m


 
  
By;
JENITA PILI- DE VERA, RN.MAN
|
| 

 
  | 
RLungs RKidneys
RHeart RBlood Vessels
RPituitary RParathyroid
RAdrenal
Cortex
p

R A combination of Oxygen &
Hydrogen without electrolytes.

R It is the most abundant compound

that is essential to life
÷
   

R Colorless
R Tasteless
R Odorless liquid
R It change from liquid to gas
R It change from liquid to solid
 

R Needed for digestion of foods
R Necessary for circulation of blood
R Necessary for elimination
R Form large percentage of plants &
animals
R Essential for many chemical
reactions
p

R Is the major constituents of the
body minus electrolytes
R 60-70% of water is found in the
body
m 

 


p


R Age

R Body Weight

R Sex
 

m 

R Fluid Taken Orally

R Food Ingested

R Oxidation of Food
  
 p



R è,200 ml/ day as H2O in beverages

R è,è00 ml/ day as ³ hidden´ H20 in

foods

R 300 ml/ day as water oxidation

  
 
 


 
R è,500 ml/ day H2O from the kidney ±
urine
R è,000 ml/ day H2O from skin &
lungs as insensible / evaporated
H2O loss
R è00 ml/ day from gastrointestinal
tract - feces
  
 
 
R Hydrolysis

R Hydrates

R Anhydride
R Hydrolysis
Process of splitting a substance
with the addition of H2O.
R Hydrates
Formation of solid compounds
through the combination or
formation of H2O & the molecule.
R Anhydride
Hydrate loss the H2O of
crystallization
m

R One of the four ultimate states of
matter, being composed of
molecules that can move about
with in limits, permitting change in
the shape of the mass without
disruptions of the substance.

R Contain water & electrolytes

m 


m 

R Provide an
aqueous medium
for cellular
metabolism
R Maintains
physical &
chemistry
constancy of
intracellular or
extracellular
fluids.
R Transport material R Aids in regulation
to & from the cell of body
temperature.
R Provides medium R Provide
for excretion of lubrication of
waste from the muscle joints.
body.

   m 

R Located with in
the cells.
R Provide s the cell
with internal
aqueous medium
necessary-
chemical function.
R 2/3-3/4
compromising
70% TBW

   m 

R Body fluids
outside the cells.
R Serves as body
transportation
system carrying
H2O, electrolytes,
nutrients & O2 ±
cell & removing
waste product ±
cell metabolism
R 30% - TBW
 


   
m 

R Interstitial Compartment

R Intravascular Compartment

R Small Fluid Compartment

R Gastrointestinal Tract



  


R 24-25 % of TBW ±
ECF
R Located in the
space between
the vascular
space & the cells
that provides cell
with external
aqueous medium
necessary ±
cellular
metabolism

     


R 4-5% of TBW in
ECF
R Blood Plasma,
colloids along
with RBC ±
maintain vascular
volume.
R Small fluid R Gastrointestinal
Compartment Tract
›



R An electrically neutral solutes.
R A substance that does not ionize,
dissociate in solution or carry an
electric charge but necessary to
maintain & control the fluid/ H2O
between the plasma & interstitial
fluid.
÷

R Are the tissue builders of the body,
inadequate intake will result in
negative nitrogen balance.

R Proteinate
The anion form of protein
Major anion with in cells.
 
R A protein form as it reaches the
blood.
R Important in the development of the
plasma colloid osmotic pressure
which helps control the flow of
water between the plasma &
interstitial fluid.


R Macromolecules of protein that are
located primarily with in the
plasma.
R Holds water within the blood
vessel.


÷ 
R Pressure exerted by plasma
protein.
R Which:
å Holds H2O with in the vessel
å Draws back H2O that escapes from
the vessel




R Compound substances which when
place in solution is being divided or
being break up into 2 electrically
charge particles known as M

›
R An atom or group of atoms having
a charge of positive or negative
electrically by virtue of having
gained or lost electrons.
R Example;
NaCl

 ÷
 
R Sodium

R Potassium

R Calcium

R Magnesium
 ›
 
R Chloride

R Bicarbonate

R Phosphate
u  
 
 
R Measurement of chemical activity
of electrolytes.
R It is measured in the most
accessible portion of Extracellular
body fluid namely ÷


u


m 

R First Phase
Blood plasma moves around the
body within the circulatory system
& nutrients & fluids are picked up
from the lungs & the GIT.

÷ 
R Interstitial fluid & its component
move between the blood capillaries
& the cells.
 
÷ 
R Fluids & its components move back
from the cells to the interstitial
space & then to the intravascular
compartment. The intravascular
fluid then flows to the kidney¶s
where the metabolic-by-products of
the cells are excreted in the form of
urine.
u

u
m 





R Diffusion
Movements of
particles into an
area which is
increase in
concentration to a
decrease
concentration.

R Movement of
fluids into an area
which is lower
concentration to
higher
concentration
m


R Movements that
separate fluids
from suspended
particles.


