...Lewis: Medical-Surgical Nursing, 9th Edition Chapter 17 Fluid, Electrolyte, and Acid-Base Imbalances KEY POINTS HOMEOSTASIS · Body fluids and electrolytes play an important role in maintaining a stable internal environment of the body. · A number of adaptive responses keep the composition and volume of body fluids and electrolytes within the narrow limits of normal to maintain homeostasis and promote health. · Many diseases and their treatments have the ability to affect fluid and electrolyte balance and alter homeostasis. WATER CONTENT OF BODY · Water is the primary component of the body, accounting for approximately 60% of the body weight in the adult. · The two major fluid compartments in the body are intracellular fluid (ICF), or inside the cells, and extracellular fluid (ECF), or outside the cells. ECF is composed of interstitial fluid, plasma, and transcellular fluids. ELECTROLYTES · Electrolyte composition varies between the ECF and ICF, though the overall concentration of the electrolytes is approximately the same in the two compartments. · The measurement of electrolytes is important in evaluating electrolyte balance, as well as in determining the composition of electrolyte preparations. MECHANISMS CONTROLLING FLUID AND ELECTROLYTE MOVEMENT · Many different processes are involved in the movement of electrolytes and water between the ICF and ECF. Some of these include simple diffusion, facilitated diffusion, and active transport. Two forces...
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...reimbursement for nursing care (Thede & Schwirian, 2015). NANDA-I states that it’s diagnoses are intended to communicate the professional judgements that nurses make every day to patients, other healthcare professional and the public (NANDA International, 2015). NANDA-I diagnoses relevant to the patient scenario given are 1) fluid volume deficit related to increased fluid loss and insufficient fluid intake 2) electrolyte imbalance related to increased fluid loss and insufficient fluid intake 3) knowledge deficit. The Center for Nursing Classification and Clinical Effectiveness, CNC (2015) defines the Nursing Intervention Classification (NIC) as a comprehensive, research-based, standardized classification of nursing interventions. “The Classification includes the interventions that nurses do on behalf of patients, both independent and collaborative interventions, both direct and indirect care” (CNC, 2015). NIC interventions relevant to the discussed scenario are fluid and electrolyte management. Activities or interventions include: 1) monitor for abnormal serum electrolytes, 2) monitor for manifestations of electrolyte imbalance, 3) maintain patent IV access and administer fluids, as...
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...helps the body remove waste, balance fluids, and produce certain hormones. When the kidneys fail, the body is not able to remove waste properly, thus needing a procedure called dialysis. Dialysis a treatment that does some of the things that healthy kidneys do when the body is no longer able to take care of itself. Although dialysis will prolong life by acting as a filter; a person on dialysis will have encounter imbalances within their bodies such as fluid imbalance, hypervolemia, electrolyte imbalance, peritonitis, and many other complications. Homeostasis enables body systems of a human being to function as expected because of proper temperature regulation. On the other hand, dialysis is the process by which waste products are excreted from our bodies artificially by means of diffusion. The process of removal of waste products in a healthy person is facilitated by kidneys. However, those individuals who suffer from kidney failure experiences problems with waste removal and dialysis has to be implemented. While dialysis is in process, individuals with renal failure tend to record several homeostatic imbalances. One of the major effects is electrolyte imbalance and this eventually leads to various conditions. For instance, a condition termed as hyperkalemia may occur if calcium levels exceed the amount that can be excreted. Another condition that may arise in the course of dialysis is arrhythmias. This can lead to electrolyte imbalance as well as change in homeostasis of...
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...With diarrhea the volume of fluid lost must be large enough to surpass the kidney’s compensation and ability to adjust excretion. With sufficient volume loss, the disorder is dependent upon the specific electrolytes lost. There is usually a wide range of electrolytes and their concentrations that are lost in diarrhea. However, the main electrolytes lost tend to be Na+, K+, and HCO3-. The diarrhea that is associated with inflammatory diarrhea is typically characteristic of stool volume < 3 L/day, and alkali and salt losses that are generally manageable. In the case of larger volume loss, there will be a significant loss of extracellular fluid volume, thus reducing the GFR, and limiting the kidney’s ability to auto regulate. This form of diarrhea is typical of secretory diarrhea, and usually presents with hypotension, acute renal failure, hyperchloremic metabolic acidosis, and hypokalemia. If the diarrhea is severe enough, lactic acidosis may occur due to tissue hypoperfusion. Our patient has been suffering a C. difficile infection. A lot of her current abnormalities can possibly be traced to an electrolyte imbalance that was caused by her excessive diarrhea.7 Acidosis can be divided up into metabolic and respiratory. Factors that cause an increase in the CO2 levels and also increasing the concentration of carbonic...
