fluid and electrolytes

  1. can anyone give me any advice and fluid and electrolytes balance for testing???
  2. Visit mrhrn06 profile page

    About mrhrn06

    Joined: Nov '04; Posts: 17
    housewife, mom

    8 Comments

  3. by   Ginyer
    Hmm...what exactly are you looking for? Normal ranges? I just started my first semester of nursing school so maybe that's why I don't understand your question.

    Ginyer
  4. by   klone
    I wish I could remember the exact words to the song our instructor just taught us.

    Basically:

    Sodium is for the brain
    Potassium is for the heart
    Calcium and Magnesium is for the muscles

    Sodium and water are married: where sodium goes, water will follow. Sodium and potassium are enemies: where sodium goes, potassium will go in the other direction.

    Potassium, Calcium and Magnesium are a family and generally all go in the same direction together.

    Not sure exactly what you're looking for as far as info...
  5. by   jenrninmi
    Hi!

    Here is some important info:

    http://www.talkelley.com/amy/notes/f...ectrolytes.htm

    Good luck!
  6. by   onduty23
    nice breakdown
  7. by   Jess-RN in 2006
    There's also a book out there called Fluid and Electrolytes Made Incredibly Easy....my friend and I both bought a copy of it before our test, she found it very helpful, and I just never took the time to sit down and read it oops....if you are having problems with F/E, it really simplies things and gives you easy ways to remember....you can get those books at most books stores, also check your school library...just a thought....
  8. by   dave1117
    [font=Footlight MT Light]Fluid and Electrolyte Balance

    - [font=Footlight MT Light]60% - 70% of total body weight is water, this is the largest constituent of the body

    - [font=Footlight MT Light]Daily balance depends on an equal ratio btw ingested and excreted fluids

    - [font=Footlight MT Light]Fluids, electrolytes, and acid base balances within the body are essential in maintaining the health and function of all systems



    [font=Footlight MT Light]In order to maintain balance within the body look at:

    - [font=Footlight MT Light]I&Os (intake and output)

    - [font=Footlight MT Light]Distribution of water

    - [font=Footlight MT Light]Electrolytes

    - [font=Footlight MT Light]Regulation of renal function

    - [font=Footlight MT Light]Regulation of pulmonary function

    - [font=Footlight MT Light]Respiration

    - [font=Footlight MT Light]Metabolism

    - [font=Footlight MT Light]Central Nervous System function





    [font=Footlight MT Light]Distribution of Fluids



    [font=Footlight MT Light]Intra Cellular Fluid (ICF)

    - [font=Footlight MT Light]Intra [font=Footlight MT Light]=[font=Footlight MT Light] inside

    - [font=Footlight MT Light]Fluid inside the cell

    - [font=Footlight MT Light]2/3 of body fluid is intracellular

    - [font=Footlight MT Light]Contains nutrients (K, Mg, HPO/phosphate)

    - [font=Footlight MT Light]40% of body weight

    -

    [font=Footlight MT Light]Extra Cellular Fluid (ECF)

    - [font=Footlight MT Light]Extra [font=Footlight MT Light]=[font=Footlight MT Light] outside

    - [font=Footlight MT Light]Fluid outside the cell (interstitum or plasma)

    - [font=Footlight MT Light]1/3 of body fluid is extra cellular

    - [font=Footlight MT Light]Transcellular or interstitial fluid is extra cellular

    - [font=Footlight MT Light]20% of body weight



    [font=Footlight MT Light]Composition of Body Fluid

    - [font=Footlight MT Light]Electrolytes:[font=Footlight MT Light] water that moves through the body that contains minerals/salts

    - [font=Footlight MT Light]Substances that develop electrical changes when dissolved in water

    - [font=Footlight MT Light]Cations:[font=Footlight MT Light] positively charged ions (Na, K, Ca, Mg)

    - [font=Footlight MT Light]Anions:[font=Footlight MT Light] negatively charged ions (Cl, HCO3, HPO4/phosphate)



