Fluids, Electrolytes, and

Acid-Base
By:
Kerwin Rico Reyes
OBJECTIVES:
• TO UNDERSTAND THE PHYSIOLOGY OF FLUIDS AND ELECTROLYTES
BALANCE AND ACID BASE BALANCE TO ANTICIPATE, IDENTIFY AND
RESPOND TO POSSIBLE IMBALANCES.
• TO BE ABLE TO USE EFFECTIVE TEACHING AND COMMUNICATION
SKILLS TO HELP PREVENT AND TREAT VARIOUS FLUID AND
ELECTROLYTE DISTURBANCES.
AMOUNT AND COMPOSITION OF BODY
FLUIDS
ELECTROLYTES
 ELECTROLYTES mEq/L

Extracellular Fluid (Plasma)

Cations
Sodium (Na) 142
Potassium (K) 5
Calcium (Ca++) 5
ELECTROLYTES IN THE BODY FLUIDS ARE ACTIVE Magnesium (Mg++) 2
CHEMICALS TOTAL CATIONS 154
1. CATIONS CARRIES POSITIVE CHARGE
Anions
2. ANIONS CARRIES NEGATIVE CHARGE
MAJOR CATIONS: Chloride (Cl-) 103
Bicarbonate (HCO³-) 26
1. SODIUM Phosphate (HPO4-) 2
2. POTASSIUM Sulfate (SO4-) 1
Organic acids 5
3. CALCIUM Proteinate 17
4. MAGNESIUM TOTAL ANIONS 154
5. HYDROGEN IONS
Intracellular Fluid
MAJOR ANIONS: Cations
1. CHLORIDE Potassium (K) 150
Magnesium (Mg++) 140
2. BICARBONATE Sodium (Na+) 10
3. PHOSPHATE TOTAL CATIONS 200
4. SULFATE
Anions
5. PROTEINATE IONS
Phosphates and sulfates 150
Bicarbonate (HCO³-) 10
Proteinate 40
TOTAL ANIONS 200
 Fluid movements
❑ Tonicity- ability of all solutes to
cause an osmotic driving force
that promotes water movements
from one compartment to the
other
❑ Hydrostatic pressure- the
pressure exerted by the fluid on
the walls of the blood vessels
❑ Osmotic pressure- the pressure
exerted by the protein plasma
REGULATION OF
BODY FLUID
COMPARTMENTS
 OSMOSIS
❑ Osmotic pressure- stop flow of water
❑ Oncotic pressure- exerted by proteins
❑ Osmotic diuresis- urine output
increase
❑ OSMOLALITY
- the total number of dissolved particles
(solute) per liter of solvent. Osmolality
affects water movement and distribution
between and within body fluid
compartments because water always
moves from lesser solute concentration
(low osmolality) to a greater solute
concentration (high osmolality)
 DIFFUSION

❑ DIFFUSION – is the natural

tendency of a substance to move
from an area of higher
concentration to one of lower
concentration.
 FILTRATION
FILTRATION
❑ is the pressure in arteries creates pressure
WATER
into arterioles, which force fluid through
arteriole wall. ELECTROLYTES

❑ allows the kidneys to filter 180 L of plasma

per day.
❑ Another example of filtration is the passage WASTE
PRODUCT
of water and electrolytes from the arterial
capillary bed to the interstitial fluid; in this
instance, the hydrostatic pressure is
furnished by the pumping action of the
heart.