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...1. Assess a healthy individual and a patient whose fluid and electrolyte or acid-base imbalance is altered using tables in book, which describes parameters to be considered in physical and clinical assessments for fluid, electrolyte, and acid-base balance. Compare and contrast your findings. • Neck veins and central venous pressure- healthy adult: normally when the patient is supine the external jugular veins will fill to the anterior border of the sternocleidomastoid muscle. With the patient sitting at a 45 degree angle venous distention normally should not extend higher than 2cm above the sternal angle. Altered patient: decreased blood volume (low cvp) increased blood volume, heart failure, vasoconstriction (high cvp) • Neuromuscular irritability-healthy adult: assess for increase or decrease neuromuscular activity = negative response. Altered patient: patients with hypocalcaemia or hypomagnesaemia respond positively with unilateral twitching of the facial muscles, including the eyelids and lips. A partial response is the development of carpal spasm. • Comparison of total intake and output of fluids-healthy adult: fluid intake equals fluid output when averaged over 2-3 days. Range of 1500-3500ml fluid intake and loss 2000ml is average adult intake and loss per day. Altered patient: when the total intake is substantially less than the total output, the patient is in danger of fluid volume deficit. When the total intake is substantially more than the total output, the...
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...levels? 70-130 is for normal non DKA, In DKA levels are 250-600+. 3. What fluid and electrolyte disturbances commonly occur and why? Hyperglycemia due to insulin deficiency causes an osmotic diuresis that leads to marked urinary losses of water and electrolytes. Urinary excretion of ketones causes additional losses of Na and K. If serum K is not monitored and replaced as needed, life-threatening hypokalemia may develop. 4. What acid-base disturbances commonly occur and why? Insulin deficiency causes the body to metabolize amino acids and triglycerides for energy instead of glucose. This leads to the production of ketones which are acidic and cause metabolic acidosis. 5. Describe the medical management and nursing management of a patient in DKA. Hydration – fluid replacement initially rapid 0.9% NS to restore fluid balance Insulin – rapid or short acting insulin IV to bring blood glucose below 250. Electrolytes – Na deficiency treated with 0.9% NS. Once fluid balance restored may switch to lactated ringers to restore potassium levels or supplement per provider order. 6. How is fluid status monitored in the acute stage of DKA? Close monitoring of I&O. Serum electrolytes. 7. How is hypovolemia corrected? How rapidly is fluid volume replaced? Why? IV NS 0.9% rapid infusion, then titrate down (100-150ml/hr) once therapeutic levels achieved, to restore fluid balance and electrolytes....
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...Nurs 2820 Fluid, Electrolyte, and Acid-Base Balance Name: _______________________________________ Case Study Jimmy Lewis is brought to the hospital emergency room by some friends. He had been vomiting for several days and was complaining of heart palpitations. Mr. Lewis is a 58-year-old white male who is homeless. He has not had any health care for at least 10 years. He is an alcoholic and drinks a quart of gin or vodka every day. He does not have a job, and his family is all out of state. The emergency physician does an initial assessment and transfers him to a hospitalist, who admits him to a medical-surgical unit for further evaluation and treatment. Mr. Lewis has lab work drawn. His electrolytes are as follows: sodium 138 mEq/L, potassium 3.1 mEq/L (low), chloride 104 mEq/L, and magnesium 1.5 mEq/L (low). His arterial blood gas measurements are as follows: pH 7.48 (high), PaCO2 40 mm Hg, HCO3 29 (high). Jamie Taylor, a 22-year-old nursing student, is assigned to Mr. Lewis. She reviews Mr. Lewis’ medical record before going in to assess him. 1. After reviewing his chart and lab work, what fluid and electrolyte imbalances would Jamie determine? (Select all that Apply) A. Fluid volume deficit B. Hypokalemia C. Hypermagnesemia D. Hyperkalemia E. Hypomagnesemia 2. What acid-base imbalance is Mr. Lewis experiencing? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis 3. The hospitalist orders an IV of D5NS to...
