Chapter 33

1. Chapter 33 Fluids and Electrolytes

2. Physiology of Fluid and Acid-Base Balance • Fluid compartments • Intracellular • Within cell • Extracellular • Within blood vessels • Interstitial • Between cells • Fluid that surrounds cells (continued)

3. Physiology of Fluid and Acid-Base Balance • Fluid compartments • Movement of molecules • Solute • Substance dissolved in solution • Solvent • Liquid that contains substance in solution (continued)

4. Physiology of Fluid and Acid-Base Balance • Fluid compartments • Movement of molecules • Permeability • Capability of substance, molecule, or ion to diffuse through membrane • Semipermeable • Selectively permeable (continued)

5. Physiology of Fluid and Acid-Base Balance • Body water distribution • 45 to 75 percent of total weight • Fat • Free of water • Replenish through ingestion • Electrolytes (continued)

6. Physiology of Fluid and Acid-Base Balance • Movement of body fluids • Physiological forces • Transportation of water, foods, gases, wastes, and ions • Maintains balance between extracellular and intracellular fluid volumes (continued)

7. Physiology of Fluid and Acid-Base Balance • Regulators of fluid balance • Fluid and food intake and loss • Skin • Lungs • Gastrointestinal tract • Kidneys (continued)

8. Physiology of Fluid and Acid-Base Balance • Acid-base balance • Homeostasis of hydrogen ion concentration in body fluids • Acid • Donates hydrogen ions • Base • Accepts hydrogen ions (continued)

9. Physiology of Fluid and Acid-Base Balance • Regulators of acid-base balance • Buffer systems • Respiratory regulation of acid-base balance • Renal control of hydrogen ion concentration

10. Factors Affecting Fluid and Electrolyte Balance • Age • Lifestyle

11. Electrolyte Disturbances • Sodium • Hyponatremia • Sodium deficit • Hypernatremia • Sodium excess (continued)

12. Electrolyte Disturbances • Potassium • Hypokalemia • Potassium deficit • Hyperkalemia • Potassium excess (continued)

13. Electrolyte Disturbances • Calcium • Hypocalcemia • Calcium deficit • Hypercalcemia • Calcium excess (continued)

14. Electrolyte Disturbances • Magnesium • Hypomagnesemia • Magnesium deficit • Hypermagnesemia • Magnesium excess (continued)

15. Electrolyte Disturbances • Phosphate • Hypophosphatemia • Phosphorous deficit • Hyperphosphatemia • Phosphorous excess (continued)

16. Electrolyte Disturbances • Chloride • Hypochloremia • Chloride deficit • Hyperchloremia • Chloride excess

17. Acid-Base Disturbances • Laboratory data • ABGs • Oxygen • Carbon dioxide • pH • Bicarbonate ion (continued)

18. Acid-Base Disturbances • Laboratory data • ABGs • Sodium • Potassium • Chloride (continued)

19. Acid-Base Disturbances • Respiratory alkalosis • Carbonic acid deficit • Respiratory acidosis • Carbonic acid excess (continued)

20. Acid-Base Disturbances • Metabolic acidosis • Bicarbonate deficit • Metabolic alkalosis • Bicarbonate excess

21. Fluids, Electrolytes, and the Nursing Process • Assessment • Health history • Lifestyle • Diet • Religion • Weight changes • Fluid output (continued)

22. Fluids, Electrolytes, and the Nursing Process • Assessment • Health history • Gastrointestinal disturbances • Fever • Wounds • Disease • Special therapies (continued)

23. Fluids, Electrolytes, and the Nursing Process • Assessment • Physical exam • Daily weight • Vital signs • Intake and output • Edema • Skin turgor (continued)

24. Fluids, Electrolytes, and the Nursing Process • Assessment • Physical exam • Oral cavity • Eyes • Jugular and hand veins • Neuromuscular system (continued)

25. Fluids, Electrolytes, and the Nursing Process • Assessment • Diagnostic and laboratory data • Hemoglobin and hematocrit • Osmolality • Urine pH • Serum albumin (continued)

26. Fluids, Electrolytes, and the Nursing Process • Diagnosis • Excess fluid volume • Deficient fluid volume • Risk for deficient fluid volume (continued)

27. Fluids, Electrolytes, and the Nursing Process • Diagnosis • Other nursing diagnoses: • Impaired gas exchange • Decreased cardiac output • Risk for infection • Impaired oral mucous membrane • Deficient knowledge (continued)

28. Fluids, Electrolytes, and the Nursing Process • Planning and outcome identification • NOC for fluid and electrolytes: • Nutritional status • Food and fluid intake • Electrolyte and acid-base balance • Fluid balance • Fluid overload severity • Hydration (continued)

29. Fluids, Electrolytes, and the Nursing Process • Planning and outcome identification • Collaboration (continued)

30. Fluids, Electrolytes, and the Nursing Process • Implementation • Monitor daily weight • Measure vital signs • Measure intake and output • Provide oral hygiene (continued)

31. Fluids, Electrolytes, and the Nursing Process • Implementation • Initiate oral fluid therapy • NPO • Restricted fluids • Forced fluids • Maintain tube feeding (continued)

32. Fluids, Electrolytes, and the Nursing Process • Implementation • Monitor intravenous therapy • Parenteral fluids • Equipment • Administration set • Preparation of intravenous solution • Initiation of intravenous therapy (continued)

33. Fluids, Electrolytes, and the Nursing Process • Implementation • Monitor intravenous therapy • Administration of intravenous therapy • Flushing • Regulation of intravenous flow rate • Calculation of flow rate • Flow-control devices (continued)

34. Fluids, Electrolytes, and the Nursing Process • Implementation • Manage intravenous therapy • Hypervolemia • Infiltration • Phlebitis • Intravenous dressing change • Discontinue intravenous therapy (continued)

35. Fluids, Electrolytes, and the Nursing Process • Implementation • Transfuse blood • Whole blood and blood products • Administration of whole blood or blood component • Safety measures (continued)

36. Fluids, Electrolytes, and the Nursing Process • Implementation • Employ complementary therapy • Traditional Chinese medicine • Food • Plants • Herbs (continued)

37. Fluids, Electrolytes, and the Nursing Process • Evaluation • Ongoing process • Client’s responses • Vital signs • Fluids • Output • Intravenous site • Necessary changes