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Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Maintaining Fluid and Electrolyte Balance
Concepts of Fluid Balance
Functions of body fluids
Fluid compartments
Electrolytes
Movement of fluids and electrolytes
Regulation of fluid balance
Problems of fluid balance
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Functions of Body Fluids
Body needs: 1500 mL daily 700 mL from food we eat 300 mL from oxidation of food
Functions Makes half the body weight Transports nutrients and wastes to and from cells Acts as solvent for electrolytes and nonelectrolytes Facilitates digestion and elimination Maintains acid-base balance Lubricates joints and other body tissues
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Fluid Compartments
Intracellular fluid compartment Contain 70% of body fluids Fluid loss at cellular level affects entire body
Extracellular fluid compartment Contain 30% of body fluids Intravascular fluids Interstitial fluids Transcellular fluids
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Electrolytes
ElectrolyteElectrolyte Normal Plasma ValueNormal Plasma Value
SodiumSodium 135 to 145 mEq/L135 to 145 mEq/L
PotassiumPotassium 3.5 to 5.0 mEq/L3.5 to 5.0 mEq/L
CalciumCalcium 4.5 to 5.5 mg/dL4.5 to 5.5 mg/dL
MagnesiumMagnesium 1.5 to 2.5 mg/dL1.5 to 2.5 mg/dL
ChlorideChloride 98 to 106 mEq/L98 to 106 mEq/L
PhosphorusPhosphorus 1.2 to 3.0 mg/dL1.2 to 3.0 mg/dL
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Movement of Fluids and Electrolytes
Osmosis Hypotonic Hypertonic
Diffusion Active transport Filtration
Colloid osmotic pressure Hydrostatic pressure
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Regulation of Fluid Balance
Thirst Intake of fluids
Lymphatic system “Sponging up”
Neuroendocrine system Hormones
Gastrointestinal system Absorbs—secretes—reabsorbs
Renal system Works with neuroendocrine system to regulate volume
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Problems of Fluid Balance Deficient fluid volume
Hypovolemia Dehydration
Excess fluid volume Hypervolemia Water intoxication
Electrolyte imbalance Deficit or excess of one or more electrolytes
Acid-base imbalance Respiratory acidosis and respiratory alkalosis Metabolic acidosis and metabolic alkalosis
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Factors Affecting Fluid Balance
Lifestyle factors Nutrition Exercise Stress
Physiological factors Cardiovascular Respiratory Gastrointestinal Renal Integumentary Trauma
Developmental factors Infants and children Adolescents and middle-
aged adults Older adults
Clinical factors Surgery Chemotherapy Medications Gastrointestinal intubation Intravenous therapy
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Assessment of Fluid Balance
General Focused assessment for deficient
fluid volume Focused assessment for excess fluid
volume Focused assessment for associated
problems
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
General Assessment
Health history Chief complaint Past history of
illnesses
Physical examination Standard clinical
measurements Weighing the client Input and output Assessing edema
Diagnostic tests Plasma sodium Plasma osmolality Urine osmolality Hematocrit Blood urea nitrogen
(BUN)
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Focused Assessment for Deficient fluid volume
Defining characteristics Extracellular Intracellular
Related factors The acuteness of the loss The severity of the loss The client’s age and state of health The degree to which the client combats the deficit
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Focused Assessment for Excess fluid volume
Defining characteristics Extracellular Intracellular
Related factors Any increase in fluid intake Any increase in sodium intake Increase in capillary permeability Protein loss The client’s response to fluid excess
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Focused Assessment for Associated Problems Electrolyte imbalances
Fluid imbalances rarely exists without electrolyte imbalance
Anticipate the risk for imbalance Metabolic acidosis
End-stage renal disease Severe diarrhea Hypoxia Hyperglycemia
Metabolic alkalosis Consumption of excessive bicarbonate products Loss of excessive potassium and hydrochloric acid
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Diagnosis
Deficient fluid volume or Risk for deficient fluid volume
Excess fluid volume or Risk for excess fluid volume
Related nursing diagnoses Fatigue Anxiety Ineffective health maintenance Imbalanced nutrition Impaired skin integrity Impaired tissue perfusion Impaired gas exchange Constipation Impaired oral mucous membranes Disturbed sleep pattern
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Planning (Expected Outcomes)
Deficient fluid volume Increase in fluid intake Moist mucous membranes Absence of tongue furrows
Excess fluid volume Decrease in peripheral edema Weight loss Decrease in fatigue and weakness
Associated problems
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Interventions
To reduce the risk of deficient fluid volume Teaching client about fluid needs Preventing excessive fluid deficits Restoring lost fluids
To increase fluid volume Restoring fluid balance Preventing further loss Instituting rehabilitative care Administering intravenous therapy
To decrease fluid volume Restoring fluid balance Preventing complications Instituting rehabilitative care
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Interventions
To balance electrolyte levels General interventions
o Nutrition is the key Sodium imbalance: hyponatremia or hypernatremia Potassium imbalance: hypokalemia or hyperkalemia Calcium imbalance: hypocalcemia or hypercalcemia Magnesium imbalance Phosphate imbalance
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Intravenous Therapy
Types of intravenous (IV) solutions
Categorized by osmolality: how solution affects other fluids Isotonic Hypotonic Hypertonic
Sites for IV therapy
Potential complications Infiltration Phlebitis Infection Air embolism Allergic reaction Circulatory overload
Care of IV site Peripheral Central
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Evaluation
The time frame for evaluating fluid or electrolyte
imbalance varies with the urgency of the imbalance.
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.