Handout Medical-Surgical Nursing Fluid and Electrolyte
Handout Medical-Surgical Nursing Fluid and Electrolyte
Homeostasis
Compartments
• Fluid spaces between cells (interstitial fluid) and the plasma space
• Interstitial
• Most prevalent anion is chloride (Cl-)
• Most prevalent cation is sodium (Na+)
• Expands and contracts
• 2/3 of ECF in interstitium
• Extracellular Fluid (ECF)
Intravascular (IV)
Transcellular Fluid
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Peritoneal fluid spaces
Diffusion
Facilitated diffusion
Active transport
Osmosis
Hydrostatic pressure
Oncotic pressure
Diffusion
Facilitated Diffusion
• Active Transport
Osmosis
• Water moves from area of low solute concentration to area of high solute
concentration
• Requires no energy
Osmotic Pressure
Hydrostatic Pressure
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• Force within a fluid compartment
• Major force that pushes water out of vascular system at capillary level
Oncotic Pressure
Fluid Shifts
Fluid Shifts
• Water deficit (increased ECF) is associated with symptoms that result from cell
shrinkage as water is pulled into vascular system
• Water excess (decreased ECF) develops from gain or retention of excess water
Fluid Spacing
• First spacing
Normal distribution of fluid in ICF and ECF
• Second spacing
Electrolytes
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Hypothalamic regulation
Pituitary regulation
Adrenal cortical regulation
Renal regulation
Cardiac regulation
Gastrointestinal regulation
Insensible water loss
Hypothalamic Regulation
Pituitary Regulation
Renal Regulation
• Kidneys are primary organs for regulating fluid and electrolyte balance
• Selective reabsorption of water and electrolytes
• Excretion of electrolytes occurs
• Renal tubules are sites of action of ADH and aldosterone
Cardiac Regulation
• Atrial natriuretic factor (ANF) is released by the cardiac atria in response to increased
atrial pressure
• ANF causes vasodilation and increased urinary excretion of sodium and water
Gastrointestinal Regulation
[Sodium]
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Hypernatremia
Hypernatremia
Nursing Management
Nursing Diagnosis
Hyponatremia
Hyponatremia
Hyponatremia
Nursing Management
Nursing Diagnosis
• Hypovolemia can occur with loss of normal body fluids (diarrhea, fistula drainage,
hemorrhage), decreased intake, or plasma-to-interstitial fluid shift
• Hypervolemia may result from excessive intake of fluids, abnormal retention of fluids
(CHF), or interstitial-to-plasma fluid shift
• Extracellular Fluid Volume Imbalances
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• Treatment for hypervolemia is use of diuretics, fluid restriction, and sodium
restriction
Nursing Management
Nursing Diagnoses
• Hypovolemia:
Excess fluid volume
Ineffective airway clearance
Risk for impaired skin integrity
Disturbed body image
Potential complications: pulmonary edema, ascites
Nursing Management
Nursing Diagnoses
• Hypovolemia
Deficient fluid volume
Decreased cardiac output
Potential complication: hypovolemic shock
Nursing Management
Nursing Implementation
• I&O
• Monitor cardiovascular changes
• Assess respiratory status and monitor changes
• Daily weights
• Skin assessment
Nursing Management
Nursing Implementation
• Neurologic function
LOC
PERLA
Voluntary movement of extremities
Muscle strength
Reflexes
[Potassium]
Potassium
Hyperkalemia
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• Causes
Increased retention
Renal failure
Potassium sparing diuretics
Increased intake
Mobilization from ICF
Tissue destruction
Acidosis
Hyperkalemia
Clinical Manifestations
Nursing Management
Nursing Diagnoses
Nursing Management
Nursing Implementation
Hypokalemia
• Causes
Increased loss
Aldosterone
Loop diuretics
GI losses
Associated with Mg deficiency
Movement into cells
Hypokalemia
Clinical Manifestations
Hypokalemia
Clinical Manifestations
• Decreased GI motility
• Altered airway responsiveness
• Impaired regulation of arterial blood flow
• Diuresis
• Hyperglycemia
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Nursing Management
Nursing Diagnoses
Nursing Management
Nursing Implementation
• Replacement PO or IV