  


R Hypertonic R Hypotonic
solution solution
- higher - Lesser
concentration of concentration of
solutes in the solutes in the
solution. solution.
 


m 

R Intracellular fluid R Extracellular fluid
(ICF) (ECF)


 


H20 Water
Electrolytes Electrolytes
Proteins Proteins
Nucleic acids RBC
Lipids WBC
Polysaccharides Platelets



 



m 

R 


Sodium
Potassium
Chloride
Calcium
Magnesium
Phosphorus
bicarbonate
›   
R Sodium - è35-è45 mEq/L
R Potassium - 3.5-5 mEq/L
R Calcium - 8.5-è0.5 mEq/L
R Magnesium - è.5-è0.5 mEq/L
R Phosphorus- 2.5-4.5 mEq/L
R Chloride - è00-è06 mEq/L
  

 
 


m 

 
R Kidney R Pituitary Gland
R Heart R Adrenal Gland
R Blood Vessel R Parathyroid Gland
R Lungs
R Gastrointestinal
tract
R Hypothalamus



R Vital to the
regulation of fluid
& electrolyte
balance. It
normally filter
è70L of plasma
per day in the
adult.
u m 




R Excretion of
metabolic wastes & R Regulations of
toxic substances. electrolytes levels
R Regulation of pH of in the extracellular
ECF by retention of fluid by retention of
hydrogen ions needed substance
R Regulation of ECF &
& excretion of
osmolality by unneeded
selective retention & substance.
excretion of body
fluids.
 

R Pumping action of
the heart
circulates blood
through the
kidneys under
sufficient
pressure for urine
to form.


R Capillary pressure
causing
vasodilation &
vasoconstriction
that influence
balance of fluids
& electrolytes.
 
R Hypoventilation &
hyperventilation
influences loss of
carbon dioxide &
H2O which effects
fluids &
electrolytes.
` 


   

R Stomach &
intestines help
balance the body
fluids &
electrolytes by
absorbing those
that are needed &
eliminating those
that are needed.


  
R Primary regulator
of water intake.
R It manufactures
hormones which
is responsible in
the retention of
H2O in the body &
excretion.
÷


` 

R Stores ADH which

is water
conserving
hormones that
causes retention
of H2O in the
body

 ` 

R Adrenal Cortex
secreted a
hormone known
as
 
, a
mineralocorticoid
which has a
profound effect
on fluid balance.
÷ 


 

R Embedded in the
corners of the
thyroid gland,
regulate calcium
& phosphate
balance by means
of ÷
 
 



 
m 




  
R Antidiuretic hormone

R Aldosterone

R Parathyroid hormone

R Thyroid hormone


 

R Also known as
vasopressin,
hormone release
from the posterior
lobe of the
pituitary gland.
R Contains water re
absorption by the
kidney &
regulates body
fluid osmolality
m 

 



R Emotional & Physiologic stress
R Presence of pain
R Reduced circulating blood volume
R Administration of morphine sulfate,
barbiturate & anesthetic agent
R Hyperosmolality

 


R Decrease in water relative to solute
concentration or increase in solute
relative to water.



R A hormone
secreted by zona
glomerulosa of
the adrenal
cortex.
R It increase renal
reabsorption of
sodium & water,
thus regulating
ECF.
m 

 

 



R Decreasing circulating blood
volume

R Hyperkalemia

R High ACTH

R Stress
÷ 



R Hormone secreted
by the parathyroid
glands that
maintain serum
calcium level.
m 

R Increasing the release of calcium
from bones
R Stimulating vitamin D production to
increase calcium reabsorption from
the GIT
R Stimulating calcium reabsorption
from urine



R Thyrocalcitonin
Help maintain calcium balance.
R T3 & T4
* T3 - Triiodothyronine
* T4 - Thyroxine
Maintain sufficient cardiac
output to adequately perfuse the kidney
nephron ± promote glomerular
filtration«.. maintain urine output.
m 

 



R Kidney

R Skin

R Lungs

R GIT



R Major avenue of
fluid output in
the form of
urine.

R In the form of
perspiration
R  

- outer layer of the
epidermis that
control fluid loss
in the skin




R Sodium Chloride

R Urea

R Lactic Acid

R Potassium
 
R As water vapor
in the expired
air.
`
R Fluid loss through
the intestine in
the form of

 that
passes from the
small intestine
into the large
intestine«contain
s H2O &
electrolytes.
m 
 
m 





R Climate
R Diet
R Stress
R Illness
R Trauma
R Medical treatment
R Medication
R Surgical procedures
   m 


R Intravenous Solution

R Total Parenteral Nutrition

R Blood Volume Replacements

R Colloids


R Fluids that
contains solutes
of a higher
molecular weight.
R Examples;
Albumin
Plasmanate
Dextran
Hetastarch
 
R Maintain Colloid
Osmotic
pressure inside
the ECF & cell
wall integrity.
R Plasmanate R Dextran
Contain Albumin, Highly
globulins, & concentrated
fibrinogen. glucose solution
which may
interfere with
blood coagulation
like Hetastarch.