FILTRATION
KIDNEYS- plasma 180ml/day
 Active transport
❑ ACTIVE TRANSPORT Na= increase in ECF
❑ implies that energy must be expended K=decrease in ECF
for the movement to occur against a Active transport
concentration gradient.
❑ From low concentration to high
Na
concentration.
❑ SODIUM POTASSIUM PUMP
(ECF)
❑ the sodium concentration is greater in
the ECF than in the ICF, and because of ICF=Na(ECF)
this, sodium tends to enter the cell by
diffusion. AND
❑ This tendency is offset by the
sodium-potassium pump, which is
located in the cell membrane and K(ICF)
actively moves sodium from the cell into
the ECF.
❑ Conversely, the high intracellular
K
potassium concentration is maintained
by pumping potassium into the cell. By
(ICF)
definition, Na is inversely proportional to K both ICF and ECF
Active transport
 Regulation of body
water gain and
loss
❑ Regulation of body water gain depends mainly on
regulating volume of water intake
❑ Thirst centre in hypothalamus governs urge to drink
❑ Thirst centre stimulated by :
❑ Nerve impulses from osmoreceptors in hypothalamus
❑ ↓ in PV or ↑ in plasma osmolality
❑ Hypothalamic osmoreceptors lose water to
plasma
❑ Increased transmission of nerve
impulses to thirst centre
❑ dry mouth and pharynx - less saliva from blood
plasma
❑ ↓ in PV = ↓BP
❑ increased angiotensin II (via JGA)
❑ stimulates thirst centre
❑ Regulation of body water (and solute) loss depends
mainly on urinary excretion
ROUTES OF GAINS AND
LOSSES
KIDNEYS
SKIN
LUNGS
GASTROINTESTINAL TRACT
SKIN

SWEATING
FEVER

EVAPORATION

600ml/day= insensible water loss

kidneys

1-2L/day of urine
volume or 1ml/kg/hr
LUNGS

400ml/day=insensible fluid loss

GASTRO-INTESTINAL TRACT
❑ Kidneys- 1-2 Liters urine volume
(1mlml/kg/hr)
❑ Skin- 600ml/day
❑ Lungs- 400ml/day
❑ GI Tracrt- 100-200ml (8 liters fluids is
circulated in the every 24 hours
WATER INTAKE
AND OUTPUT
 LABORATORY TESTFOR
EVALUATING FLUID STATUS
 COMPARISON OF SERUM AND URINE OSMOLALITY
FLUID FACTORS INCREASING OSMOLALITY FACTORS DECREASING OSMOLALITY

SERUM Free water loss SIADH

(275- 300 mOsm/kg Diabetes insipiduos Renal failure
Sodium overload Diuretic use
Hyperglycemia Adrenal insufficiency
Uremia

URINE Fluid volume deficit Fluid volume excess

(250-900 mOsm/kg) SIADH Diabetes insipidus
HF
Acidosis

Urine osmolarity determines the amount of:

❑ Urea
❑ Creatinine
❑ Uric acid
 NORMAL VALUES
SERUM OSMOLALITY 275- 300 mOsm/kg
URINE OSMOLARITY 250- 900 mOsm/kg

URINE SPECIFIC GRAVITY 1.010- 1.025

BLOOD UREA NITROGEN 10- 20 mg/dl ( 3.5-7 mmol/L)

CREATININE 0.7- 1.5 mg/dl (60-130 mmol/L)

HEMATOCRIT 44- 52% (males)

39- 47% (females)
URINE SODIUM 50- 220 mEq/24 h
(50- 220 mmol/24h)
HOMEOSTATIC
MECHANISM
❑ Kidney functions
❑ Filters 170L of plasma/day
❑ Heart and blood vessels function
❑ Lung function
❑ Pituitary functions
❑ Anti-diuretic Hormone
❑ Adrenal Functions
❑ Aldosterone
❑ Parathyroid functions
 KIDNEY FUNCTIONS Heart
Maintains a balance of Blood pressure
electrolytes (potassium, Controls the volume of fluids
Water sodium and calcium) for
the heart rhythm
regulates the in and out of water

Waste
Acid base balance Remove waste products:
Influence on the blood pH urea, uric acid, and other
waste in the urine