    [font=Footlight MT Light]Electrolytes

    - [font=Footlight MT Light]Hold fluid within compartments (intracellular or extracellular)

    - [font=Footlight MT Light]Helps maintain acid base balance relationship

    - [font=Footlight MT Light]Are essential for enzyme activity

    - [font=Footlight MT Light]Aid in the transmission of impulses

    - [font=Footlight MT Light]Help to facilitate protein and carbohydrate metabolism







    [font=Footlight MT Light]Movement of Body Fluids:

    - [font=Footlight MT Light]Diffussion:[font=Footlight MT Light] process in which molecules move from higher concentration to lower concentration by random movement until the concentration is equal

    - [font=Footlight MT Light]Osmosis:[font=Footlight MT Light] movement of a solvent (water) through a semi permeable membrane from an area of lower concentration (more dilute) to a higher concentration (less dilute)

    - [font=Footlight MT Light]Most body membranes are semi permeable allowing water and any uncharged molecules to pass freely

    - [font=Footlight MT Light]Active Transport:[font=Footlight MT Light] movement of large or charged particles from an area of lesser to greater concentration requires metabolic and energy

    - [font=Footlight MT Light]Filtration:[font=Footlight MT Light] process which force is used to push fluid through a filter b/c of the difference in pressure btw 2 sides of the filter, substances move in response to pressure, hemodialysis is based on filtration



    [font=Footlight MT Light]Classification of Fluids

    [font=Footlight MT Light]Isotonic Solutions:

    - [font=Footlight MT Light]Same osmolarity as blood plasma (280-295)

    - [font=Footlight MT Light]Osmolarity: is the drawing power of water dependent on the number of molecules in the solution

    - [font=Footlight MT Light]Has the same electrolyte concentration as plasma (ie normal saline 0.9%)

    - [font=Footlight MT Light]ICF & ECF remain balanced

    [font=Footlight MT Light]Hypertonic Solution:

    - [font=Footlight MT Light]Has greater concentration than plasma

    - [font=Footlight MT Light]Solution will leave water out of the cells

    - [font=Footlight MT Light]Pull water in vascularate

    - [font=Footlight MT Light]Ie D5 NS, DW50%

    [font=Footlight MT Light]Hypotonic Solution:

    - [font=Footlight MT Light]Lesser electrolyte concentration than plasma

    - [font=Footlight MT Light]Water will not necessarily remain in vascularate

    - [font=Footlight MT Light]Therefore moving water in the cells

    - [font=Footlight MT Light]Ie 0.45%NaCl/ NS





    [font=Footlight MT Light]Body Fluids are Regulated by:

    - [font=Footlight MT Light]Fluid intake

    - [font=Footlight MT Light]Hormonal controls

    - [font=Footlight MT Light]Fluid output

    - [font=Footlight MT Light]Homeostasis: physiological balance the body is able to maintain by responding to disturbances in fluids and electrolytes preventing and repairing damage

    - [font=Footlight MT Light]Fluid volume is regulated by osmotic pressure(pulling water by the number of molecules present)



    [font=Footlight MT Light]Fluid Intake:

    - [font=Footlight MT Light]Regulated by thirst mechanism (conscious desire for water)

    - [font=Footlight MT Light]When osmolarity increases the thirst mechanism is stimulated by the hypothalamus

    [font=Footlight MT Light]Thirst is stimulated by:

    - [font=Footlight MT Light]Fluid loss

    - [font=Footlight MT Light]Hypovolemia

    - [font=Footlight MT Light]Vomiting

    - [font=Footlight MT Light]Hemorrhaging

    - [font=Footlight MT Light]K+/potassium depletion

    - [font=Footlight MT Light]Psychological factors

    - [font=Footlight MT Light]Dry pharyngeal mucous membranes



    [font=Footlight MT Light]Hormonal Regulation

    [font=Footlight MT Light]ADH-Anti Diuretic Hormone: [font=Footlight MT Light]released in response to changes in blood osmolarity