   

R Whole blood

R Plasma

R Platelets

R PRBC
 
÷ 
 ›


R An IV fluid providing concentrated
glucose, protein, electrolytes, trace
elements, & lipids which is used for
patients who are unable to take in
foods or fluids through the
digestive tract.

  

R Fluids containing fluids &
electrolytes which is used to
replace volume & correct
abnormalities.
R Types of IV solution:
* Isotonic solution
* Hypotonic solution
* Hypertonic solution



R Has the same
osmolar
concentration or
tonicity as
plasma.




R Contain lower
osmolar
concentration
than serum




R Higher
concentration of
particles in
solution
compared with
the plasma.
R Example:
Protein solution
Hyperalimentation solution
of è0% , 50% , 70%
Dextrose
 



 m 



R Osmolality R Creatinine

R Osmolarity R Hematocrit

R Urine Specific R Urine Sodium

Gravity Values

R BUN
 


R Laboratory value R Serum Osmolality:
defining solute 280-300mOsm/kg
concentration per
liter of solvent.
R Urine Osmolality:
R It measures the
solute 50-è400 mOsm/kg
concentration per
kg in blood &
urine
R Milliosmoles per
kg of H20
(mOsm/kg)
m 
  


R Urine R Serum

Fluid Volume * Diabetes

Deficit Insipidus
* Hyperglycemia
* Sodium
Overload
Uremia
m 
  


R Urine R Serum

Fluid volume * Renal failure

Excess * Diuretics
* Adrenal
Insufficience
 


R Measurement of R Measures in
the number of milliosmoles per
solute particles liter (mOsm/L)
per liter of
solution. R 270 ± 300 mOsm/L
R Most commonly
used to express
the osmotic
pressure of body
fluids

 ` 


R Measures the kidneys ability to
excrete & conserve H2O
R Normal Range:
è.00è- è.040
Random :
è.0è0 ± è.020
Physiologic Range:
è.025 ± è.035

›
R Made up of 6

which is an end
product of protein metabolism
R Normal Range:
è0-20 mg/dl
(3.5 mmol/L)
m 


 
›
R GI Bleeding

R Dehydration

R Increase protein intake

R Fever

R Sepsis
m 


 
›
R End Stage Liver Disease

R Low protein Diet

R Starvation

R Condition that result in expanded

fluid volume


R End product of muscle metabolism.
R Normal Range:
0.6 ± è.5 mg/dl
53 ± è33 mmol/L



R Measures the volume percentage of
RBC in whole blood
R Normal Range:
Female : 37 ± 47 %
Male: 40 ± 54%




 


R Dehydration
R Polycythemia
- Abnormal increase in the
erythrocytes in the circulating
blood.





 



R Overhydration

R Anemia


   
R Normal Range:
50- è30 mEq/L
50- è30 mmol/L



m 





R Clients dependent on others to
meet their food & fluid needs.
R Clients who have gained or lost
more than 5 lb in a week
R Clients who are permitted nothing
per orem
R Clients with retention catheters &
urinary drainage system
R Clients with intravenous infusion
R Clients with special drainages orr
suctions
R Clients receiving diuretics
R Clients experiencing excessive
fluid losses & requiring increased
intake
R Clients who retain fluids
R Clients with fluid restrictions
R Post operative clients
R Clients with severe trauma or
burns
R Clients with chronic diseases
R Confused clients or those who/
with altered level consciousness
who may not be able to
communicate needs or respond to
thirst.

m 
  
R Isotonic Imbalance
= Happen when water & electrolytes
are lost or gained in equal
proportions.
R Osmolar Imbalance
= Involves the loss or gain of only
water.
m 
m 

  

R Isotonic loss of water & electrolytes

R An osmolar loss of only water
R An isotonic gain of water and
electrolytes
R Osmolar gain of only water

 m 




  

R Fluid Volume Deficit

R Dehydration (Hyperosmolar
imbalance)
R Fluid Volume Excess
R Overhydration (Hypo- osmolar
imbalance)


R Fluid Volume Deficit
R Result when fluid loss exceeds fluid
intake.
R Water and electrolytes are lost in
the same proportions
R Causes:
* Vomiting
* Diarrhea
* Gastrointestinal
Suctioning
R Sweating
R Decrease Intake
R Presence of Nausea
R Drainage of secretions from fistula
R Inability to swallow
R Unavailability of fluids
R Confusion
R Depression


R Diabetes Insipidus
R Adrenal Insufficiency
R Osmotic Diuresis
R Hemorrhage
R Coma
R Burn
R Ascites with liver dysfunction
 u 


R Acute weight loss
R Decreased skin turgor
R Oliguria
R Concentrated urine
R Postural hypotension
R Weak, rapid heart rate
R Flattened neck vein
R Cool clammy skin
R Thirst
R Anorexia
R Nausea
R Lassitude
R Muscle cramps
R Muscle weakness
 

 

R BUN

R Hematocrit

R CVP

R Urine Specific Gravity


÷




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[÷›  
R è = edema barely detectable with
slight pitting
R 2 = deeper pit but fairly normal
contours
R 3 = deep pit & puffy appearance
R 4 = excessive fluid accumulation
with deep pit & frankly swollen
appearance
 


