By:
Samson Ehe Teron
Mechanism for fluid and
electrolyte movement
osmosis filtration
diffusion
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osmosis
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diffusion
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diffusion
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filtration
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Fluid and electrolyte
balances
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cations
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sodium potassium
calcium magnesium
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Electrolytes are measured
milliequivalent per litre
of water
(mEq / L)
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Equivalent refers to the chemical
combining power of a substance or
the power of cations to unite with
anions to form molecules
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most abundant cat ion in the
extracellular fluid
sodium is regulated by
Urinary output
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functions
Maintain balance of extracellular fluid, thereby
it controls the movements of the water between
fluid compartments
135 to 145
mEq/L
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Main intracellular cat ion
Helps in maintaining fluid balance of
the intracellular fluid
Potassium is regulated by
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functions
Regulates neuromuscular excitability and muscle
contraction
3.5 to 5.3
mEq/L
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Calcium is the most abundant element
in the body
Calcium is extracellular fluid
Regulated by the action of
Thyroid gland parathyroid gland
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Parathyroid hormone (PTH) controls
the balance among bone calcium,
gastrointestinal absorption and
kidney excretion of calcium.
Muscle relaxation
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Normal concentration
of calcium
4 to 5
mEq/L
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Magnesium is the second most
important cat ion in the
intracellular fluid
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functions
Precipitation of metabolic activities of cells
Enzyme activity
Muscular excitability
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Normal concentration
of magnesium
1.5 to 2.4
mEq/L
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anions
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chloride
phosphate
bicarbonate
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Phosphate is a buffer anion in
extracellular and intracellular fluid
kidneys
Parathyroid hormone
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Activated vitamin D
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functions
Development and maintenance of bones and
teeth
2.5 to 4.5
mEq/L
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Chlorides are found in extracellular and
intracellular fluids
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Chloride is regulated through
kidneys
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Normal concentration
of chloride
100 to 106
mEq/L
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Bicarbonate is found in extracellular
and intracellular fluids
22 to 26
mEq/L
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Normal venous
bicarbonate value
24 to 30
mEq/L
In venous blood, bicarbonate
is measured as
carbondioxide content
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FLUID VOLUME
DISTURBANCES
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Fluid
volume deficit
hypovolemia
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Fluid Volume Deficit
Mild 2% of body weight loss
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Pathophysiology
results from loss of
body fluids and occurs
more rapidly when coupled
with decreased fluid
intake
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Clinical manifestations
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Concentrated urine
Postural hypotension
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Weak, rapid, heart rate
Oliguria
Increased temperature
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Nursing Diagnosis
Fluid volume Deficit r/t
Insufficient intake, vomiting, diarrhea,
hemorrage, m/b dry mucous membranes
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Nursing management
Restore fluids by oral or IV
Treat underlying cause
Monitor I & O at least every 8
hours
Daily weight
Vital signs
Skin turgor
Urine concentration
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Fluid
volume excess
hypervolemia
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Pathophysiology
may be related to
fluid overload or
diminished function of the
homeostatic mechanisms
responsible for regulating
fluid balance
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Contributing factors
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Clinical manifestations
Edema
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Tachycardia
Increased blood
Pressure
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Increased weight
crackles
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Nursing Diagnosis
Fluid volume excess r/t
CHF, excess sodium intake,
renal failure
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Nursing management
Preventing FVE
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Electrolyte Imbalances
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SODIUM
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Sodium
Normal range 135 to 145 mEq/L
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HYPONATREMIA
Sodium level
less than 135
mEq/L
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causes
Vomiting Diarrhea
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Sweating Diuretics
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Clinical manifestations
Poor
skin Dry
turgor mucosa
Decreased
saliva Anorexia
production vomiting
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Clinical manifestations
Nausea/