    - [font=Footlight MT Light]Increase in osmolarity ADH is released

    - [font=Footlight MT Light]ADH works directly on renal tubules

    - [font=Footlight MT Light]Water returns to vascular system

    - [font=Footlight MT Light]Dilutes the blood and decreases its osmolarity

    - [font=Footlight MT Light]Temporary decrease in urinary output until blood is sufficiently diluted

    [font=Footlight MT Light]Aldosterone:[font=Footlight MT Light] volume regulator

    - [font=Footlight MT Light]Released in response to increased plasma (K/potassium)

    - [font=Footlight MT Light]To save sodium and eliminate K/potassium

    [font=Footlight MT Light]Angiotansin:[font=Footlight MT Light] causes selective vasoconstriction

    - [font=Footlight MT Light]Increases the blood flow to kidneys

    - [font=Footlight MT Light]Improves renal perfusion





    [font=Footlight MT Light]Fluid Output
    [font=Footlight MT Light]Involves 4 organs:


    - [font=Footlight MT Light]Kidneys: major regulatory organ

    - [font=Footlight MT Light]Lungs: expire about 400ml/day

    - [font=Footlight MT Light]GI Tract: loses 100-200ml/day (feces)

    - [font=Footlight MT Light]Skin: activated sweat glands

    [font=Footlight MT Light]Insensible Fluid Loss:[font=Footlight MT Light] continuous and not perceived by person

    [font=Footlight MT Light]Sensible Fluid Loss:[font=Footlight MT Light] occurs through excess perspiration and can be perceived

    - [font=Footlight MT Light]An average of 500-600ml of sensible and insensible fluid is lost via skin per day



    [font=Footlight MT Light]Regulation of Electrolytes (Cations +)

    - [font=Footlight MT Light]When one cation leaves the cell it is replaced by another cation

    - [font=Footlight MT Light]Maintains neutrality

    [font=Footlight MT Light]
    Major Cations:

    [font=Footlight MT Light]Sodium (Na)

    - [font=Footlight MT Light]Most abundant in ECF

    - [font=Footlight MT Light]Regulates metabolic activities

    - [font=Footlight MT Light]Normal level is 135-145 mEq/L

    [font=Footlight MT Light]Potassium (K+)

    - [font=Footlight MT Light]Is the principle cation in ICF

    - [font=Footlight MT Light]Regulates metabolic activities

    - [font=Footlight MT Light]Necessary for transmission and conduction of nerve impulses

    - [font=Footlight MT Light]Regulated by diet and renal excretion

    - [font=Footlight MT Light]Normal level is 3.5-5 mEq/L

    [font=Footlight MT Light]Calcium (Ca++)

    - [font=Footlight MT Light]Stored in the bone, blood, and body cells

    - [font=Footlight MT Light]99% is in bone and 1% is in blood ECF

    - [font=Footlight MT Light]Calcium is needed for bone and teeth formation, blood clotting, nerve impulses, and muscle contraction

    - [font=Footlight MT Light]Normal level is 4.5 mEq/L

    [font=Footlight MT Light]Magnesium (Mg++)

    - [font=Footlight MT Light]Essential for enzyme and neuro chemical activities

    - [font=Footlight MT Light]Muscle excitability

    - [font=Footlight MT Light]Regulated by diet, renal and parathyroid hormone

    - [font=Footlight MT Light]Located in ICF and ECF, and in bones

    - [font=Footlight MT Light]Normal level is 1.5-2.5 mEq/L



    [font=Footlight MT Light]Major Anions:

    [font=Footlight MT Light]Chloride (Cl-)

    - [font=Footlight MT Light]Found in ECF

    - [font=Footlight MT Light]It follows sodium

    - [font=Footlight MT Light]Regulated by diet and kidneys

    - [font=Footlight MT Light]Normal values are 95-108 mEq/L

    [font=Footlight MT Light]Bicarbonate (HCO3-)

