Nursing Health Assessment of Fluids and Electrolytes in The Body by NgoRN

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									Fluid, Electrolyte, and
 Acid-Base Balances



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  Distribution of Body Fluids

• Extracellular
  – Interstitial fluid
  – Intravascular fluid
  – Transcellular fluid
• Intracellular




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 Composition of Body Fluids

• Water
• Electrolytes: anions and cations




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  Movement of Body Fluids

• Osmosis
     — Osmolarity, fluid concentrations,
    osmotic pressure
• Diffusion
• Filtration
• Active transport


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  Regulation of Body Fluids

• Fluid intake (adult: 2200 to 2700
  ml/day)
• Hormonal regulation: ADH,
  aldosterone, renin-angiotensin
• Fluid output




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    Regulation of Electrolytes:
             Cations

•   Sodium (Na+)
•   Potassium (K+)
•   Calcium (Ca++)
•   Magnesium (Mg++)



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                   Lab Values
•   Sodium                        135 – 145
•   Potassium                     3.5 – 5.0
•   Calcium                       4.5 – 5.5
•   Bicarbonate                   22 – 26 arterial
                                  24 – 30 venous
• Chloride                        90 – 110
• Magnesium                       1.5 – 2.5
• Phosphate                       1.7 – 4.6
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  Regulation of Electrolytes:
           Anions

• Chloride (Cl-)
• Bicarbonate (HCO3-)
• Phosphate (PO4-)




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      Acid-Base Balance

• Chemical regulation of acid-base
  balance
  – Carbonic acid–bicarbonate buffer
    system




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      Acid-Base Balance

• Biological regulation of acid-base
  balance
  – Hydrogen ion and potassium
  – Hydrogen ion and hemoglobin
  – Chloride shift




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      Acid-Base Balance

• Physiological regulation of acid-base
  balance
  – Lungs
  – Kidneys




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      Electrolyte Imbalances
• Sodium:                           • Calcium:
  – Hyponatremia                          – Hypocalcemia
                                          – Hypercalcemia
  – Hypernatremia
                                    • Magnesium:
• Potassium:                              – Hypomagnesemia
  – Hypokalemia                           – Hypermagnesemia
  – Hyperkalemia                    • Chloride:
                                          – Hypochloremia
                                          – Hyperchloremia


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        Fluid Imbalances

• Isotonic fluid imbalances
  – Fluid volume deficit (FVD)
  – Fluid volume excess (FVE)
• Osmolar imbalances
  – Hyperosmolar (dehydration)
  – Hypoosmolar (water excess)



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        Acid-Base Balance:
           ABG Analysis
•   pH
•   PaCO2
•   PaO2
•   Oxygen saturation
•   Base excess
•   Bicarbonate (HCO3-)


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      Acid-Base Imbalances

•   Respiratory acidosis
•   Respiratory alkalosis
•   Metabolic acidosis
•   Metabolic alkalosis




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    Assessment of Risk Factors
•   Age
•   Acute illness
•   Chronic illness
•   Environmental factors
•   Diet
•   Lifestyle
•   Medication
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        Client Assessment

•   Physical assessment
•   Intake and output
•   Laboratory studies
•   Client expectations




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        Nursing Diagnoses

•   Decreased cardiac output
•   Deficient fluid volume
•   Excess fluid volume
•   Impaired mobility
•   Impaired skin integrity
•   Ineffective tissue perfusion


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                    Planning
• Goals and outcomes
     – Client will demonstrate fluid balance
    by moist, mucous membranes,
    balanced I&O, and stable daily weights
    within 48 hours
• Setting priorities
• Continuity of care


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            Implementation

•   Client education
•   Daily weights and I&O measurement
•   Enteral replacement of fluids
•   Restriction of fluids
•   Parenteral replacement of fluids and
    electrolytes


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                  IV Therapy
•   Types of solutions
•   Equipment
•   Initiation of lines
•   Regulating IV flow rates
•   Maintaining the system
•   Complications
•   Discontinuation
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        Blood Replacement

•   Blood groups and types
•   Autologous transfusion
•   Blood transfusions
•   Transfusion reactions: hemolytic,
    febrile (nonhemolytic), mild allergic,
    anaphylactic, circulatory overload,
    sepsis

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 Interventions for Acid-Base
         Imbalances
• Support of prescribed medical
  therapies
• Maintenance of IVs
• Administration of medications
  (insulin, fluid and electrolyte
  replacement)
• Monitoring: client status, ABGs

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        Restorative Care

• Home IV therapy
• Nutritional support
• Medication safety




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                 Evaluation

• Client care
• Client expectations




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