R Caused by
trapping of fluid
by coagulated
proteins in tissue
spaces; skin
become thick &
hardened with an
orange- peel
appearance due
to severe
stretching.
p 

R A very severe
form of edema
R Fluid leaks out of
skin pores when
pressure exerted
over area
 


R Specific depends on the cause of
edema:
R Pharmacology & nutrition
u  

R Monitor I & O
R Administer prescribed drugs
R Restrict fluid & sodium intake
R Instruct client to read food labels
for sodium content
R Elevate body parts prone to edema
avoid pressure / sharp bends
R Use elastic support stocking &
sleeves
R Keep skin over edematous tissue
clean & lubricated
R Change client position frequently
R Monitor electrolytes for sign of
hypokalemia or hyponatremia &
administer prescribed electrolytes
supplements if needed.

   
R Acute Renal R Chronic Renal
failure failure
å Abrupt reversible * Irreversible slow
cessation of renal or progressive
function failure of the
å Urine output kidneys to
400ml/24 hours function that
result in death
unless treatment
is instituted.



R Pre- renal failure

R Intra- renal failure

R Post- renal failure

÷    
R Refer to those factors which causes
decreased blood flow to kidneys
e.g. decrease of cardiac output ,
hypotension, hypovolemia such as:
å Severe hemorrhage
å Shock
å Severe burn
å Severe loss of body fluids
R Severe dehydration

R Circulatory collapse

R Hemorrhage during maternal cycle

R Hepatorenal syndrome

R Septic shock

 
 
R Refers to those factors which cause
damage to the parenchyma of the
kidneys like;
R AGN
R Acute Pyelonephritis
R Due to:
å Carbon Tetrachloride
å Sulfonamides
å Gentamycin
å Poison Mushroom
å Mercury
å Radiographic contrast agent
å Transfusion reaction
å Complication of Pregnancy
å Hypercalcemic crisis
å Acute interstitial nephritis
å Severe crushing injuries
÷

 
R Factors which cause obstruction of
the ureters or bladders outlets
R E.g. Tumor
å Scar tissue
å Calculi
å Trauma
 u 


R Subjective symptoms:
å Irritability & confused
å Headache
å Anorexia
å Circumoral numbness
å Tingling of extremities
å Lethargy
å Drowsiness ± Stupor - Coma
 



å Sudden dramatic drop in urinary
output
å Restlessness, twitching, convulsion
å Nausea & vomiting
å Skin pallor, anemia & increased
bleeding time
å Ammonia odor ± breath &
perspiration
å Generalized edema, hypovolemia,
hypertension & increased venous
pressure
å Deep rapid respiration
å Elevated serum level BUN, Crea, K,
Na, pH, CO2
å ( ) Albumin in urine, decreased
specific urine gravity
  



å Correct the underlying cause of
renal failure
å Complete bed rest
å Diet therapy
- Restrict sodium, Protein intake
å Monitor v/s, I & O
å Administer diuretics
R Monitor urine specific gravity
R Report for sign of oliguria
R Report sign of Respiratory infection
R Prepare client for dialysis;
å Hemodialysis
å Peritoneal Dialysis
÷
  

R Dialyzing solution
is introduced via a
catheter inserted
in the peritoneal
cavity, the
peritoneal
membrane is used
as a dialyzing
membrane.


R CIPD
- Chronic
Intermittent
Peritoneal
Dialysis
÷
R Continuous
Ambulatory
Peritoneal
Dialysis
÷
R Continuous
Cycler Assisted
peritoneal
Dialysis
Automatic PD R Drake- Willock
Cycling PD Cycler
machine«.è
64 machine«è
70
R Automated R Peritoneal
Peritoneal Catheter
Dialysis Cycler
›  
R Prior:
å Explain procedure, equipment, &
care
å Obtained consent
å Weigh
å Measure abdominal girth
å Monitor serum electrolytes, BUN,
CREA
å Make the patient void
R Warm dialysate to body
temperature
R Shave abdomen
R Administer sedatives as
prescribed
R Assist physician with insertion of
peritoneal catheter
 
R Make sure outflow
line is clamped
R Open inflow line &
allow dialysate to
flow into
peritoneum
R Clamp inflow line after dialysate
has flowed into the peritoneum
R Allow dialysate solution to remain
in peritoneal cavity for specified
time
R Unclamped outflow line after ³
dwell time´ is completed
R Allow solution to drain by gravity
R Record type of dialysate used
R Measure amount of fluid that flowed
in & amount that flowed out
R Report any deficit or excess
R Record color of outflow drainage.
u  
    
R Turn client from side to side
R Elevate head of bed
R Check line for kink, clots or leaks
R Notify physician to reposition
catheter if necessary

 

