Chapter 13 Assessment and Care of Patients with Fluid and Electrolyte Imbalances - PowerPoint Presentation

Slide1

Chapter 13

Assessment and Care of Patients with Fluid and Electrolyte ImbalancesSlide2

Homeostasis

Extracellular fluid

Intracellular fluid

Interstitial fluidTranscellular fluidsSlide3

Clinical Significance: Blood Pressure

Blood pressure is an example of hydrostatic filtering forces. It moves whole blood from the heart to capillaries where filtration can occur to exchange water, nutrients, and waste products between the blood and the tissues.Slide4

Blood Pressure Slide5

Clinical Significance: Edema

Edema develops with changes in normal hydrostatic pressure differences.Slide6

Fluid BalanceSlide7

Clinical Significance: Diffusion

Diffusion is important in the transport of most electrolytes and particles through cell membranes.

Sodium pumps.

Glucose cannot enter most cell membranes without the help of insulin.Slide8

Clinical Significance: Osmosis and Filtration

The thirst mechanism is an example of how osmosis helps maintain homeostasis.

The feeling of thirst is caused by the activation of cells in the brain that respond to changes in ECG osmolarity.Slide9

Fluid Balance

Fluid intake

Fluid loss:

Minimum amount of urine needed to excrete toxic waste products is 400 to 600 mLInsensible water lossSlide10

Hormonal Regulation of Fluid Balance

Aldosterone

Antidiuretic hormone

Natriuretic peptidesSlide11

Dehydration

Fluid intake is less than what is needed to meet the body’s fluid needs, resulting in a fluid volume deficit.

Consideration for older adults.Slide12

Collaborative Care—

Dehydration

Assessment

HistoryPhysical assessment/clinical manifestations:

Cardiovascular changes

Respiratory changes

Skin changes

Neurologic changes

Renal changesSlide13

Dehydration: Laboratory Assessment

Elevated hemoglobin

Elevated hematocrit

Elevated serum osmolarityElevated glucose

Elevated protein

Elevated BUN

Elevated electrolytes

Hemoconcentration Slide14

Dehydration: Interventions

Patient safety

Fluid replacement

Drug therapySlide15

Fluid Overload

Excess of body fluid.

Most problems caused by overhydration are related to fluid volume excess in the vascular space or to dilution of specific electrolytes and blood components.Slide16

Collaborative Care—

Fluid Overload

Assessment

Patient safetyPulmonary edema

Drug therapy

Nutrition therapy

Monitoring of I&OSlide17

Sodium (135 to 145 mmol/L)

Sodium level is vital for skeletal muscle contraction, cardiac contraction, nerve impulse transmission, and normal osmolarity and volume of the ECF.Slide18

Hyponatremia

Sodium level below 136 mEq/L

Cerebral changes

Neuromuscular changesIntestinal changes

Cardiovascular changesSlide19

Hyponatremia Interventions

The priority for nursing care of the patient with hyponatremia is monitoring the patient’s response to therapy and preventing hypernatremia and fluid overload.

Drug therapy.

Nutrition therapy.Slide20

Hypernatremia

Serum sodium level over 145 mEq/L

Nervous system changes

Skeletal muscle changesCardiovascular changesSlide21

Hypernatremia Interventions

Priorities for nursing care of the patient with hypernatremia include monitoring the patient's response to therapy and preventing hyponatremia and dehydration.

Drug therapy.

Nutrition therapy.Slide22

Potassium (3.5 to 5.0 mEq/L)

Depolarization and generation of action potentials, as well as regulating protein synthesis and glucose use and storageSlide23

Hypokalemia

Serum potassium level below 3.5 mEq/L

Can be life threatening because every body system is affected

Respiratory changesMusculoskeletal changes

Cardiovascular changes

Neurologic changes

Intestinal changesSlide24

Hypokalemia Interventions

The priorities for nursing care of the patient with hypokalemia are ensuring adequate oxygenation and patient safety for falls prevention, preventing injury from potassium administration, and monitoring the patent's response to therapy.

Drug therapy.

Nutrition therapy.

Safety measures.

Respiratory monitoring.Slide25

Hyperkalemia

Serum potassium greater than 5.0 mEq/L.

Cardiovascular changes are the most severe problems from hyperkalemia and are the most common cause of death in patients with hyperkalemia.