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...Acid base medical conditions Dominique Naudy Kaplan University Respiratory acidosis is a medical condition that occurs when the lungs cannot get rid of all the carbon dioxide that is produced by the body. When there is too much carbon dioxide in the human body it causes the blood to become too acidic. There are two types of respiratory acidosis. They are chronic respiratory acidosis, and acute respiratory acidosis. Chronic happens over a long period of time, “This leads to a stable situation, because the kidneys increase body chemicals, such as bicarbonate, that help restore the body's acid-base balance.” (Dugdale, 2012 para 2) Acute respiratory acidosis occurs when the carbon dioxide accumulates in the body extremely fast, and the kidneys cannot balance the body. For a diagnosis of clinical acidosis there has to be low arterial pH (<7.36. As well as pCO2 and an increase in the plasma [HCO3-]. The normal range for pH is between 7.35-7.45, normal range for PCO2 is between 36-44 and normal range for HCO3- 22-26. When a person has respiratory acidosis the pH decreases, the PCO2 increases and HCO3 increases. (University of Iowa, 2015) Compensatory mechanism is the way the body reacts to maintain homeostasis. The body uses its own mechanisms to counteract an acid base disorder. When a patient has a chronic respiratory disorder the “kidneys can compensate for chronic respiratory disorders by either holding on to or dumping bicarbonate.” (UCSF, 2003 para 1). When a patient...
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...muscle is about 75% water, while bone is about 25% water and some water is found in cells. Water is essential to the human body. Not only is water part of the makeup of the body it is also a vital part of the body’s functions. Water is in the bloodstream cells and the spaces between the cells. Water moves back and forth between body compartments in order to equalize the concentration of dissolved particles. When the concentration of particles in one compartment is higher than in another compartment, water will move toward the compartment with the most dissolved substances. This is called osmosis. Osmosis not only drives the movement of water from one body compartment to another, but it also allows water from the diet to move from the fluid of the gastrointestinal tract into the blood. Water is a part of the life line that makes the body function properly. Water bathes the cells and cleanses and lubricates internal and external body surfaces. Surfaces like the eyes and joints. The saliva in the mouth makes it easier to chew and swallow food. Blood is made up mostly of water and travels throughout the body delivering oxygen and nutrients to cells and returning waste products to the lungs and kidneys to be excreted. Water also helps regulate body temperature. Water in the blood helps regulate body temperature by increasing or decreasing the amount of heat lost at the surface of the body. When the body’s temperature starts to get higher, the blood vessels in the skin dilate...
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...The human body works best when the levels of fluid and electrolytes are within a normal range. When a patient with a serious liver disease is presented with health problems, the health care providers must understand every aspect of the problems in order to provide the appropriate care. This includes understanding the pathophysiology, assessing the patient correctly, and reaching the goals of the plan. By following these steps, the patient will be provided the care he or she is entitled to. Obvious ascites with 3+ edema Ascites is the collection of fluid within the peritoneal cavity due to increased hydrostatic pressure from portal hypertension. Cirrhosis is the most common cause of ascites whereas ascites is the most common complication...
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...pathophysiologic changes in diabetes. a. Why do blood glucose levels increase? i. Blood glucose levels increase when the body does not have sufficient insulin or when the body cannot utilize the insulin appropriately. If there is too little insulin, glucose cannot get into the cell. The cell is starving due to glucose not being able to enter the cells, therefore leading the increase of glucose production by the liver. Insulin is needed to breakdown sugar for energy. b. What are commonly seen blood glucose levels for DKA and HHNK? i. DKA 250 to 600 ii. HHNK 600 to 1000 c. What fluid and electrolyte disturbances commonly occur during the acute phase and why do they occur? i. Water, sodium, potassium, and chloride are the fluid and electrolyte disturbances that commonly occur...
