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Level 109

Fluid & Electrolyte Acid-Base Balance


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Hypovolemia (Fluid Volume Deficit)
Results from a loss of body fluids, serum electrolyte concentrations are lost at the same proportions and ratio of the electrolyte to water remain the same. Males has more body water while people who…
Hypovolemia Causes
Vomiting, diarrhea, GI suctioning, excessive sweating, hemorrhage, and third space shifting such as third degree burns. If pt has a NG tube, they could loose fluids (remember to record the I&O).
Hypovolemia Clinical Manifestations
Acute weight loss, decreased skin turgor, oliguria, concentrated urine, thirst, tachycardia, cool clammy pale skin.
Specific Gravity
Has no units - same deal as density
Hypovolemia in the Elderly
Age related changes such as reduced renal, cardiac, and respiratory function and disturbances hormonal regulations. Test the skin turgor in the forehead and the sternum. Elderly could also purposefully restrict fluids to avoid incontinence.
Hypovolemia Nursing Interventions
I&O at least q8hrs, daily weights, vital signs (decrease BP), assess skin and tongue turgor, mucous membranes, identify patients at risk especially small kids, infants, elderly, and the sick. Correct the fluid volume deficit.
Sodium (Na+)
Normal serum values of 135-145 mEq/L, mostly found outside of the cell, primary determinant of ECF and osmolarity, and regulates body's fluid balance. *Remember Na+ before water fluids!
Hyponatremia
Net gain of water or loss of Na-rich fluids.
Hyponatremia Nursing Interventions
Early detection and treatment to prevent serious consequences. I&O- Measure overall fluid volume. Daily weight, GI assessment, neuro assessment, encourage foods and fluids high in sodium, and avoids excessive water supplements.
Hypernatremia
Serum sodium levels > 145 mEq/L. Causes is fluid deprivation in unconscious patients who cannot perceive, respond to, or communication thirst. Diabetes insipidus- Loss water is leading to the increase of sodium.
Hypernatremia Nursing Interventions
Prevention is offer fluids at regular intervals. Assess for abnormal losses of water, lower water intake, large gains of sodium, and medication history. Correction is to monitor patient response to treatment.
Potassium (K+)
Normal serum value of 3.5-5.0 mEq/L, mostly found within the cell and needed for muscle and nerve function. *Could lead to having more heart problems!
Hypokalemia
Serum potassium is <3.5…
Hypokalemia Nursing Interventions
Monitor for early presence, prevention include foods in high in potassium (bananas, melon, citrus fruits, potatoes, and green vegetables such as spinach). Correct hypokalemia and administer IV potassium.
Hyperkalemia
Serum potassium is >5.0 mEq/L. Major causes is renal failure that seldom occurs in patients with normal renal function and treatment induced. Less common than hypokalemia but is more fatal. Example is giving CPR=Pt needs Bicarbonate stat.
Hyperkalemia Clinical Manifestations
Disturbances in cardiac conduction such as ventricular dysrrhythmia, muscle weakness and paralysis like resp. and speech muscles. Nausea, intermittent intestinal colic and diarrhea.
Hyperkalemia Nursing Interventions
Identify those at risk and monitor, high levels should be rechecked and verified due to draw blood at a central line. Prevention and correcting hyperkalemia.
Calcium (Ca+)
Normal serum values such as 8.6-10.2 mg/dl. Most stored in bones and teeth, needed for muscle and nerve function.
Hypocalcemia (Increase CNS Excitation)
Serum calcium of <8…
Hypocalcemia Clinical Manifestations
Tetany, tingling sensation in finger tips, mouth and feet. Muscle spasms, pain due to spasms, trousseasu's spasms, chvostek's sign, mental changes, seizures, and cardiac changes.
Hypocalcemia Nursing Interventions
Initiate seizure precautions, monitor airway due to laryngeal stridor, teach need for adequate dietary intake to avoid osteoporosis, teach value of weight bearing exercises, teach medication effects on calcium such as neurovascular assessment.
Hypercalcemia (CNS Depressed)
Serum calcium level >10.2 mg/dL. Calcium levels inversely related to phosphorus levels, can cause death. Causes malignancies, hyperparathyroidism, bone mineral loss due to immobilization, thiazide diuretics.
Hypercalcemia Clinical Manifestations
Confusion, impaired memory, slurred speech, lethargy, coma, constipation, muscle and bone pain, anorexia, neurovascular, decreased neuromascular excitability, excessive urination such as excessive thirst.
Hypercalcemia Nursing Interventions
Increase patient mobility, encourage oral fluids/IV fluids such as monitor cardiac rate and rhythm.
Plasma pH
Hydrogen ion concentration.
Increased H+
Decreased pH=Acidic
Decreased H+
Increased pH=Alkalotic
First Buffering System
Bicarbonic-Carbonic Acid: Normal Ratio is 20:1. 20 bicarbonate HCO3 and 1 carbonic acid is H2CO3. Adjusts the amounts to maintain normal ratio of pH. Normal value pH 7.35-7.45.
Second Buffering System
Lungs: CO2 is potential acid when dissolved in water. CO2+H2O= H2CO3. Control the CO2 levels by increasing respiration= decreased CO2 (Alkalosis) and decrease respiration=increased CO2 (Acidosis). Normal value PaCO2 35-45 mmHg
Third Buffering System: Kidneys
Regulates bicarbonate levels in ECF and excretes or retain H+. Acidosis. Excretes H+ and retain HCO3. Alkalosis- Excretes HCO3 and retain H+. HCO3 is 22-26 mEq/L.
metabolic acidosis
Abnormal condition of high hydrogen ion concentration in the extracellular fluid caused by either a primary increase in hydrogen ions or a decrease in bicarbonate.
Metabolic Acidosis Causes
Impaired kidney function such as acute or chronic renal failure, diabetic ketoacidosis, shock (decreased BP) and severe diarrhea.
Metabolic Acidosis Clinical Manifestations
Headache, confusion, drowsiness, increased respiratory rate and depth such as hyperventilation. Nausea and vomiting, decreased muscle tone, vasodilation with decreased CO, dysrrhythmias, decreased BP, cold, clammy skin. Hyperkalemia- Shift to potassium to make it out of the cells.
Metabolic Acidosis Treatment
Correct metabolic deficit, administer bicarbonate, monitor: potassium levels, calcium levels in chronic metabolic acidosis. The pt might need dialysis.
metabolic alkalosis
Abnormal condition characterized by the significant loss of acid from the body or by increased levels of bicarbonate.
Metabolic Alkalosis Causes
Gastric suctioning and vomiting, long term diuretic therapy and significant K+ depletion. Longterm steroid use, cystic fibrosis, excessive alkali ingestion of antacids containing bicarb and use of sodium bicarb in CPR.
Metabolic Alkalosis Clinical Manifestations
Dizziness, tingling in fingers and toes, hypertonic muscles (leading to the decrease of calcium levels), depressed respirations, atrial tachycardia, pH >7.6 leading to ventricular disturbances.
Metabolic Alkalosis Treatment
Correct the underlying cause, monitor I&O, restore normal fluid volume, potassium administration, H2 receptor antagonists (decreased acid production and keep to prevent alkalosis).