Neuromuscular changes.

Intestinal changes.Slide26

Hyperkalemia Interventions

Drug therapy—Kayexalate, insulin

Cardiac monitoring

Health teachingSlide27

Calcium (9.0 to 10.5 mg/dL)

Calcium is a mineral with functions closely related to those of phosphorus and magnesium.

Absorption of dietary calcium requires the active form of vitamin D.

Calcium is stored in the bones.

Parathyroid hormone.

Thyrocalcitonin. Slide28

Hypocalcemia

Total serum calcium level below 9.0 mg/dL

Cultural considerations

Women’s health considerationsNeuromuscular changesSlide29

Hypocalcemia (Cont’d)Slide30

Hypocalcemia (Cont’d)

Cardiovascular changes

Intestinal changes

Skeletal changesSlide31

Hypocalcemia Interventions

Drug therapy

Nutritional therapy

Environmental management—seizure precautions

Injury prevention strategies Slide32

Hypercalcemia

Total serum calcium level above 10.5 mg/dL.

Effects of hypercalcemia occur first in excitable tissues.

All systems are affected.Slide33

Hypercalcemia (Cont’d)

Cardiovascular changes are the most serious and life-threatening problems of hypercalcemia.

Neuromuscular changes.

Intestinal changes.Slide34

Hypercalcemia Interventions

Drug therapy—IV 0.9% sodium chloride, furosemide, calcium chelators, phosphorus, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors

Dialysis

Cardiac monitoringSlide35

Phosphorus (3.0 to 4.5 mg/dL)

Most phosphorus can be found in the bones.

Phosphorus is needed for activating vitamins and enzymes, forming adenosine triphosphate, and assisting in cell growth and metabolism.

Food sources include meats, fish, dairy products, and nuts.

Plasma levels of calcium and phosphorus exist in a balanced reciprocal relationship.Slide36

Hypophosphatemia

Serum phosphorus level below 3.0 mEq/L.

Most of the effects of hypophosphatemia are related to decreased energy metabolism and imbalances of other electrolytes and body fluids.Slide37

Hypophosphatemia (Cont’d)

Manifestations are most apparent in the cardiac, musculoskeletal, and hematologic systems and the CNS.

Cardiac changes.

Musculoskeletal changes—rhabdomyolysis.

CNS changes.Slide38

Hypophosphatemia Interventions

Oral replacement of phosphorus

Vitamin D supplements

IV phosphorusNutrition therapy—increasing the intake of phosphorus-rich foods while decreasing the intake of calcium-rich foodsSlide39

Hyperphosphatemia

Serum phosphorus level above 4.5 mEq/L.

Problems caused by hyperphosphatemia center on the hypocalcemia that results when serum phosphorus levels increase.

Does not cause many direct problems with body function.

Causes include renal insufficiency, certain cancer treatments, increased phosphorus intake, and hypoparathyroidism.Slide40

Hyperphosphatemia Interventions

Because calcium and phosphorus ions exist in the blood in a balanced reciprocal relationship, management of hyperphosphatemia entails the management of hypocalcemia.Slide41

Magnesium (1.3 to 2.1 mg/dL)

Magnesium is critical for skeletal muscle contraction, carbohydrate metabolism, ATP formation, vitamin activation, and cell growth.Slide42

Hypomagnesemia

Serum magnesium level below 1.2 mEq/L.

Effects of hypomagnesemia are caused by increased membrane excitability and the accompanying serum calcium and potassium imbalances.Slide43

Hypomagnesemia (Cont’d)

Neuromuscular changes.

CNS changes.

Intestinal changes.Interventions for hypomagnesemia:

Drugs—IV magnesium sulfateSlide44

Hypermagnesemia

Serum magnesium level above 2.1 mEq/L.

When magnesium excess occurs, excitable membranes are less excitable and need a stronger-than-normal stimulus to respond.

Cardiac changes.

CNS changes.

Neuromuscular changes.

Respiratory changes.Slide45

Hypermagnesemia Interventions

Magnesium-free IV fluids

Furosemide

Calcium Slide46

Chloride (98 to 106 mEq/L)

Imbalances of chloride usually occur as a result of other electrolyte imbalances.

Usually corrected by interventions for correcting other electrolyte or acid-base problems.