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Understanding Fluid, Electrolyte & Acid-Base Imbalances

Learn about fluid balance, electrolyte imbalances, and acid-base control in patients. Explore causes, signs, symptoms, and interventions for balance disruptions.

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Understanding Fluid, Electrolyte & Acid-Base Imbalances

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  1. Chapter 6 Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances

  2. Fluid Balance • Intracellular Fluid • Extracellular Fluid • Interstitial Fluid • Intravascular Fluid • Transcellular Fluid

  3. Control of Fluid Balance • Pressure Sensors • Antidiuretic Hormone

  4. Movement of Fluids and Electrolytes • Active Transport • Passive Transport • Diffusion • Filtration • Osmosis

  5. Tonicity • Isotonic • Hypertonic • Hypotonic

  6. Fluid Gains and Losses • Gains • Food • Fluid • Losses • Sensible • Insensible

  7. Fluid Imbalances • Dehydration • Hypovolemia • Fluid Overload

  8. Dehydration Signs and Symptoms • Thirst • Rapid, Weak Pulse • Low Blood Pressure • Dry Skin and Mucous Membranes • Skin Tenting • Decreased Urine Output • Increased Temperature

  9. Interventions for Deficient Fluid Volume • Monitor Daily Weight • Monitor Intake and Output • Increase Fluid Intake • Treat Underlying Cause • Use CAUTION with Elderly Patients

  10. Fluid Excess SignsandSymptoms • Bounding Pulse • Elevated Blood Pressure • Respiratory Changes • Edema • Increased Urine Output • Weight Gain • Heart Failure

  11. Interventions for Excess Fluid Volume • Monitor Weight and Urine Output • Place in Fowler’s Position • Administer Oxygen • Administer Diuretics • Restrict Fluid and Sodium

  12. Electrolytes • Cations + • Anions -

  13. Sodium Imbalances • Hyponatremia • Hypernatremia

  14. Food Sources of Sodium • Pizza • Canned Vegetables • Canned Soups • Salty Snacks • Prepared Foods Na+

  15. Hyponatremia Signs and Symptoms • Sodium <135 mEq/L • Fluid Excess or Deficit • Mental Status Changes • Weakness • Nausea and Vomiting

  16. Interventions for Hyponatremia • Monitor Intake and Output • Monitor Weight • Restrict Fluids • Administer Diuretics/Steroids

  17. Hypernatremia Signs and Symptoms • Sodium >145 mEq/L • Thirst • Mental Status Changes • Seizures • Muscle Weakness • Respiratory Compromise

  18. Interventions for Hypernatremia • Treat Fluid Imbalance First • Monitor Intake and Output • Monitor Weight • Administer Diuretics • Restrict Dietary Sodium • Treat Cause

  19. Potassium Imbalances • Hypokalemia • Hyperkalemia

  20. Food Sources of Potassium • Sweet Potato • Beet Greens • Potato • Yogurt • Prune Juice • Soybeans • Bananas K+

  21. Hypokalemia Signs and Symptoms • K+ <3.5 mEq/L • Muscle Weakness • Shallow Respirations • Mental Status Changes • Cardiac Dysrhythmia and Arrest

  22. Interventions for Hypokalemia • Treat Underlying Cause • Offer Potassium-rich Foods • Administer Potassium Replacement • Teach Patient • Signs and Symptoms to Report • Self-administration of Supplement

  23. Hyperkalemia Signs and Symptoms • K+ >5 mEq/L • Muscle Twitching and Cramps • Later Muscle Weakness • Diarrhea • Low Blood Pressure • Cardiac Dysrhythmia and Arrest

  24. Interventions for Hyperkalemia • Limit Dietary Potassium • Hold Potassium Supplements • Administer Medications as Ordered • Potassium-losing Diuretic • Kayexalate • Insulin with Glucose

  25. Calcium Imbalances • Hypocalcemia • Hypercalcemia

  26. Food Sources of Calcium • Fortified Cereals • Canned Salmon • Spinach • Yogurt • Cheese • Milk Ca++

  27. Hypocalcemia Signs and Symptoms • Ca++ <9 mg/dL or 4.5 mEq/L • Mental Status Changes • Hyperactive Deep Tendon Reflexes • Diarrhea • Cardiac Dysrhythmia and Arrest

  28. Hypocalcemia Signs and Symptoms (cont’d)

  29. Interventions for Hypocalcemia • Treat Cause • Increase Dietary Calcium • Administer Medications as Ordered • IV Calcium Gluconate • PO Calcium Supplements • Aluminum Hydroxide to Bind Phosphate

  30. Hypercalcemia Signs and Symptoms • Ca++ >11 mg/dL or 5.5 mEq/L • Increased Heart Rate and Blood Pressure • Skeletal Muscle Weakness • Decreased GI Motility • Decreased Blood Clotting

  31. Interventions for Hypercalcemia • Administer Fluids • Administer Medications as Ordered • Furosemide (Lasix) • Pamidronate (Aredia) • Zoledronic Acid (Zometa) • Calcitonin • Hemodialysis

  32. Magnesium Imbalances • Hypomagnesemia • Hypermagnesemia Mg+

  33. Hypomagnesemia Signs and Symptoms • Mg++ <1.5 mEq/L • Positive Trousseau’s Sign • Positive Chvostek’s Sign • Cardiac Dysrhythmia and Arrest

  34. Interventions for Hypomagnesemia • Treat Underlying Cause • Administer Magnesium Replacement

  35. Hypermagnesemia Signs and Symptoms • Mg++ >2.5 mEq/L • Hypotension • Lethargy • Skeletal Muscle Weakness • Respiratory Failure • Cardiac Dysrhythmia and Arrest

  36. Interventions for Hypermagnesemia • Administer IV Fluids • Administer Medications as Ordered • Loop Diuretics (Furosemide) • Dialysis

  37. Acid-Base Balance • Acid: Substance that Releases a Hydrogen Ion • Base (Alkali): Substance that Binds Hydrogen • Normal pH 7.35–7.45

  38. Acid-Base Control • Cellular Buffers • Lungs • Kidneys

  39. Acid-Base Imbalances • Acidosis • Respiratory • Metabolic • Alkalosis • Respiratory • Metabolic

  40. Arterial Blood Gas Values

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