Homeostasis . Extracellular fluid. Intracellular fluid. Interstitial fluid. Transcellular fluids. 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, nut.... ID: 685659
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Assessment and Care of Patients with Fluid and Electrolyte ImbalancesSlide2
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
Clinical Significance: Edema
Edema develops with changes in normal hydrostatic pressure differences.Slide6
Clinical Significance: Diffusion
Diffusion is important in the transport of most electrolytes and particles through cell membranes.
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
Minimum amount of urine needed to excrete toxic waste products is 400 to 600 mLInsensible water lossSlide10
Hormonal Regulation of Fluid Balance
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
HistoryPhysical assessment/clinical manifestations:
Dehydration: Laboratory Assessment
Elevated serum osmolarityElevated glucose
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
Patient safetyPulmonary edema
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
Sodium level below 136 mEq/L
Neuromuscular changesIntestinal changes
The priority for nursing care of the patient with hyponatremia is monitoring the patient’s response to therapy and preventing hypernatremia and fluid overload.
Serum sodium level over 145 mEq/L
Nervous system changes
Skeletal muscle changesCardiovascular changesSlide21
Priorities for nursing care of the patient with hypernatremia include monitoring the patient's response to therapy and preventing hyponatremia and dehydration.
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
Serum potassium level below 3.5 mEq/L
Can be life threatening because every body system is affected
Respiratory changesMusculoskeletal changes
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.
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.
Drug therapy—Kayexalate, insulin
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.
Total serum calcium level below 9.0 mg/dL
Women’s health considerationsNeuromuscular changesSlide29
Environmental management—seizure precautions
Injury prevention strategiesSlide32
Total serum calcium level above 10.5 mg/dL.
Effects of hypercalcemia occur first in excitable tissues.
All systems are affected.Slide33
Cardiovascular changes are the most serious and life-threatening problems of hypercalcemia.
Drug therapy—IV 0.9% sodium chloride, furosemide, calcium chelators, phosphorus, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors
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
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
Manifestations are most apparent in the cardiac, musculoskeletal, and hematologic systems and the CNS.
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
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
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
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
Intestinal changes.Interventions for hypomagnesemia:
Drugs—IV magnesium sulfateSlide44
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.
Magnesium-free IV fluids
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.
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