Orthostatic
abdominal
hypotension
cramping
Confusion
Altered &
mental lethargy
status
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Nursing interventions
Assess clinical manifestations
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HYPERNATREMIA
Sodium level
more than 145
mEq/L
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CAUSES
Loss of fluids
Water deprivation
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Clinical manifestations
- Thirst
- Flushed skin
- Postural hypotension
Encourage fluids
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Normal serum potassium
concentration is 3.5 to 5.5 mEq/L
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HYPOKALEMIA
Potassium level
less than 3.5
mEq/L
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CAUSES
Loss of K+ in the form of
vomittings ,GI suction
poor K intake
diuretics
steroid administration
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Clinical manifestations
Muscle weakness
Leg cramps
Fatigue
Lethargy
Anorexia
Nausea, vomitting
Decreased bowel sounds
Decreased bowel motility
Cardiac dysrhythmias
Depressed deep tendon reflex #
Nursing interventions
Potassium level
more than 5.5
mEq/L
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Causes
Decreased renal potassium excretion as
seen with renal failure and oliguria
Renal insufficiency
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Nursing interventions
Monitor ECG changes telemetry
Give Kayexelate
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CALCIUM
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Normal serum calcium level is 4
to 5 mEq/L
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HYPOCALCEMIA
Calcium level
less than 4
mEq/L
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Causes
- Vitamin D/Calcium deficiency
- Primary/surgical
hyperparathyroidism
- Pancreatitis
- Renal failure
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Clinical Manifestations
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Trousseaus sign carpal
spasms
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Chvosteks sign cheek
twitching
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Seizures, mental changes
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ECG shows prolonged QT
intervals
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Nursing interventions
- IV/PO Calcium Carbonate or Calcium
Gluconate
Calcium level
more than 5
mEq/L
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Causes
- Hyperparathyroidism
- Prolonged immobilization
- Thiazide diuretics
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Clinical manifestations
- Muscle weakness, nausea and
vomiting
- Constipation
- Cardiac Arrest
(high level)
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Nursing interventions
- Calcitonin
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MAGNESIUM
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Normal serum magnesium level
is 1.5 to 2.4 mEq/L
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HYPOMAGNESEMIA
magnesium
level less than
1.5 mEq/L
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Causes
- Chronic Alcoholism
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- TPN
- Diabetic ketoacidosis
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Clinical manifestations
- Neuromuscular irritability
- Positive Chvosteks and Trousseaus
sign
- EKG changes with prolonged QRS,
depressed ST segment, and cardiac
dysrhythmias
- May occur with hypocalcemia and
hypokalemia
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Starved possible cause of
hypomagnesemia
Seizures
Tetany
Anorexia and arrhythmias
Rapid heart rate
Vomiting
Emotional lability
Deep tendon reflexes increased
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Nursing interventions
- IV/PO Magnesium replacement,
including Magnesium Sulfate
- Give Calcium Gluconate if
accompanied by hypocalcemia
- Monitor for dysphagia, give soft
foods
- Measure vital signs closely
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Foods high in Magnesium:
Green leafy vegetables
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Nuts
Legumes
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Seafood
Chocolate
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HYPERMAGNESEMIA
magnesium
level more than
2.4 mEq/L
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Causes
- Renal failure
- Untreated diabetic ketoacidosis
- Excessive use of antacids and
laxatives
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Clinical manifestations
- Flushed face and skin warmth
- Mild hypotension
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PHOSPHORUS
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Normal serum phosphorus
level is 2.5 to 4.5 mg/100 ml
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HYPO
PHOSPHOTEMIA
Phosphorus
level less than
2.5 mEq/L
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Causes
- Most likely to occurs with
overzealous intake or
administration of simple
carbohydrates
- Severe protein-calorie
malnutrition (anorexia
or alcoholism)
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Clinical manifestations
- Muscle weakness
- Seizures and coma
- Irritability
- Fatigue
- Confusion
- Numbness
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Nursing interventions
- Prevention is the goal
- IV Phosphorus for severe
- Prevention of infection
- Monitor phosphorus levels
- Increase oral intake of
phosphorus rich foods
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Foods rich in phosphorus
- Milk and milk products
- Poultry
- Whole grains
- Organ meats
- Nuts
- Fish
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HYPER
PHOSPHOTEMIA
Phosphorus
level more than
4.5 mEq/L
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Causes
- Renal failure
- Chemotherapy
- Hypoparathyroidism
- Tetany
- Muscle weakness
- Similar to Hypocalcemia because
of reciprocal relationship
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Nursing interventions
- Treat underlying cause
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