Blood
Releases erythropoietin,
for manufacturing of red
blood cells in the bone
Bones marrow during hypoxia
Activates vitamin D, which
helps absorb calcium
 HEART FUNCTIONS
The four main functions of the heart
are:
❑ Pumping oxygenated blood to the
other body parts.(5 to 6 liters of blood every
minute)
❑ Pumping hormones and other vital
substances to different parts of the
body.
❑ Receiving deoxygenated blood and
carrying metabolic waste products
from the body and pumping it to the
lungs for oxygenation.
❑ Maintaining blood pressure.
HEART FUNCTIONS
 LUNG FUNCTION
Functions
❑ Gas Exchange – oxygen and carbon
dioxide.
❑ Breathing – movement of air.
❑ Protection – from dust and microbes
entering body through mucus
production, cilia, and coughing.
❑ Maintaining acid-base balance
LUNG VOLUME
PITUITARY FUNCTIONS

32
 PITUITARY FUNCTIONS
HYPOTHALAMUS Autonomic regulatory
system

ADH

STORAGE OF
ADH
WATER
CONSERVING PITUITARY GLAND
HORMONE

WILL RELEASED
AS NEEDED

33
 ADRENAL FUNCTIONS
❑ Glucocorticoid=cho;chon;
fat metabolism OUTER ZONE OF ADRENAL CORTEX
❑ Mineralocorticoid
❑ Androgen=male sex Cortisol
hormones ❑ the primary stress
ZONA
hormone, increases
GLOMERULOSA
sugars (glucose) in
the bloodstream,
enhances your
brain's use of glucose
ALDOSTERONE and increases the
MINERALOCORTICOID
availability of
substances that
repair tissues.
❑ Cortisol also curbs
•Na RETENTION CORTISOL functions that would
•K EXCRETION Less potent than be nonessential or
aldosterone harmful in a
fight-or-flight
34
situation.
 PARATHYOID FUNCTION
PARATHYROID

PARATHYROID HORMONE

CALCIUM PHOSPHORUS

1. BONE RESORPTION,
2. CALCIUM ABSORPTION FROM INTESTINES
3. CALCIUM REABSORPTION FROM THE RENAL TUBULES

research and prepared by BATMAN 35

PARATHYROID HORMONE VS CALCITONIN
Other mechanism
Baroreceptor
Renin-angiotensin-aldosterone system
Adh and thirst
Osmoreceptor
Release of atrial natriuretic peptide
 BARORECEPTORS SYMPATHETIC AND
PARASYMPATHETIC,
CHANGES IN PRESSURE WITHIN BLOOD VESSELS AND ENDOCRINE
REGULATION

CENTRAL NERVOUS SYSTEM

LOW PRESSURE HIGH PRESSURE

LEFT ATRIUM 1. NERVE ENDINGS OF HIGH PRESSURE AFFERENT

THE AORTIC ARCH ARTERIOLE OF THE
2. CARDIAC SINUSES JUXTAGLOMERULAR APPARATUS OF
ARTERIAL THE NEPHRON
PRESSURE
BARORECEPTOR
ALDOSTERONE CARDIAC RATE
RELEASED CONSTRICT CONDUCTION
STIMULATES
RENAL CONTRACTILITY
SYMPATHETIC
ARTERIOLE BLD VOLUME
NERVOUS SYSTEM
research and prepared by BATMAN 38
 RENIN- ANGIOTENSIN- ALDOSTERONE
SYSTEM
BLOOD FLOW/ PRESSURE
JUXTAGLOMERULAR
Inactive(liver) ANGIOTENSINOGEN CELLS OF THE
KIDNEYS
RENIN

In response to ANGIOTENSIN 1
increase renin ACE
ADRENAL NEPHRON
ANGIOTENSIN II
CORTEX Potent vasoconstrictor