    - [font=Footlight MT Light]Found in ECF and ICF

    - [font=Footlight MT Light]Essential component of carbonic acid (bicarb buffering system), need in acid base balance

    - [font=Footlight MT Light]Normal values are 22-26 mEq/L

    [font=Footlight MT Light]Phosphate (PO4-)

    - [font=Footlight MT Light]Buffer primarily found in ICF

    - [font=Footlight MT Light]Assist in acid base regulation

    - [font=Footlight MT Light]Helps to develop and maintain teeth and bones

    - [font=Footlight MT Light]Inversely proportional with calcium (if one rises the other falls)

    - [font=Footlight MT Light]Regulated by diet, kidneys, and intestinal absorption

    - [font=Footlight MT Light]Normal values are 2.5-4.5 mg/100ml





    [font=Footlight MT Light]Sodium (Na+)



    [font=Footlight MT Light]Hyponatremia

    - [font=Footlight MT Light]Lower than normal sodium concentrations in the blood

    - [font=Footlight MT Light]Results of Na loss (ie increased sweating, low Na diet)

    - [font=Footlight MT Light]Result of H2O excess (ie adrenal insufficiency)

    - [font=Footlight MT Light]Tx depends on the cause



    [font=Footlight MT Light]Usually Na is lost hen water is lost

    [font=Footlight MT Light]The body then adapts by decreasing water excretion and therefore Na excretion is also decreased b/c Na follows water

    [font=Footlight MT Light]If this continues

    [font=Footlight MT Light]You can have Na in the ECF that is diluted



    [font=Footlight MT Light]S/S: Personality change, Postural hypotension, N/V/D, Tachycardia



    [font=Footlight MT Light]Hypernatremia

    - [font=Footlight MT Light]Higher than[font=Footlight MT Light]normal Na concentration in the blood

    - [font=Footlight MT Light]Result of excess water loss (ie increased sensible and insensible water loss

    - [font=Footlight MT Light]Result of Na excess (ie ingestion of large amount of salt solutions)

    - [font=Footlight MT Light]The body will try to conserve as much water as possible via renal absorption

    - [font=Footlight MT Light]If the cause is b/c of increased aldosterone secretion than Na is retained and K/potassium is excreted



    [font=Footlight MT Light]S/S: Dry flushed skin, Thirst, Dry mucous membranes, Agitation



    [font=Footlight MT Light]Nursing Care Plan r/t (Na imbalances)

    - [font=Footlight MT Light]No NANDA Dx regarding specific electrolyte disturbances

    - [font=Footlight MT Light]But if a pt had hyponatremia (low Na) due to Na loss, pt can have postural hypotension and you can state:
    NANDA: Risk of injury r/t dizziness secondary to postural hypotension and hypotension




    [font=Footlight MT Light]Nursing Intervantions:

    - [font=Footlight MT Light]ID pts at risk for Na imbalances

    - [font=Footlight MT Light]Monitor lab tests: electrolytes, H&H, Urine specific gravity

    - [font=Footlight MT Light]Health teaching regarding fluid intake/restriction and Na needs

    - [font=Footlight MT Light]Read labels for Na content (increased Na intake for canned, processed, and frozen foods)


    [font=Footlight MT Light]Potassium (K+)


    [font=Footlight MT Light]Hypokalemia

    - [font=Footlight MT Light]Inadequate amts of K+ in the ECF

    - [font=Footlight MT Light]Since normal levels of K+ are low (3.5-5 mEq/L) there is little tolerance for function

    - [font=Footlight MT Light]Most common cause is K+ wasting diuretics

    - [font=Footlight MT Light]Also from GI loss

    - [font=Footlight MT Light]Polyuria

    - [font=Footlight MT Light]Excessive use of K+ free IV solutions



    [font=Footlight MT Light]S/S: Weakness, fatigue, decreased muscle tone, decreased bowel sounds, weak irregular pulse, parathesias (tingling in extremities), EKG changes, ventricular disrhythmias



