Schuylkill Health School of Nursing 2011

Fluid and Electrolyte Balance

Pamela Krupilis MSN, RN, CNS
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
A. Composition of Body Fluids
Fluid water & other components
Electrolyte any compound when
dissolved in water, separates into
electrically charged particles called ions.
Cations (+) charged ions
Anions (-) charged ions
Non-electrolytes substance does not
ionize or carry an electrical charge
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
B. Distribution of Body Fluids
Extracellular fluid moving outside the cell
1. Interstitial Fluid between the cells or
tissue
2. Intravascular Fluid plasma
Intracellular fluid within the cell
membrane containing dissolve solutes or
substances.
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
3. Movement of Body Fluids
Body fluids are not static.
Shift from compartment to compartment to
maintain homeostasis.
Why do we need fluids?
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Types of Movement
1. Diffusion movement of liquids or
gases from an area of higher
concentration to an area of lower
concentration.
2. Osmosis movement of water through
a semi permeable membrane from an area
of lesser concentration to an area of
higher concentration.
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Osmotic Pressure occurs as solute
particles collide against one another.
Osmolality number of mOsm/kg of water
(280-295 mOsm/kg)
Osmolarity mOsm/L of solution.
Solute substance that is dissolved in a
liquid to form a solution.
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Tonicity
a. Isotonic Solution same osmolality as
plasma. Ex: 0.9%NSS, LR
b. Hypotonic Solution lesser osmolality
than plasma. Fluid will move into the
cell. Ex: 0.45%NSS
c. Hypertonic Solution higher osmolality
than plasma. Fluid will move out of the
cell. Ex: D5/0.45% NSS, D5NSS, D5LR
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
3. Filtration transfer of water & diffusible
substances from high pressure to low pressure.
a. Hydrostatic pressure exerted by the
pumping action of the heart. Fluids are filtered
through the arterial end of the capillaries where
the pressure is greater.
b. Colloid Osmotic Pressure exerted by
nondiffusible plasma proteins (albumin) in larger
solutes. Fluids reenter the venous end of the
capillaries because the pressure is greatest
there.
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
4. Active Transport requires metabolic
activity to move materials across the cell
membrane.
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
C. Regulation of fluid & electrolytes
Fluid Intake
Lymphatic System
Neuroendocrine System
Antidiuretic Hormone (ADH)
Renin Angiotensin Aldosterone System
Thyroid Hormone (Calcitonin)
Parathyroid Hormone
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
GI System
Renal System
Electrolytes
Sodium Regulation
Potassium Regulation
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
D. Disturbance in Fluid & Electrolytes
Balance
1. Isotonic Imbalances
a. Fluid Volume Deficit
b. Fluid Volume Excess
2. Osmolar Imbalances
a. Hyperosmolar Imbalance
b. Hypoosmolar Imbalance
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Electrolytes
Sodium 135 to 145 mEq/L
Potassium 3.5 to 5.1 mEq/L
Calcium 8.9 to 10.3 mg/dL
Magnesium 1.3 to 2.1 mEq/L
Phosphate 2.5 to 4.5 mEq/l
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
3. Electrolyte Imbalances
Hyponatremia
Signs & Symptoms
Hypernatremia
Signs & Symptoms
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Hypokalemia
Signs & Symptoms
Hyperkalemia
Signs & Symptoms
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Hypocalcemia
Signs & Symptoms
Hypercalcemia
Signs & Symptoms
Schuylkill Health School of Nursing 2011
Schuylkill Health School of Nursing 2011
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Hypomagnesium
Signs & Symptoms
Hypermagnesium
Signs & Symptoms
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
Hypophosphatemia
Signs & Symptoms
Hyperphosphatemia
Signs & Symptoms
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
E. Variables Affecting Fluid & Electrolyte Balance
1. Lifestyle Factors
a. Nutrition
b. Exercise
c. Stress
d. Age
e. Physiological Factors
f. Clinical Factors
Schuylkill Health School of Nursing 2011
Fluid & Electrolyte Balance
2. Nursing Diagnosis
a. Fluid Volume Excess
b. Fluid Volume Deficit
3. Planning
4. Implementation
5. Evaluation
Schuylkill Health School of Nursing 2011
Factors to Consider with I and O
Oral liquids
Foods that are liquid @ room temp
Ice chips
IV fluids
Formula & H2O administered through GI
feeding
Fluids used to flush enteral feeding tubes
Fluids used to flush NG drainage tubes
Schuylkill Health School of Nursing 2011
Factors to Consider with I and O
Urine
Vomitus
Liquid stool
Drainage from gastric suction tubes
Drainage from chest tube
Drainage from closed drainage tubes
Schuylkill Health School of Nursing 2011
Questions???