RESTORE BLOOD Na AND WATER

ALDOSTERONE RETENTION
VOLUME
K=increase
Na=decrease
Adrenocorticotropic
BLOOD FLOW AND PRESSURE
hormone increase research and prepared by BATMAN 40
THIRST
 ANTIDIURETIC HORMONE
Functions:
❑ Retention of water by the kidney:
❑ The principal physiologic effect of ADH is the retention of water by the kidney by stimulating reabsorption
of water by the distal convoluted and collecting renal tubules.
❑ Effect on blood vessels and blood pressure: It increases the blood pressure due to the contraction of the
blood vessels, arterioles, and capillaries.
❑ Effect on heart: It increases the blood pressure.
❑ Muscle contraction: It causes the contraction of a smooth muscle-like ureter, urinary bladder, intestine,
etc.
❑ On respiration: Hyperpnoea with occasional apnea. This is due to changes in blood pressure with reflex
acts on the respiratory center.
❑ Metabolic effect: ADH produces glycogenolysis (in the liver), hyperglycemia, and glycosuria. Sugar
tolerance is reduced. The effect is only a secondary one.
❑ Neurotransmitter: It is NT in the brain and spinal cord.
❑ Tropic action: It increases ACTH secretion from the anterior pituitary gland by its action on V3 receptor,
(V18).
 ANTIDIURETIC HORMONE
REGULATES WATER EXCRETION FROM THE KIDNEYS

INCREASED OSMOLALITY OTHER FACTORS THAT AFFECT

THE PRODUCTION AND THE
ADH IS PRODUCED RELEASE OF ADH:
•BLOOD VOLUME
INCREASE PERMEABILITY •TEMPERATURE
TO WATER •PAIN
•STRESS
•OPIATES
MORE WATER IS ABSORBED IN THE •BARBITURATES
BLOOD •NICOTENE

DECREASED URINE
OUTPUT

DECREASED OSMOLALITY(diluted urine)

research and prepared by BATMAN 44

ANTIDIURETIC HORMONE
OSMORECEPTORS
CHANGES IN Na CONCENTRATION

HYPOTHALAMUS

OSMORECEPTORS

NEURONS DEHYDRATED

POSTERIOR PITUITARY; AWARE

Increase
reabsorption of
RELEASED OF ADH
water and
decrease urine
output
research and prepared by BATMAN 46
 OSMORECEPTORS

Osmoreceptor
❑ sensory receptor
primarily found in the
hypothalamus of most
homeothermic
organisms that detects
changes in osmotic
pressure.
 ATRIAL NATRIURETIC FACTORS
Oppposite to BLOOD VOLUME
renin-aldosterone
angiotensin system;
decrease blood volume
CELLS OF THE ATRIUM

NEPHRON ANP

POTENT DIURETIC STRETCHING ATRIAL WALLS INHIBITS

THIRST

Na WASTING
Pituitary gland releases ADH FLUID
VASCULAR INTAKE
VOLUME
research and prepared by BATMAN 48
ATRIAL NATRIURETIC FACTORS
REGULATING ELECTROLYTES
There are three hormones that play key roles
in regulating fluid and electrolyte balance:
1. antidiuretic hormone, released from the
posterior pituitary;
2. aldosterone, secreted from the adrenal cortex;
and
3. atrial natriuretic peptide, produced by the
heart.
IMPORTANCE
1. MAINTAINING FLUID BALANCE
2. CONTRIBUTING TO ACID BASE REGULATION
3. FACILITATING ENZYME REACTION
4. NEUROMUSCULAR REACTION

Na / Cl - NOT STORED IN THE BODY

K / Ca - STORED IN CELLS/ BONE, RESPECTIVELY
 IV Fluid Replacement
❑ Isotonic fluids (approximate normal serum plasma) that have the same
concentration of solutes as blood plasma.
❑ Rapid ECF expansion needed
❑ D5W, NS, LR
❑ Hypotonic fluids: lesser concentration of solutes than plasma
❑ Treatment of cellular dehydration
❑ 0.45% NS,0.2% NS, 2.5% dextrose
❑ Hypertonic: greater concentration of solutes than plasma
❑ Treatment of water intoxication
❑ D5 ½ NS, D10W, 3% NS
❑ Shifts fluids from ICF & ECF to intravascular component – expands blood
volume
❑ Now can be removed by kidneys
research and prepared by BATMAN 53
EFFECTS OF THE FLUIDS IN THE CELL
HYPERTONIC ISOTONIC HYPOTONIC

