Chapter 76 Disorders in Fluid and Electrolyte Balance

Fluids and Electrolytes Balance • A normal balance between the body’s fluids and electrolytes, and acids and bases must exist for a person to be healthy. • Homeostasis – Dynamic process by which the body constantly adjusts to internal and external stimuli – Disrupted by abnormalities of fluid levels and electrolyte content Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diagnostic Tests • Basic metabolic panel (BMP) • Comprehensive metabolic panel (CMP) • Hematologic tests of the complete blood count (CBC), clotting factors, and liver function tests (LFTs) • Arterial blood gas (ABG) evaluations • Urine and other body fluids Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Medical Treatment • Electrolyte excess – Oral or rectal medication to draw electrolytes out of the body through the gastrointestinal system. – Oral or intravenous (IV) medications may draw fluids or certain electrolytes from the body for elimination through the urinary system. • Electrolyte deficit – Specific electrolytes may be added to a largevolume infusion or given in a smaller volume via intermittent infusion. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process • Data collection • Planning and implementation – Teaching the client and family – Treating edema – Monitoring daily fluid balance – Administering medications – Assisting with mouth and Skin care • Evaluation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? The nurse is responsible for notifying the primary healthcare provider of significant changes in laboratory values. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True Although laboratory personnel may have highlighted or noted critical values, the nurse is generally responsible for notifying the primary healthcare provider of significant changes in laboratory values or of critical laboratory values. Critical values are those laboratory levels that are considered serious or life threatening. The nurse documents that the laboratory values have been reported. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fluid Volume Excess • Excessive retention of water and sodium in the ECF. • Possible causes – Increased fluid intake, decreased urine output – Excess ingestion of sodium – Physical disorders that result in a decreased ability of the heart to pump effectively – Stress from surgery or other physical trauma that causes aldosterone and antidiuretic hormone (ADH) production, resulting in sodium and water retention Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fluid Volume Excess (Cont’d) • Edema: Local or generalized clinical manifestation of many disorders involving FVE – Congestive heart failure, thrombophlebitis, liver cirrhosis – Poor lymphatic drainage – Inflammation – Physical stress – Low protein levels – Sodium retention Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fluid Volume Excess (Cont’d) • Dependent edema • Sacral edema • Pitting edema •

Fluid Volume Deficit • Deficiency of fluid and electrolytes in the ECF. • Dehydration: Decreased volume of water; does not occur without electrolyte changes • Possible causes – Inadequate fluid intake and starvation – Loss of body fluids – Prolonged fever – Inability of the body to conserve and reuse water by concentrating the urine Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Electrolyte Functions • Potassium (K) – Major electrolyte in intracellular fluid (ICF) – Controls cellular osmotic pressure and activates enzymes – Regulates acid–base balance and maintains nerve and muscle function – Influences kidney function and sugar uptake Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Electrolyte Functions (cont’d) • Sodium (Na) – Major electrolyte in extracellular fluid (ECF) – Influences distribution of water – Maintains acid–base balance and nerve function • Calcium (Ca) – Major component of bones and teeth – Affects permeability of cell membranes and nerve function. – Blood coagulation, maintenance of heartbeat Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Electrolyte Functions (cont’d) • Magnesium (Mg) – May be needed in activation of enzymes – Aids in some neuromuscular functions • Chloride (Cl) – Plays a key role in acid–base balance – Helps to maintain water balance • Phosphorus (P) and Phosphate (PO 4) – Component of bone – Involved in most metabolic processes Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Electrolyte Imbalance Potassium (K) EXCESS Hyperkalemia DEFICIENCY Hypokalemia Sodium (Na) Hypernatremia Hyponatremia Calcium (Ca) Hypercalcemia Hypocalcemia Magnesium (Mg) Hypermagnesemia Hypomagnesemia Chloride (Cl) Hyperchloremia Hypochloremia Phosphorus (P) and Hyperphosphatemia Hypophosphatemia Phosphate (PO 4) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Imbalances in Older Adults • Decreased renal and respiratory functioning • Thirst mechanisms are depressed; deliberate limitation of fluid intake. • Regular medications affect renal and cardiac function and fluid balance; routine procedures induce serious fluid volume deficits. • Subtle or atypical signs of disturbances; skin turgor is a less valid observation of dehydration. • Self-medication with enemas, laxatives, or remedies, such as baking soda. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? In elderly individuals, the thirst sensation

Answer False In some individuals, especially the elderly, the thirst sensation may be diminished or depressed. Individuals with impaired sensations, altered mental status, or communication difficulties may be unable to perceive, communicate, or respond to thirst. Thirst is also a major symptom of hypernatremia. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Acid-Base Balance: Acidosis • Acidosis – When the blood is more acidic than normal • Metabolic acidosis – Deficit in bicarbonate ions (HCO 3+) or an excess in hydrogen ions (H+) • Respiratory acidosis – Increase in carbon dioxide in the blood Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Acid-Base Balance: Alkalosis • Alkalosis – When the blood is more basic than normal, because of a loss of body acids or excessive retention of alkaline substances • Metabolic alkalosis – Excess of bicarbonate, often owing to excess bicarbonate antacid administration or a loss of acids • Respiratory alkalosis – Deficit of plasma CO 2 usually caused by hyperventilation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? A simple treatment for respiratory acidosis is for the client to breathe into a paper bag. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False A simple treatment for respiratory alkalosis, usually caused by hyperventilation, is for the client to breathe into a paper bag, thereby retaining needed CO 2 in the body. The client rebreathes his or her own CO 2, thus replacing the CO 2 needed by the body. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins