Fluid and electrolytes

• Fluid Compartments

  Intracellular (ICF)

  Extracellular (ECF): Intravascular and Interstitial
• Fluid Concentration

  - Isotonic: equal concentration

  - Hypotonic: lower concentration

  - Hypertonic: higher concentration
• Factors affecting Fluid and Electrolyte Balance - Intake

  Food and fluids not readily accessible, Fatigue or weakness, Difficulty communicating, depression or confusion, Anorexia, Nausea
• Factors affecting Fluid and Electrolyte Balance - Output

  Vomiting, Diarrhea, Diuretics, Surgery
• Fluid Volume Deficit (FVD)

  - Hypovolemia or isotonic fluid loss

  - Loss of body fluids

  - Inadequate intake

  - Third space fluid shifts

  
• Fluid Volume Deficit Assessments

  - Dry Mucous Membrane

  - Vascular volume = tachycardia

  - Low BP

  - Low urine output

  - weight loss

  - Decrease skin turgor**
• Fluid Volume Deficit Labs

  - Increased Hematocrit

  - Increased Urine specific gravity

  - Increased Blood Urea Nitrogen (BUN)

  - Increased Creatinine
• Fluid Volume Deficit Interventions

  - Give Fluids

  - Assess LOC

  - Monitor I&O's

  - Daily weights

  - Fall precautions
• Fluid Volume Excess (FVE)

  - Hypervolemia

  - Equal concentration of water and sodium

  - Excess fluids in ECF compartments

  - Oliguria (low urine output)

  
• Fluid volume excess assessments

  - Increased BP

  - Increased Pulse

  - Increased Weight

  - Increased Edema

  - Increased Crackles in lungs

  - Increased risk for skin breakdown
• Fluid Volume Excess labs

  - Low hematocrit

  - Low Urine specific gravity

  - Low BUN

  - Low Creatinine

  
• Fluid Volume Excess Interventions

  - Restrict fluids and sodium

  - Assess lungs

  - Monitor I & O's

  - Daily weights - edema

  - Assess circulation

  - Reposition q2 hrs

  - Administer ordered diuretics
• Sodium (Na+)


  135-145 mEq/L

  
• Hyponatremia


  - low sodium in blood

  - Increase in water to total body sodium

  - Water moves ECF to ICF

  
• Hyponatremia assessments


  - Low serum Na+ <135 mEq/L

  - Decrease Neurological function

  - Risk for seizures

  - Decrease muscle strength
• Hyponatremia interventions

  - Seizure precautions

  - Monitor vital signs

  - Monitor I & O's

  - Understand/address underlying cause
• Hypernatremia

  - High sodium in blood

  - Water loss greater than Na+ loss

  - Enteral feeding with no extra water intake

  - Water moves from ICF to ECF

  
• Hypernatremia assessments

  - Na+ >145 mEq/L

  - Neurological changes

  - Increase in thirst

  - Restlessness/Agitation

  - Weakness
• Hypernatremia Interventions

  - Assess neurological status

  - Monitor I & O's

  - Monitor vital signs

  - Understand/Address underlying cause
• Potassium


  3.5-5.0 mEq/L

  
• Hypokalemia

  - K+ <3.5 mEq/L

  - Increased loss of K+

  -Decreased intake

  - Decreased Magnesium
• Hypokalemia Assessment

  - Weak, irregular pulses

  - ECG changes - inverted/flat T wave

  - Cramping

  - Weakness

  - Decreased deep tendon reflexes
• Hypokalemia Interventions

  - Offer K+ rich foods

  - Give K+

  - Monitor heart rhythm

  - Monitor vital signs and I & O's

  - Fall precautions
• Hyperkalemia

  - K+ >5.0 mEq/L

  - Increased intake

  - Decreased output

  - Medications
• Hyperkalemia assessments

  - Dysrhythmias

  - ECG changes - tall peaked T waves

  - Hypotension

  - Abdominal cramping/ Increased motility
• Hyperkalemia Interventions

  - Stop/Restrict potassium

  - Given K+ wasting diuretics

  - Monitor ECG

  - Monitor vital signs (BP & HR)

  - Monitor I & O's
• Calcium (Ca)


  8.6 - 10.2 mg/dL
• Hypocalcemia

  - Ca++ <8.6 mg/dL

  - Inadequate calcium intake

  - Increase Ca++ loss

  - Malabsorption - vitamin D deficiency

  - Hypoparathyroidism

  - Hyperphosphatemia
• Hypocalcemia assessments

  - Tetany, twitching, seizures

  - Trousseau's sign (hand/finger spasms)

  - Chvostek's sign (facial twitching)

  - Hypotension
• Hypocalcemia Interventions

  - Seizure precautions

  - Calcium supplements

  - Foods high in Ca++

  - Monitor heart rhythms
• Hypercalcemia

  - Ca++ 10.2 mg/dL

  - Increased intake (Ca++ & Vitamin D)

  - Diuretics (Thiazides)

  - Hyperparathyroidism
• Hypercalcemia Assessment

  - Change in LOC

  - Lethargy

  - Cardiac dysrhythmias

  - Constipation

  - Decreased reflexes

  - Muscle weakness
• Hypercalcemia Interventions

  - Fluids

  - Diuretics (furosemide)

  - Foods low in Ca++

  - Neuro checks

  - Fall precautions
• Magnesium (Mg)


  1.3 - 2.3 mEq/L
• Hypomagnesemia

  - Mg++ <1.3 mEq/L

  - Malabsorption (alcoholism & chronic diarrhea)

  - Prolonged gastric suctioning

  - Vomiting

  - Diuretics
• Hypomagnesemia Assessment

  - Tremors, tetany, twitching

  - Seizures

  - Arrhythmias

  - Hyperactive reflexes

  - Hypoactive bowel sounds
• Hypomagnesemia Interventions

  - Seizure precautions

  - Monitor for dysrhythmias

  - Give magnesium
• Hypermagnesemia

  - Rare

  - Chronic renal diseases

  - Adrenal insufficiency
• Hypermagnesemia Assessments

  - Weakness

  - Lethargy

  - Dysrhythmias

  - Respiratory depression

  - Facial flushing

  - Hypoactive DTR
• Hypermagnesemia Interventions

  - Monitor ECG changes

  - Focused neuro assessment

  - Monitor vital signs

  - Give ordered diuretics

  - Education on foods low in magnesium