Adult Fluid Balance and Electrolyte Imbalances

fluid that is transcellular, intracellular, extracellular, interstitial, and plasma are in the…

first space

accumulation of fluids to the interstitial space

second space

Second Space Edema

• decreases ___________ _________

• increases ___________ __________

oncotic pressure, hydrostatic pressure

Increased Interstitial Oncotic Pressure damages cap walls, so fluid will ________ to the ______________ space

shift, interstitial

Fluid accumulation in non-functional areas between cells, where it is hard to move back

third space

How does Fluid stay in the Vascular System?

• ____________ ____________ pulls fluids into vessels

• ______________ hold onto it.

oncotic pressure, capillaries

Blood plasma gets oncotic pressure from…

protein, albumin

What are 4 main disruptors of fluid balance?

alterations in ADH, Thirst Mechanism, Kidney funct, and GI changes

ADH controls how much fluid the body ________ _______

holds onto

What are 5 Gerontological considerations for Fluid Volume Overload?

structural changes in kidneys, hormonal changes, loss of subQ tissue, dec thirst mechanism, function changes

What are 4 main ways to assess fluid volume overload?

daily weights, I&O, urine specific gravity, serum/blood osmolarity

Low urine specific gravity means…

urine is dilute from excess fluid

High urine specific gravity means…

urine is concentrated from fluid deficit

Fluid Excess

• Urine Specific Gravity = _____

• serum/blood osmolarity = _____

low, low

Fluid Deficit

• Urine specific gravity = _______

• serum/blood osmolarity = ________

high, high

HYPERosmolarity

• ________ in solute

• _______ ________

increase, water deficit

HYPOosmolarity

• _________ in solute

• ________ _________

decrease, water excess

What are 3 main causes of fluid volume deficit?

hemorrhage, inadequate intake, GI loss

5 Signs and Symptoms of Fluid Volume Deficit?

weight loss, dry skin, tachycardia, seizures/coma, postural hypotension

Expected Labs for Fluid Volume Deficit

• elevated _____, _________ ___________, and ________ __________ ___________.

BUN, serum osmolarity, urine specific gravity

What are 4 main causes of fluid volume excess?

renal failure, HF, excess hypo/iso fluids, corticosteroids

What are 6 main signs of fluid volume excess?

weight gain, edema, dyspnea, crackles, inc BP, S3 sound

Labs for Fluid Volume Excess

• DEC _________ ___________

• DEC _______ __________ _________

• _______ low to dilution of the blood

serum osmolarity, urine specific gravity, RBC

Fluid Volume Deficit Treatment

• _______ and _______ care

• encourage _________

• _____ fluids as ordered

• ______ ___________

• oral rehydration ______________

• assess ______ __________

oral, skin, PO, IV, fall precaution, solution, fluid balance

Fluid Volume Excess Treatment

• __________

• fluid __________

• skin care

• _____ ___________

• _______/___________

• ____________ extremities with edema

diuretics, restriction, fall precautions, para/thoracentesis, elevate

When should you not elevate edematous extremities?

HF

When giving Furosemide assess… (4)

I&O, K+, BP, fluid excess/defecit

Furosemide is given _____mg/min, and _____mg/mL

10, 10

Furosemide is __________ if pushed too fast

ototoxic

What are 3 adverse effects of Furosemide?

dehydration, hypokalemia, too much output

Normal Sodium Range is…

135-145

Normal Potassium Range is…

3.5-5

Sodium

• influences _______ ____________

• Generates and transmits _______ __________

• __________ ____________

• regulates ______/_______ balance

• Primary determinant of ____________.

water distribution, nerve impuses, muscle contraction, acid base, osmolality

changes in Na+ = changes in serum/blood ___________

osmolality

Potassium

• main factor in nerve and muscle cell _________ _________

• impacts _______/_______________ function

• regulates ______/______ balance

• main source is ______

• excreted via ______

• proper excretion through good __________ function

resting potential, cardiac, neuromuscular, acid base, diet, urine, kidney

What are the 2 kinds of Sodium Imbalance?

Hypo and hypernatremia

Sodium <135 meq/L is…

hyponatremia

Sodium >145 meq/L is…

hypernatremia

What are 4 causes of Hyponatremia?

GI loss, diuretics, adrenal insufficiency, excessive hypotonic fluid

What are 4 causes of Hypernatremia?

Hypertonic/Isotonic IV fluid, hypertonic tube feed w/o enough water, hyperventilation, and near drowning in salt water

What are 5 Hyponatremia Manifestations?

confusion, fatigue, seizure, coma, low BP

What are 5 Hypernatremia Manifestations?

skin flush, agitation, low fever, thirst, inc BP

Hyponatremia Treatment

• fluid ___________

• __________ sodium containing IV solutions (___% __________ ________)

• encourage oral sodium intake

• IF SEVERLY LOW (___% ___________ ___________)

restriction, isotonic, 0.9, sodium chloride, 3, sodium chloride

Hypernatremia Treatment

• If mild, __________ solution (_____% _____________ ____________)

• If severe ___________ solution (_____ _______)

• restrict ________ in ______

• ___________

isotonic, 0.9, sodium chloride, hypotonic, D5 water, sodium diet, diueretics

Sodium imbalances must be corrected _________ to avoid ___________ damage.

slowly, neurological

What are 6 Hypokalemia Causes?

diet, dialysis, GI loss, Renal loss, diuretics, and large amounts of insulin

What are 7 Hyperkalemia Causes?

excessive intake, rapid admin of K+, Renal disease, adrenal insuff, lack of insulin, ACE inhibitors, Spirinolactone

Insulin is needed to pull _____ into cells. Without insulin you can develop ___________.

K+, Hyperkalemia

Manifestations of Hypokalemia

• leg _________/weakness

• fatigue, confusion

• EKG changes: ______ ___-_______, __________ ______

• __________ pulse

• decreased __________ and muscle ______

• __________ ______

cramping, flattened T wave, prolonged QRS, flattened T wave, irregular, reflexes, tone, shallow resp

What are 5 Manifestations of Hyperkalemia?

resp distress, muscle cramps, tall T wave, wide QRS, dec contractility

Pts with hyper/hypo __________ need to be telemonitored or on continuous cardiac monitor.

kalemia

Treatment for Hypokalemia

• if pt can produce urine > or equal to ______mL/kg/hr give _____________ K+ pills/liquid

• If MILD… higher K+ _____

• If SEVERE… ____ ______ _________

5, supplemental, diet, IV K+ infusion

K+ is a __________ so make sure to…

vesicant, assess IV site

IV K+ infusions are usually given at _____ mEq/hr

10

What is another way to treat hypokalemia besides K+?

beta agonists like albuterol

Beta Agonists treat Hypokalemia by…

pulling K+ into cells

Treatment for Hyperkalemia

• encourage _____ and _________

• ____________

• ___________ ____________

• ___________ for pts with kidney failure

• low K+ diet

• __________ IV push given with ________

BM, diuresis, dieuretics, sodium polystyrene, dialysis, insulin, D50

IV push Insulin is given to pt’s with HYPERkalemia to…

draw K+ into cells

In instances of HYPERkalemia, D50 is given with insulin IV push to…

prevent hypoglycemia

Even though it won’t change K+ levels ___________ ___________ is given to protect cardiac cells from _____________ due to ______________.

calcium gluconate, dysrhythmias, hyperkalemia

NEVER push ______ IV or cardiac arrest will occur

K+

Sodium Polystyrene exchanges _____ for _____ in the intestines and excretes ______ via BM

K+, Na+, K+

What are 2 Key assessments for a pt receiving Sodium Polystyrene?

GI output, K+ levels