R The client is attached to a machine
that pumps the blood along a semi-
permeable, dialyzing solution is on
the other side of the membrane &
osmosis and/or diffusion of waste,
toxins & fluids from the client
occur.
Kolff Rotating drum R Kolff Brigham
è
43, èst Dialysis
dialysing machine machine:è
48
R Milton- Roy Model R Travenol RSP:
A, First machine è
67
use for Nocturnal
Home Hemo: è
64
R Cordis Dow
Seratron Dialysis
Machine:è
7

÷  
R Remove the end product of protein
metabolism from blood
R Maintain safe level of electrolytes
R Remove excess fluid from the
blood
R Correct acidosis & replenish blood
bicarbonate system

R Subclavian catheter
R Anteriovenous shunt
R Bovine graft
R Gortex graft
R Arteriovenous fistula
R Saphenous vein graft
R External shunt - Exanguination
›  
R Secure consent
R Have client void
R Assess v/s before & every 30 mins.
During procedure
R With hold anti HPN, sedatives, &
vasodilators, diuretics
R Ensure bed rest
R Change position frequently
R Assess insertion site
R Maintain patency of femoral or
subclavian catheter
R Assess for patency of shunt, fistula
or graft by listening to bruit &
feeling thrills or pulsation
R Determine client response for
dialysis
÷
 
 

R Dialysis Disequilibrium syndrome:
* Nausea & vomiting
* Hypertension
* confusion
* Seizures
R Hypovolemia (Hypovolemic shock)
 
R Failure of circulatory system to
provide tissue perfusion necessary
for normal cellular function &
failure to remove waste products of
metabolism that accumulate due to
inadequate venous return


R Hypovolemic shock

R Vasogenic shock

R Cardiogenic shock

R Shrill shock

 
R Result from decreased
intravascular volume of at least è5-
25 % causing decreased venous
return
÷
  

R Hemorrhage

R Dehydration

R Third space of fluid

  


R Injury/ trauma
R Surgery
R GIT bleeding
R Delivery of baby
R Bleeding disorder
R Defect in coagulation
R Liver disease
R Hemophilia
R DIC


 
R Tissue Hypoxia

R Infarction
  
R Abruptio Placenta
R Retained Dead Tissue
R Amniotic fluid Embolism
R Ca ± pancrease, lungs, stomach,
prostate
 





R Prolonged vomiting
R Excessive diarrhea
R Excessive GIT drainage
R Overuse of diuretics
R Endocrine disorder
 
   

R Burn

R Peritonitis

R Bowel obstruction

R Liver disease
  


R Changes in vital sign
R Changes in the level of
consciousness
R Changes in the skin & mucous
membrane
R Changes in urine output
 
u  
R CXR
R CBC
R Electrolytes
R BUN/ CREA
u  

R Maintain adequate fluid volume

R Insert foley catheter

R Monitor I & O

R Fluid therapy
m 

  
 

R Whole blood or blood products

R Plasma expander

R Crystalloid Solution
u
 m 


R Rales

R Peripheral edema

R Jugular venous distention

›  
 
R Normal serum concentration: è36-è45
mEq/L
R Minimum daily intake
requirements:2gm/day
R Sources:
* Processed & canned foods
* Fish & smoked & sausage type foods
* Processed cheese
* Snack type foods
m 

R Conduction of neural impulses
R Muscular contraction
R Regulates osmotic pressure &
therefore volume of ECF



R A sodium deficit in the blood
plasma Na level below è35 mEq/L
R Predisposing factor:
å Increased Na loss
å Decreased Na intake
å Dilutional Hyponatremia
÷ 

 

R Increased Na loss
å Renal lossed
å Gastrointestinal losses
å Endocrine imbalance
å Skin loss

R Decreased sodium intake

R Dilutional Hyponatremia

å Excessive ingestion of H2O

å Water retention
 
 

R History & physical examination

R Serum Na Concentration

R Serum osmolarity



è.Decrease BP
2. Weak thready pulse
3. Oliguria
4. Postural hypotension
5. Weight gain
6. Increase BP
7. Pulmonary edema
8. Altered level of sensorium

. Weakness
è0. Cramps
èè. Muscle twitching
è2. Convulsion
è3. Anorexia
è4. Diarrhea
è5. Abdominal cramps.
 

R Shock

R Coma

R Co- existing electrolytes

deficiencies
÷

R Advise client working in hot
environment to drink sodium
containing fluids or add salt- diet/
ingest salt tablets.
R Monitor clients on diuretics ± Na
depletion
R Teach client/ outpatients to
recognize & report S/s of
hyponatremia
u  

R Administer prescribed NaCL

R Restrict H2O intake

R Administer prescribed diuretic

R Relieve CNS alteration from cellular

swelling



R Serum level higher than è45 mEq/l

R Predisposing factor:
å Primary hypernatremia
å Decreased Extracellular H2O
resulting in increased serum Na
÷ 

 
  



 
R Infusion of saline
R Excessive ingestion of sodium salt
in diet/ drugs
R Salt water drowning
R Renal disease
R Hyperaldosteronism
R Cushing syndrome/disease
R Excessive Na intake in client with
renal failure
÷ 

 

