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Fluid and Electrolytes
Fluid and Electrolytes
I. PHYSIOLOGY
A. BODY FLUIDS- as primary body fluid, water is most important nutrient of life
- humans can survive for only a few days without water
1. FUNCTIONS OF WATER
• provide medium for transporting nutrients to cells, wastes from
cells, and substances such as
hormones, enzymes, blood platelets, and red and white blood
cells
• facilitate cellular metabolism an d proper cellular chemical
functioning
• act as solvent for electrolytes and nonelectrolytes
• help maintain normal body temperature
• facilitate digestion and promote elimination
• act as tissue lubricant
B. ELECTROLYTES
electrolyte – substance capable of breaking into electrically charged ions
when dissolved in a solution
4. MAGNESIUM (MG2+) – most cation found within body cells – heart, bone,
nerve, and muscle tissues
- 2nd most important cation in ICF
- important for metabolism of carbohydrates and proteins
- important for many vital reactions involving enzymes
- necessary for protein and DNA synthesis, DNA and RNA
transcription, and translation of
RNA
- maintains normal intracellular levels of potassium
- helps maintain electrical activity in nervous tissue and muscle
membranes
- adult daily avg. requirement about 18 – 30 mEq, with children
requiring larger amts.
- found in most foods, but especially in vegetables, nuts, fish, whole
grains, peas and beans
D. FLUID BALANCE
- desirable amt of fluid intake and loss in adults ranges from 1500 – 3500
mL each 24 hrs., with most
people averaging 2500 mL/day
- individual’s health state as well as balance between actual intake
and loss must be
considered
- intake should normally be approx. balanced by output or fluid loss
- may not always occur in a single 24-hr. period but should be
achieved within 2 – 3 days
1. FLUID SOURCES
a. Ingested Liquids – makes up largest amt of water intake
- primarily regulated by thirst mechanism - stimulated
by intracellular dehydration and
decreased blood volume
2. FLUID LOSSES – through kidneys as urine, intestinal tract in feces, and skin
as perspiration (sensible
losses)
- insensible losses include ex. of invisible amt of water lost from
skin constantly through
evaporation and from the lungs exhaled as breaths
- losses vary according to person and circumstances
- any deviations from normal ranges for a balanced water intake
and output should alert nurse
to potential imbalances
3. ACID-BASE IMBALANCE
- arterial blood gases (ABGs) are common lab test used in
assessment acid-base imbalance
- venous blood results are only specific for particular
extremity or area where blood is
drawn and do not provide information on how well
lungs are oxygenating
blood
- pH of plasma indicates balance or impending acidosis or
alkalosis
- carbon dioxide (PaCO2) is influenced almost entirely by respiratory
activity
- when low, carbonic acid leaves body in excessive amts
- when high, there are excessive amts of carbonic acid in
body
- imbalances occur when carbonic acid or bicarbonate levels
become disproportionate
II. ASSESSMENT
- imbalances can seriously compromise the patient’s health status and
may prove life-threatening
- nursing assessment is directed toward:
• identifying patients at high risk for fluid, electrolyte, and acid-base
imbalance
• determining that a specific imbalance is present and identifying the
nature of the imbalance
along with severity, etiology, and defining characteristics
• determining effectiveness of plan of care
C. BODY WEIGHT
- believed to be more accurate indicator of fluid gained and lost
- use same scale ea. time at the same time ea. day (in morning,
before breakfast, after
voiding) wearing the same or similar dry clothing
- use a bed scale if patient is unable to stand
- rapid variations in wt. reflect changes in body fluid volume
- 2% loss of total body wt (TBW) = mild volume deficit
- 2% gain of TBW = mild volume excess
- 5% loss of TBW = moderate volume deficit
- 5% gain of TBW = moderate volume excess
- 8% loss of TBW = severe volume deficit
- 8% gain of TBW = severe volume excess
H. FACIAL APPEARANCE
- severe volume deficit = pinched and drawn facial expression
- volume deficit of 10% = decreased intraocular pressure, eyes appear
sunken and feel soft to touch
I. EDEMA
- measurement of extremity or body part with millimeter tape is more
exact method of measurement
- edema not usually apparent until retention of 5 – 10 lbs of excess
- excess of interstitial fluid accumulating predominantly in lower
extremities of ambulatory pts. and
presacral region of bed-ridden pts
- pitting edema not evident until at least 10% increase in wt
- may be localized (thrombophlebitis) or generalized (heart failure,
cirrhosis)
- presence of periorbital edema or pedal edema should prompt
investigation in other body parts
J. VITAL SIGNS
1. BODY TEMPERATURE – fever increases loss of fluids; important for early
detection and interventions
- elevations probably related to lack of available fluid for sweating
- decrease temperature with volume deficit uncomplicated by
infection
- elevation between 101 – 103 increases fluid requirements by 500
mL/day
- above 103 increases it by 1000 mL/day
L. NEUROMUSCULAR IRRITABILITY
- to test for Chvostek’s sign, facial nerve should be percussed anterior to
ear lobe
- to test for Trousseau’s sign, blood pressure cuff is inflated for 3 minutes
- deep tendon reflex is elicited and may be hyperactive with
hypocalcemia, hypomagnesemia,
hypernatremia, and alkalosis
- muscle being tested should be slightly stretched and patient
relaxed
- deep tendon reflex may be hypoactive with Hypercalcemia,
hypermagnesemia, hypokalemia, and
acidosis
- reflex graded as: 0 = no response +1 = somewhat
diminished but present
+2 = normal +3 = brisker than avg.; possibly
indicative of disease
+4 = hyperactive
IV. IMPLEMENTING
- interventions include dietary modifications, modification of intake,
medication admin., IV therapy,
blood and blood products replacement, and TPN
V. EVALUATION