Never push IV
Painful in peripheral veins
Never give with anuric renal failure
• Teach prevention methods
[Calcium]
Calcium
Calcium
• t Controlled by
Parathyroid hormone
Calcitonin
Vitamin D
Hypercalcemia
Hypercalcemia
Hypercalcemia
• Management includes
loop diuretic
hydration with isotonic saline infusion
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synthetic calcitonin
mobilization
Nursing Management
Nursing Diagnosis
Hypocalcemia
Hypocalcemia
• Others include laryngeal stridor, dysphagia, numbness, and tingling around the mouth
or in the extremities
Hypocalcemia
• Management
Treat cause
Oral or IV calcium supplements
Treatment of pain and anxiety to prevent hyperventilation-induced respiratory
alkalosis
[Phosphate]
Phosphate
• Involved in acid-base buffering system, ATP production, and cellular uptake of glucose
• Maintenance requires adequate renal functioning
• Essential to function muscle, RBCs, and nervous system
Hyperphosphatemia
• Causes include
Acute or chronic renal failure
Chemotherapy
Excessive ingestion of milk or phosphate
Containing laxatives
Large intakes of vitamin D
Hyperphosphatemia
Clinical Manifestations
• Hypocalcemia
• Muscle problems (tetany)
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• Deposition of calcium-phosphate precipitates in skin, soft tissue, cornea, viscera, and
blood vessels
Hyperphosphatemia
• Management
Identifying and treating underlying cause
Restricting foods and fluids containing phosphorus
Adequate hydration and correction of hypocalcemic conditions
Sevelamer (Renagel)
Hypophosphatemia
• Causes include
Malnourishment/malabsorption
Alcohol withdrawal
Use of phosphate-binding antacids
During parenteral nutrition with inadequate replacement
Hypophosphatemia
Clinical Manifestations
• CNS depression
• Confusion
• Muscle weakness and pain
• Arrhythmias
• Cardiomyopathy
Hypophosphatemia
• Management
Oral supplementation
Ingestion of foods high in phosphorus
May require IV administration of sodium or potassium phosphate
[Magnesium]
Magnesium
Hypermagnesemia
• Causes include
Increased intake or ingestion of products containing magnesium when renal
insufficiency or failure is present
Hypermagnesemia
Clinical Manifestations
• Lethargy
• Drowsiness
• N/V
• Reflexes impaired
• Somnolence
• Respiratory and cardiac arrest can occur
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Hypermagnesemia
• Management
Prevention
IV CaCl or calcium gluconate
Fluids
Hypomagnesemia
• Causes include
Prolonged fasting or starvation
Chronic alcoholism
Fluid loss
Hypomagnesemia
Hypomagnesemia
Clinical Manifestations
Hypomagnesemia
• Management
Oral supplements
Increase dietary intake
If severe, parenteral IV or IM magnesium
[Protein] Imbalances
Hypoproteinemia
• Caused by
Anorexia
Malnutrition
Starvation
Fad dieting
Poorly balanced vegetarian diets
Hypoproteinemia
Hypoproteinemia
Clinical Manifestations
• Edema
• Slow healing
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• Anorexia
• Fatigue
• Anemia
• Muscle loss
• Ascites
Hypoproteinemia
Management
IV Fluids
Purposes
Maintenance
When oral intake is not adequate
Replacement
When losses have occurred
IV Fluids
D5W
• Isotonic
• Provides 170 kcal/L
• Free water
Moves into ICF
Increases renal solute excretion
D5W
• Prevents ketosis
• Supports edema formation
• Decreased chance of IV fluid overload
• Usually compatible with medications
• Isotonic
• No calories
• More NaCl than ECF
• 30% stays in IV (most)
70% moves out of IV
• Expands IV volume
Preferred fluid for immediate response
Risk for fluid overload higher
• Does not change ICF Volume
• Blood products
• Compatible with most medications
Lactated Ringer’s
• Isotonic
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• More similar to plasma than NS
l Has less Na Cl
l Has K, Ca, PO4, lactate (metabolized to HCO3)
• Expands ECF, IV
• Common replacement fluid
D5 ½ NS
• Hypertonic
• Common maintenance fluid
• KCl added for maintenance or replacement
D5 ½ NS
• Provides calories
Prevents ketosis
D10W
Hypertonic
Provides 340 kcal/L
Free water
Limit of dextrose concentration may be infused peripherally
Plasma Expanders
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