 

m  
 ›
R Excessive H2O loss

R Decreased water intake




è. Thirst
2. CNS alteration
3. Dry flushed skin
4. Dry fissured mucous membrane
5. Weight loss
6. Decrease BP
7. Weak, thready pulse
8. Increased temperature


 
R Agitated

R Restlessness

R Disorientation

R Hallucination
 
 

R History & physical examination
R Serum osmolarity
R Serum Na concentration
R Laboratory test
R Urine specific gravity
 

R Manic excitement

R Hypovolemia

R Coma
÷

R Restrict Sodium intake
R Placed on regular schedule of H2O
administration
R Check for adequacy of renal
function prior to administration of
IV electrolytes.
u  

R Diuretics to remove Na
R Discontinue Na containing IV fluids
R Renal dialysis
R Liberal administration of water
R Monitor electrolytes
R Assess for manifestation of fluid
overload-H2O replacement therapy
R Assist client while ambulating
÷
 
R Normal serum K:
3.5-5.0 mEq/L
R Daily requirements:
0.5-è.5 gm
Sources:
* Meats
* Fish
* Milk products
* fruits/ vegetables
m 

R Regulates intracellular osmotic
pressure & fluid volume
R Participate in acid base balance
R Co- factor in metabolic reactions
R Critical in neuromuscular
excitability of skeletal, cardiac, &
smooth muscle

 
R Decreased serum K below 3.5
mEq/L
R Predisposing factors:
å Inadequate K intake
å Increase K loss from body
å K shift into cells
÷ 

 





R Diet or IV solution deficit in K

R Inability to eat
÷ 

 
 
 


R Renal losses

R GI losses

R Skin losses
÷ 

 
 



R Alkalosis or alkalinizing drugs

R Insulin & glucose therapy




R CNS alteration
R Altered neuromuscular activity
R ECG alteration
R Postural hypotension
R Shallow breathing
R Respiratory muscle paralysis
R Metabolic alkalosis


 
Ê

 


  
  


 


 


   
  
Ê
  






 


 
 



 
 
 

÷

 


 

R History & physical assessment

R Serum K concentration

R Serum pH
 

R Ventricular fibrillation

R Respiratory Arrest

R Potentiation for digitalis toxicity


   

u  

R Prevention depends on the
situation
R Nursing history & assessment
R Replenish K preferably by oral
route
å Food high in K
å K supplement:
å KCL K-lyte
å K gluconate Cena K
R Monitor client for sign &
symptoms of K toxicity
R Assess adequacy of renal function
R Monitor ECG & pulse, muscle
strength
R Assist client while ambulating &
observe client frequently

 
R Increased serum K above 5.5 mEq/L

R Predisposing factor:
å Excessive K intake
å Decreased K excretion
å K shift out of the cells
÷ 

 
  




R Decreased renal excretion

R Decreased fecal excretion

÷ 

 
 




R Cell injury

R Acidosis or acidifying drugs

 




R History & physical examination

R Serum k concentration



R Manifestation of altered cell
polarization, which affect
neuromuscular activity
å Neural & skeletal muscle alterations
å Cardiac alteration
å Smooth muscle alterations
÷ 
  
p

 
 
  

 
  

 

R Ventricular fibrillation

R Cardiac arrest

R Respiratory arrest
u  

R Monitor serum K in patient
receiving K containing medications
& in client in acidosis
R Avoid transfusion of old, stored
blood
R Check adequacy of urine output
prior to administration of IV
solution containing K
R Monitor ECG
R Increase K excretion with
prescribed dialysis /ion exchange
resins
R Decrease K release from cell
R Increased cellular uptake of K
R Monitor client for sign & symptoms
of hypokalemia
R Safety precaution
R K reducing medication:
* Kayexalates (Sodium Polystyrene
Sulfonate)
uu  
R Normal serum: è.5-2.5 mEq/L
R Daily requirements:
Non-pregnant -250 mg
R Absorption:
GIT
R Excretion:
Normal kidneys
m 

R Regulation of synaptic
transmission at neuromuscular
junction & in CNS

R Co-factor in variety of enzymatic

reactions in metabolic pathways
u   

R Green vegetables
R Nuts
R Sea foods
R Whole grains
R Dried beans
R Cocoa
R Banana
R Legumes
R Oranges

 
R Decreased serum Mg level below
è.5 mEq/L

R Predisposing factor:
å Inadequate intake
å Decreased absorption of mg
å Excessive excretion or fluid loss
÷ 

 


u


R Malnutrition

R Increased dietary intake of Calcium

without increasing Mg intake

R Prolonged IV infusion of Mg free IV

solutions without oral Mg intake
÷ 

 

 


u
R Diarrhea

R Genetic Mg absorption defect

R Mal absorption syndromes

R Presence of high Ca, fat or

phosphorus in GIT
÷ 

 


 

R Diuretics

R Diabetic Ketoacidosis

R Prolonged GI suction

R Hypoaldosteronism



R Manifestation of increased CNS &
neuromuscular excitability
resulting from increased
acetylcholine release
A. CNS alterations
B. Neuromuscular alterations
R Cardiovascular alterations
÷
 

