Fluids & Electrolytes

Recommended daily fluid intake for adults

2500 mL

How is water balance measured?

weighing a person at the same time, with the same scale in the same clothing each day

A loss of ______ of body fluid in an adult is life threatening

15%

Symptoms of Fluid overload

Early signs: Restlessness, gradual increase in heart rate, headache, dyspnea, nonproductive cough. Late signs: Hypertension, severe dyspnea, gurgling respirations.

Nursing Considerations for Fluid overload

Monitor for early signs and symptoms of fluid excess. If fluid overload suspected, provide bed rest in high Fowler position.

Clinical manifestations of Hyponatremia

Lethargy, confusion, weakness, muscle cramping, seizures, anorexia, nausea, vomiting, serum osmolality

Interventions for Hyponatremia

encourage foods high in sodium; restrict water intake; administer hypertonic IV saline ensure Na+ levels increase by only 4 to 6 mEq/L in any 24-hour period.

Causes of Hypernatremia

Excess sodium intake, hypertonic IV solutions, hypertonic enteral feedings without adequate water, excessive loss of water due to diarrhea, inadequate intake of water, insensible loss due to fever

Clinical manifestations of Hypernatremia

Thirst, dry and sticky mucous membranes, weakness, elevated temperature, confusion, irritability, decreased levels of consciousness, hallucinations, seizures, serum osmolality >290 mOsm/kg

Interventions for Hypernatremia

Monitor level of consciousness, intake and output, limit salt intake; increase water intake; administer hypotonic IV solutions as ordered.

Causes of Hypokalemia

Loss of potassium due to vomiting, gastric suction, diarrhea, laxative abuse, frequent enemas, potassium-wasting diuretics, inadequate intake seen in anorexia, alcoholism, debilitated patients, hyperaldosteronism

Clinical manifestations of Hypokalemia

Weak, irregular pulse, fatigue, lethargy, anorexia, nausea, vomiting, muscle weakness and cramping, decreased peristalsis, hypoactive bowel sounds, paresthesia, cardiac dysrhythmias

Interventions for Hypokalemia

Monitor heart rate and rhythm with ECG, encourage foods high in potassium; administer potassium supplements

Causes of Hyperkalemia

Renal failure, massive trauma, crushing injuries, burns, hemolysis, IV potassium, potassium-sparing diuretics, acidosis

Clinical manifestations of Hyperkalemia

Anxiety, irritability, confusion, dysrhythmias, including bradycardia and heart block, muscle weakness, flaccid paralysis, paresthesia, abdominal cramping

Interventions for Hyperkalemia

monitor cardiac rhythm with ECG; monitor laboratory results for serum potassium levels; limit potassium-rich foods

Causes of Hypocalcemia

Hypoparathyroidism, pancreatitis, vitamin D deficiency, inadequate intake of calcium-rich foods, hyperphosphatemia, chronic alcoholism

Clinical manifestations of Hypocalcemia

Confusion, anxiety, numbness and tingling of extremities, muscle cramps that progress to tetany and seizures, hyperactive reflexes, cardiac dysrhythmias

Interventions for Hypocalcemia

Monitor heart rate and rhythm; institute fall and seizure precautions; administer oral and/or IV calcium supplements as ordered; encourage calcium-rich foods.

Causes of Hypercalcemia

Prolonged bed rest, hyperparathyroidism, bone malignancy, Paget disease, osteoporosis

Clinical manifestations of Hypercalcemia

Lethargy, stupor, coma, decreased muscle strength and tone, anorexia, nausea, vomiting, constipation, pathologic fractures, dysrhythmias

Interventions for Hypercalcemia

Monitor heart rate and rhythm; encourage increased fluid intake; increase patient activity, including active ROM.

What is the primary cause of respiratory acidosis?

Hypoventilation due to factors like chest injury, asthma attack, or medications.

What are common clinical manifestations of respiratory acidosis?

Headache, altered level of consciousness, dyspnea, and muscle twitching.

What interventions are recommended for respiratory acidosis?

administer oxygen, and encourage deep breathing and coughing

What is the primary cause of respiratory alkalosis?

Hyperventilation due to pain, salicylate overdose, or anxiety.

What are the clinical manifestations of respiratory alkalosis?

Tachypnea, numbness, muscle cramping, and ECG changes.

What interventions are recommended for respiratory alkalosis?

Encourage slow, deep breaths, and provide reassurance and emotional support.

What are common causes of metabolic acidosis?

Shock, trauma, diabetic ketoacidosis, salicylate overdose, and chronic renal failure.

What are the clinical manifestations of metabolic acidosis?

Kussmaul respirations, hypotension, weakness, and nausea.

What interventions are recommended for metabolic acidosis?

administer sodium bicarbonate, and have mechanical ventilation available.

What is a common cause of metabolic alkalosis?

Vomiting, nasogastric suctioning, or overuse of bicarbonate antacids.

What are the clinical manifestations of metabolic alkalosis?

Hypotension, muscle twitching, seizures, and increased deep tendon reflexes.

What interventions are recommended for metabolic alkalosis?

assess level of consciousness and initiate seizure precautions.

What is the effect of hypoventilation on blood pH?

It decreases pH, leading to acidosis.

How does hyperventilation affect blood pH?

It increases pH, leading to alkalosis.

What is Kussmaul respiration?

Deep, labored breathing often associated with metabolic acidosis.

What is the significance of monitoring ABG results?

It helps assess the severity of acid-base imbalances and guide treatment.

What is the normal range of sodium (Na+) in mEq/L?

135-145 mEq/L

Why is sodium essential for nerve and muscle function?

It is essential in depolarization.

What percentage of a healthy adult's weight is water?

Almost 60%.

What are the two main types of body fluid?

Intracellular fluid and extracellular fluid.

What are the components of extracellular fluid?

Interstitial, intravascular, and transcellular fluids.

What stimulates the secretion of ADH?

Increased osmolarity of blood plasma, indicating dehydration.

What mechanism monitors blood plasma osmolarity?

Osmoreceptors located in the hypothalamus.

filtration

the movement of fluid and solutes from an area of higher pressure to an area of lower pressure

diffusion

the movement of solutes across a selectively permeable membrane from areas of higher concentration to lower

isotonic fluid

causes no fluid shift into/out of cells. Given for dehydration; ex: normal 0.9 % saline

hypertonic fluids

More concentration than body fluids- pulls water out of the cell= cell shrivels

hypotonic fluid

lower osmolarity than plasma causing fluids to shift into the cell. Cells swell.

average daily urine output

1500 mL

Average daily total fluid output

2500 mL

The lungs assist with acid-base balance by retaining or ridding the body of

CO2

The kidneys assist with acid base balance by retaining or excreting:

HCO3

osmosis

Movement of water across a semipermeable membrane from an area of lower solute concentration to higher solute concentration