    [font=Footlight MT Light]Hyperkalemia

    - [font=Footlight MT Light]Greater than normal amts of K+ in the blood

    - [font=Footlight MT Light]Severe hyperkalemia produces cardiac conduction abnormalities

    - [font=Footlight MT Light]Primary cause: renal failure b/c renal impairment decreases amounts of K+ the kidney can excrete

    - [font=Footlight MT Light]Also caused by massive cellular damage in burns and adrenal insufficiency



    [font=Footlight MT Light]S/S: anxiety, dysrhythmias, weakness, diarrhea

    [font=Footlight MT Light]Cardiac arrest can occur



    [font=Footlight MT Light]Nursing Care:

    - [font=Footlight MT Light]ID those at risk

    - [font=Footlight MT Light]Monitor K+ levels, lab data

    - [font=Footlight MT Light]Monitor K+ intake (diet, IV fluids)

    - [font=Footlight MT Light]Health teaching (ie K+ meds/restrictions)

    - [font=Footlight MT Light]Monitor S/S



    [font=Footlight MT Light]Hypokalemia

    - [font=Footlight MT Light]Foods high in K+ (bananas, coffee, apricots, cantaloupe, OJ, dry fruit)

    - [font=Footlight MT Light]K+ supplement may be ordered



    [font=Footlight MT Light]Hyperkalemia

    - [font=Footlight MT Light]Discourage foods w/ high in K+


    [font=Footlight MT Light]Calcium (Ca)
    - [font=Footlight MT Light]Normal level 4.0-5.0 mEq/L

    - [font=Footlight MT Light]Promotes muscle contraction

    - [font=Footlight MT Light]Transmission of nerve muscles

    - [font=Footlight MT Light]Cell membrane integrity (bones, teeth building and maintenance)



    [font=Footlight MT Light]Hypocalcemia

    - [font=Footlight MT Light]Low Ca levels

    - [font=Footlight MT Light]Thyroid disease (parathyroid) hypothyroid

    - [font=Footlight MT Light]Increased phosphorus levels (cause decreased Ca levels)

    - [font=Footlight MT Light]Decreased vitamin D in diet

    [font=Footlight MT Light]S/S:

    [font=Footlight MT Light]r/t diminished function of neuromuscular/cardiac/renal systems

    [font=Footlight MT Light]Numbness and tingling in fingers and toes, tetany(muscle cramps), pathological function, EKG abnormalities



    [font=Footlight MT Light]Hypercalcemia

    - [font=Footlight MT Light]Increased serum Ca level

    - [font=Footlight MT Light]Often s/s of underlying disease w/excess bone re absorption and release of Ca in blood (ie noeplastic disease, osteoporosis, prolonged immobilization)

    [font=Footlight MT Light]S/S: N/V, weakness, lethargy, back pain, personality changes, cardiac arrest



    [font=Footlight MT Light]Nursing Care

    - [font=Footlight MT Light]ID those at risk (immobilized pts)

    - [font=Footlight MT Light]Monitor lab data

    - [font=Footlight MT Light]Monitor Ca in diet/IV fluids

    - [font=Footlight MT Light]Health teaching (sources are milk and dairy, refrigeration, exp dates, safety precautions with weakness, confusion and weak bones, vitamin D r/t Ca)

    - [font=Footlight MT Light]Monitor s/s Ca imbalances

    - [font=Footlight MT Light]Ca supplements

    - [font=Footlight MT Light]Increase mobilization with hypercalcemia
  9. by   FutureNurse2005
    dave, that sure helped me! lol I have a test on this next week! thank you!
  10. by   cherokeesummer
    Thanks, that sure was a lot of information but I bet it will help me out on my test next week!!!!

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