R Consist of
twitching of
muscles supplied
by the facial nerve
when the nerve is
tapped
   
R Carpo pedal
spasm will occur
as ischemia of the
ulnar nerve
develops
 
 

R History & Physical examination

R Serum Magnesium level

 

R Convulsion

R Cardiac arrhythmias
u  

R Prevention depends on situations
R Nursing history & assessment
R Monitor client for manifestation of
Mg excess
R Have Calcium Gluconate available
R Safety & seizures precautions

 
R Increased serum Mg greater than
2.5 mEq/L associated sign &
symptoms appear if Mg exceeds 4
mEq/L
R Predisposing factors:
å Decreased renal excretion
å Increased Mg intake or absorption



R CNS alteration

R Skeletal muscle alterations

R Cardiovascular alterations
m 
÷  

 
 

R History & Physical Exam

R Serum Mg level
 

R Over sedation
R Respiratory depression
R Cardiac arrhythmias
R Coma
R Arrest
u  

R Prevention:
å Do not administer Mg containing
medication if renal function is
inadequate
å Teach proper use of antacids/
cathartics
å Decrease intake of food rich in Mg



R Provide adequate fluid ±adequate
excretion of urine
R With hold medication containing Mg
R Conduct prescribe dialysis
procedure
R Administer prescribed Calcium
Gluconate
R Monitor client for manifestation of
Mg deficit / Calcium toxicity
  ÷ 

R 75% - Ca & PO4 , derived from milk
& milk product
R 30% - ingested Ca absorbed-
intestine & excreted - feces
R 70% - ingested PO4 absorbed-
intestine & excreted- urine
R Vitamin D- increase Ca absorption
& renal excretion of PO4
m 

R Ca & PO4 essential component of
bone & teeth
R PO4 involved in metabolic
reactions & cellular energy
production
R PO4 functions in acid- base balance
R Ca regulates membrane
permeability & nerve transmission
R Ca triggers muscle contractions
R Ca involves in blood coagulations
R Ca essential for hormone secretion

R NORMAL VALUE:
å Ca :

-èèmg/dl or 4.5-5.8 mEq/L
å PO4:
3-4.5 mg/dl or è.7- 2.6 mEq/L
÷ 

R Function in cellular energy
metabolism combines with calcium
ions in bones, providing hardness.

R Involve in structure of genetic

material DNA & RNA
 
R Milk
R Milk products
R Green leafy vegetables
R Sardines
R Clams
R Oyster
 



R History & P.E

R Serum Ca concentration

R HYPOCALCEMIA
decrease serum Ca below
mg/
dl or 4.5 mEq/L
÷
  
÷ 


 

R Decrease intake of Ca
R Decrease Ca absorption
å Vitamin D deficiency
å Overuse of antacids
R Increase Ca losses
å GI losses
å Loss in exudates
R Decrease availability of
physiologically active free Ca
å Alkalosis
å Massive transfusion with citrated
blood

R Hypothyroidism



R Manifestation of increased
neuromuscular excitability;
å Numbness & tingling
å Muscle spasm
å Tetany
å Cramps
å Convulsion
å ( ) trousseaus & Chevostek¶s sign
å Laryngospasm
R Manifestation of depressed cardiac
contractility;
å Weak cardiac contractions
å Cardiac arrhythmias
 

R Convulsion
R Respiratory arrest
R CHF
R Cardiac arrest
R Pathological fracture
u  

R Oral ± increase dietary intake of Ca
& Vitamin D
R Administer prescribed Ca
supplement- IV/ IM
å Ca CL
å Ca gluconate
å Calcium lactate

 
R Increased serum Ca above èèmg/ dl
R Predisposing/Precipitating factors:
å Excess Ca or Vitamin D
å Hyperthyroidism
å Increased availability of
physiologically active free Ca
R Increased Ca mobilization from
bone;
å Multiple fractures
å Prolonged immobilization
å Tumors (breast/ lungs/ kidney
etc«)
å Bone tumors



R CNS depression, altered level of
sensorium
R Decrease deep tendon reflexes
R Muscle weakness
R Decrease GI mobility
R Nausea & vomiting
R Constipation
R Cardiac arrythmias
 
 

R History & P.E
R Serum Calcium

R COMPLICATIONS:
å Renal failure
å Cardiac arrest
å Pathological fracture
å Potentiation of digitalis toxicity
u  

R Restrict dietary intake of Ca
R Hydrate client- promote renal
excretion of Ca
R Maintain acid urine ± increase Ca
solubility
R Prevent UTI
R Administer prescribed Mithramycin
R Avoid vitamin D supplement
 

R Most abundant anion in
extracellular fluid
R Help balance Na
R Major component of gastric
secretions.