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...patient assessment was that she was confused, had a few misperceptions about what was going on with her family and their world, however she was not alert enough to give me anything objective in nature. | #1)Risk for electrolyte imbalance related to: Hyponatremiaas evidenced by: Hypertension, generalized edema, Rapid thready pulse, Cold/clammy skin, | ND #1: Electrolyte and Acid/Base Balance (NOC)The patient will: Display heart rate, BP, and laboratory results within normal limits. Between 9am-12pm 5/7/152) The patient will: display absence of cardiac dysrhythmias, muscle weakness, paresthesias, twitching, spasms, and dizziness between 9am-12pm 5/7/15 | Assess: Identify the patient at risk for hyponatremia and the specific cause, sodium loss or fluid excess.1) Monitor I&O. Calculate fluid balance. Weigh daily.(Indicators of fluid balance are important, because either fluid excess or deficit may occur with hyponatremia.) 2) Assess level of consciousness/neuromuscular response. (Sodium deficit may result in decreased mentation (to point of coma), as well as generalized muscleweakness/cramps, convulsions.)3) Maintain quiet environment; provide safety/seizure precautions.(Reduces CNS stimulation and risk of injury from neurological complications)4) Encourage foods and fluids high in sodium, e.g., milk,meat, eggs, carrots, beets, and celery. Use fruit juices and bouillon instead of plain water(Unless sodium deficit causes serious symptoms requiringimmediate IV replacement, the patient...
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...Babies might drink countless bottles of water in each day or formula diluted too much while athletes lose water and electrolytes by sweating. When a person drinks too much water from being dehydrated, water intoxication and hyponatremia are results if it is not accompanied with electrolytes. During intoxication, or too much water enters the body’s cells, the tissues swell because of the excess fluid. A person’s cells have to maintain a specific concentration gradient so that excess water, or serum, induces sodium in an attempt to get back the necessary concentration. As more water accumulates, the serum sodium concentration declines and that would be hypothermia. A way that cells attempt to recuperate the electrolyte balance is for the water outside of the cell to come back in the cell by osmosis and osmosis the movement of water from higher to lower concentration. Electrolytes are more concentrated inside the cells than they are outside, but the water outside the cell is way more concentrated because it contains fewer electrolytes than the water inside the cell. Electrolytes and water try to balance concentration. Hypothetically speaking, cells could swell up to where it can burst. Water intoxication has the same effects like drowning in water. The imbalance of electrolytes and the swelling of tissues can definitely cause not only an irregular heartbeat, but allow fluid into the lungs and...
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...Hypernatremia and Hyponatremia Hypernatremia is a type of electrolyte disorder that occurs when there is increased serum sodium of 145meq/L or higher due to sodium retention. Oversecretion of aldosterone, adrenocorticotropic, contributes to the hypernatremia, the increased sodium concentration affects the respiratory system, the kidney, and the gastrointestinal system (Huether, & McCance, 2013). The thirst receptors in the hypothalamus is stimulated due to the water imbalance, which is hard to correct in babies and older individuals. Consequently, other condition that could affect normal response to the thirst include, trauma, neoplasm, or vascular abnormalities resulting in hypernatremia. Furthermore, the antidiuretic (ADH) or vasopressin...
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...Fundamentals II Exam 3 Study Guide Chapter 41 – Fluid, Electrolyte, and Acid-Base Balance 1. Extracellular Fluid (ECF): Located OUTSIDE cells. Makes up about 1/3 total body H2O in adults. Two major divisions: Intravascular Fluid (plasma) and Interstitial Fluid (btw. cells and outside blood vessels. Minor division: Transcellular fluid – cerebrospinal, pleural, peritoneal and synovial fluids (all excreted by epithelial cells). Intracellular Fluid (ICF): Located INSIDE cells. Makes up about 2/3 total body H2O in adults. 2. ECV Deficit: BUN >25 mg/dl Insufficient isotonic fluid in the extracellular compartments. Output of isotonic fluid exceeds intake of sodium-containing fluid. Signs and Symptoms – sudden weight loss, postural hypotension, tachycardia, thready pulse, neck veins flat or collapsing with inhalation when supine, dry mucous membranes, poor skin turgor, restlessness, clammy skin, hypovolemic shock. ECV Excess: BUN <10 mg/dl Too much isotonic fluid in the extracellular compartments. Intake of sodium-containing isotonic fluid has exceeded fluid output. (When you eat too much salt and don’t drink enough H2O and you get bloated.) Signs and Symptoms – Sudden weight gain, edema, neck veins full when upright or semi upright, crackles in dependent portions of lung, pulmonary edema. 3. Isotonic: A fluid with the same concentration of nonpermeant particles as blood. Ex. - 0.9% sodium chloride, commonly called normal saline (NS)...
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