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Fluid and Electrolytes

Imbalances
By: Ms. Tanya Champion

Objectives:
Upon completion of this lesson, the student will be able
to:
1. List the causes of fluid and electrolyte imbalances.
2. Identify types of fluid and electrolyte imbalances.
3. Identify purpose of fluid replacement.
4. Identify clues of possible imbalances.
5. State the normal lab values related to fluid and
electrolyte imbalances.
6. Identify interventions delegated for treatment.

Fluid, electrolyte, and acid-base balances are


needed to maintain health and function in all
body systems. These balances are maintained
by the intake and output of water and
electrolytes and regulation by the renal and
pulmonary systems. Conditions which Increase
Susceptibility to Fluid and Electrolyte
Imbalances are persons with: diarrhea,
vomiting, gastric/intestinal suction,
hemorrhage, high prolonged fever, edema,
special diets, ascites, and draining wounds.

The body is trying to maintain homeostasis.


Homeostasis is the state of equilibrium naturally
maintained by the adaptive responses of the
body, many disease and treatments can affect
fluid and electrolytes. Water and minerals help
the body maintain an appropriate balance and
distribution of water, Total body weight is 80%
at birth and decreases to about 60% in adults.

Clues to imbalances
1. Sudden wt. gain or loss
2. Sudden change in vital signs
3. Presence of any of the previously mentioned
conditions which may cause fluid and
electrolyte imbalances
4. Fluid balance records that show a
pronounced discrepancy between fluid Intake &
Output
5. Post-trauma or post-op condition

Based on the signs and symptoms exhibited


and lab values is an indicator of which fluid
and electrolyte is imbalanced. Also several
imbalances may have similar symptoms and
one imbalance can trigger another. Therefore it
is important to monitor data and analyze
factors.

Signs and symptoms


Fluid volume excess (Hypervolemia)
-Too much water in the vascular space
vascular space=veins, capillaries, chambers of the
heart.
-WEIGHT GAIN (2% mild FVE, 5% moderate, 8% severe)
-I/O (fluid intake greater than output), -FULL BOUNDING
PULSES, -TACHYCARDIA, -INCREASED BLOOD PRESSURE
and VENOUS PRESSURE, -DISTENDED NECK VEINS,
-MOIST CRACKLES IN LUNGS, -SOB, -MENTAL
CONFUSION

Signs and symptoms


Fluid volume deficit Hypovolemia
big deficit=shock
not enough fluid
-COMPLAINTS OF WEAKNESS AND THIRST
WEIGHT LOSS(2% loss mild 5% loss moderate 8%
loss severe) FLUID INTAKE LESS THAN OUTPUT
DECREASED SKIN TURGOR SUBNORMAL
TEMPERATURE DRYMOUTH ORTHOSTATIC
HYPOTENSION -WEAK PULSE DECREASE IN

Lab Values
Normal Values in Plasma:
Na+ 135-145 mEq./L
K+ 3.5-5.0 mEq.L.
Ca++ 4.5-5.5 mEq./L or 9-11 mg%
Mg++ 1.4-2.3 mEq./L
Cl 98-106 MEq./L.
HC03- Adults 25-29 mEq./L
Children 20-25 mEq./L.
HP04- 1.72 - 2.6 mEq./L.
PR0 6-8 Gm./100 ml. (6-8 Gms.%)
pH 7.35 -7.45

Measurements of hydration status:


serum osmolality 270-300 mOsm/Kg.
serum Na+ 35-145 mEq./L.
BUN 6-22 mg./100ml.
Hct. 37-47l./100 ml. (female)
0-54 ml./100 ml. (male)
urine specific gravity 1.003-1.030
urine osmolality 38-1400 mOsm/Kg.

Determination of arterial blood gas values used to diagnose hydrogen (acid-base)


imbalances
Normal values:
pH 7.40 (Range 7.35 - 7.45 - If > 7.8 or < 6.8,
death)
pCO2 40 mm Hg
pO2 75-100 mm Hg
HCO3 22-26 mEq./L

Delegated interventions for treatment


*Some of the interventions are completed by RN but
LVN needs to be aware of patients full treatment.
1. Record intake and output
2. Weigh patient at the same time and while wearing
the same amount of clothing each day, use the same
scales daily.
3. Regulation of diet and regulation of oral fluid
intake.
4. Administration of medication - Example. diuretics,
K+ preparation based on imbalance

Delegated interventions for treatment


5. Tube feedings - Need to administer water in between
feeding to prevent hypertonic dehydration
6. IV Infusions - While the oral route is preferred for fluid
and electrolyte administration, there are times when IV
infusions must be utilized. Example: Person who are
unable to eat.
7. Blood transfusions
8. Parenteral hyperalimentation-nutrients through a
central venous catheter via enteral route.

Safety Precautions
High risk for falls due to changes in
vital signs, and mental status.

After given work assignment the nurse reviews


patient records prior to providing care. On
review of the patients records, which patient is
at risk for fluid volume deficit?

1.A patient with a colostomy.


2.A patient with congestive heart failure.
3.A patient with decreased kidney function.
4.A patient with frequent wound irrigations.

After given work assignment the nurse


reviews patient records prior to providing
care. On review of the patients records,
which patient is at risk for fluid volume
excess?
1.A patient taking diuretics
2.A patient with renal failure
3.A patient with an ileostomy
4.A client who requires GI suctioning

Reference:
Phillips, W.J., etal, (2003). Medical
Surgical Nursing: Heath and
illness perspectives (7th ed.) St.
Louis: Mosby.

A patient with a colostomy.


The cause of a fluid volume deficit include vomiting, diarrhea,
conditions that cause increased respiration or diarrhea,
conditions that cause increased respirations or increased
urinary output, insufficient IV fluid replacement, draining
fistulas, and the presence of an ileostomy or colostomy. A
client with CHF or decreased kidney function or a client
receiving frequent wound irrigations is at risk for fluid volume
excess.

The patient with renal failure.


The causes of fluid volume excess include decreased kidney
function, congestive heart failure (CHF), the use of hypotonic
fluids to replace isotonic fluid losses, excessive irrigation of
wounds and body cavities, and excessive ingestion of sodium. The
patient with an ileostomy, the client on diuretics, and the client on
GI suctioning are a t risk for fluid volume deficit.