R Sources:
Salt
 

R FUNCTION:
å Help maintain osmotic pressure &
fluid volume - ECF
å Essential for production of HCL by
gastric parietal cells
å Participate in regulations of acid/
base balance

 
R Decreased serum Cl level below
6
mEq/L
R Predisposing factor:
* Loss commonly parallel to Na loss
or dilution by excess H20
* Independent loss
* Decrease intake of Cl



R Edema
R Distended neck vein
R Tachycardia
R Increased urine output
R Increased BP
R Crackles, wheezing, shortness of
breathing
R Thirst
R CNS alterations
R Dry flushed skin
R Weight loss
R Decreased BP
R Weak thready pulse
R Increased temperature
u  

R Monitor electrolytes
R Specific depend on the underlying
cause
R Safety & seizure precautions

 
R Increased serum level above è06
meq/L

R Prediposing factors:
Excessive ingestion or infusion of
Cl containing compounds such as
KCl , NaCl, ammonium chloride

    
R Acid
Compound that yields hydrogen
ions when dissociated in solution.
R Properties:
å Acts as an electrolytes in H20
å Reacts with base to form H20 & salt
å Destroy body tissues


R Hydrochloric acid

R Carbonic acid

R Acetic acid

R Lactic acid


  

R Secreted by the parietal cells of the

stomach , transform pepsinogen
into pepsin.

R Carbonic acid
- one form in which CO2 is
transported in the blood
- part of the bicarbonate buffer
system
 
 

R Builds up in muscle tissue during

exercise & it is transported to the
liver via the circulatory system
where it is completely oxidized into
Co2, H20 , & energy
 
R A compound that combines with an
acid to form H20 & a salt

R properties:
* Acts as an electrolyte in H20
* Destroy body tissue
 
R Magnesium Hydroxide

R Aluminum Hydroxide

R Ammonium Hydroxide
 

R Compound formed when an acid is
neutralized by a base

R Properties:
* Acts as an electrolyte in H20
* Crystalline in nature
* ³Salty´ taste
 

R Sodium chloride
R Potassium chloride
R Silver nitrate
R Barium sulfate
R Ferrous sulfate
R Sodium bicarbonate
    
 
 
R Lungs
- maintain acid-base balance by
controlling CO2 in the body.

R Kidneys
- it maintain acid-base balance by
controlling HC03
÷


Ventilation

respiration respiration

hypoventilation hyperventilation

Excretion of CO2 Excretion of CO2

Retention of CO2 Retention of CO2

H2CO3 H2CO3

Respiratory Acidosis Respiratory Alkalosis

Respiratory Acidosis Respiratory Alkalosis

H2CO3 H2CO3

Kidney to retain HCO3 Excretion HCO3

HCO3 HCO3
Metabolic Alkalosis
Metabolic Acidosis
÷  

   
R pH
- denotes the power strength of
hydrogen ions in a solution
Normal value:
7.35 ± 7.45
R pC02
- partial pressure of CO2
measurement of respiratory
function
normal value:
35-45 mmHg
R HCO3
- measurement of metabolic
function
Normal Value:
22-26 mEq/L
R Example:

pCO2 - 60 = respiratory acidosis

HCO3 - 32 = metabolic alkalosis
pH - 7.43 = normal

 
   
R Uncompensated type

R Compensated type
* Partially compensated type
* Fully compensated type

 





R Example:
pCO2 - 3è = Respiratory alkalosis
HCO3 - 25 = Normal
pH - 7.52 = Alkalosis
R pCO2 - 3
= Normal
HCO3 - è8 = Metabolic acidosis
pH - 7.3è = Acidosis
÷ 
 
 




R Example:

pCO2- 50 = Respiratory acidosis

HCO3- 30 = Metabolic alkalosis
pH- 7.5 = Alkalosis
m 
 


R Example:

pCO2- 55 = Respiratory Acidosis

HCO3- 3è = metabolic alkalosis
pH- 7.37 = Normal
u
 

R State of excess acid accumulation
& deficient base HCO3.
R Symptoms result from the body¶s
attempt to correct the acidotic
condition through compensatory
mechanism in the lungs, kidneys &
cells.
R ABG reveals: pH below 7.35
HCO3 below 24 meq/L
 
R Cellular breakdown
R Chronic alcoholism
R Diabetic ketoacidosis
R Diarrhea or
Intestinal malabsorption
R Renal insufficiency & failure



R Headache
R Lethargy
R Drowsiness
R CNS depression
R Stupor
R Kussmaul¶s respiration
 


R IV fluid administration& insulin
administration
R Na bicarbonate IV or orally
R Endotracheal intubation &
mechanical ventilation
R Oral hygiene
R Insulin or oral anti diabetic therapy
u
  
R Decrease amount of acid or
increased amount of base (HCO3)
R ABG reveals:
pH greater than 7.45
HCO3 above 2
mEq/L
 
R Loss of gastric juices
R Fistula
R Excessive intake of bicarbonate of
soda or other antacid
R Excessive intake of alkaline
R Use of steroid & certain diuretics
R Hyper adrenocorticism



R Hypoventilation
R Irritability
R Carphology
R Nausea & Vomiting
R Diarrhea
R Cyanosis
R Atrial tachycardia
R Twitching
R Apnea
 


R Ammonium chloride

R Potassium supplement
R Ê



R