– Calcium gluconate reverses cardiac effects– Diet restrictions