BEFORE CELL CELL CELL

AFTER CELL CELL

research and prepared by BATMAN 54

 IV solutions classified based on their
purpose
❑ Nutrient solutions
❑ contain dextrose, glucose, and levulose to make up the carbohydrate component – and water
❑ D5W, D5NSS.
❑ Electrolyte solutions
❑ contains varying amounts of cations and anions that are used to replace fluid and electrolytes for
clients with continuing losses
❑ 0.9 NaCl, Ringer’s Solution, and LRS
❑ Alkalinizing solutions
❑ administered to treat metabolic acidosis
❑ LRS
❑ Acidifying solutions
❑ used to counteract metabolic alkalosis
❑ D51/2NS, 0.9 NaCl
❑ Volume expanders
❑ solutions used to increase the blood volume after a severe blood loss, or loss of plasma
❑ dextran, human albumin, and plasma
Crystalloids
❑ contain small molecules that flow easily across semipermeable
membranes.
❑ They are categorized according to their relative tonicity in relation to
plasma.
❑ There are three types:
❑ isotonic
❑ hypotonic
❑ hypertonic
 ISOTONIC SOLUTION
❑ 0.9% NaCl (Normal Saline Solution, NSS)
❑ It is administered to correct extracellular fluid volume deficit because it remains within the
ECF.
❑ Dextrose 5% in Water (D5W)
❑ . It is administered to supply water and to correct an increase in serum osmolality.
❑ Lactated Ringer’s 5% Dextrose in Water (D5LRS)
❑ It is the most physiologically adaptable fluid because its electrolyte content is most closely
related to the composition of the body’s blood serum and plasma.
❑ used to correct dehydration, sodium depletion, and replace GI tract fluid losses.
❑ It can also be used in fluid losses due to burns, fistula drainage, and trauma.
❑ It is the choice for first-line fluid resuscitation for certain patients.
❑ It is often administered to patients with metabolic acidosis.
❑ Ringer’s Solution
❑ Indications are the same for Lactated Ringer’s but without the contraindications related to
lactate.
 Nursing Considerations for Isotonic
Solutions
❑ Document baseline data
❑ Observe for signs of fluid overload
❑ Monitor manifestations of continued hypovolemia
❑ Prevent hypervolemia
❑ Elevate the head of the bed at 35 to 45 degrees
❑ Elevate the patient’s legs
❑ Educate patients and families
❑ Close monitoring for patients with heart failure
 Hypotonic Solution
❑ 0.45% Sodium Chloride (0.45% NaCl)
❑ used to treat hypernatremia and other hyperosmolar conditions
❑ 0.33% Sodium Chloride (0.33% NaCl)
❑ is used to allow kidneys to retain the needed amounts of water and is typically
administered with dextrose to increase tonicity
❑ 0.225% Sodium Chloride (0.225% NaCl)
❑ used as a maintenance fluid for pediatric patients as it is the most hypotonic IV fluid
available at 77 mOsm/L.
❑ Used together with dextrose.
❑ 2.5% Dextrose in Water (D2.5W)
❑ used to treat dehydration and decreased the levels of sodium and potassium
❑ It should not be administered with blood products as it can cause hemolysis of red blood
cells.
Nursing Considerations for Hypotonic Solutions
❑Document baseline data
❑Do not administer in contraindicated conditions
❑Risk for increased intracranial pressure (IICP)
❑Monitor for manifestations of fluid volume deficit
❑Warning on excessive infusion
❑Do not administer along with blood products
 HYPERTONIC SOLUTION
❑ Hypertonic Sodium Chloride IV Fluids
❑ are used in the acute treatment of sodium deficiency (severe hyponatremia) and should be used
only in critical situations to treat hyponatremia
❑ also used in patients with cerebral edema.
❑ 3% sodium chloride (3% NaCl)
❑ 5% sodium chloride (5% NaCl)
❑ Hypertonic Dextrose Solutions
❑ used to provide kilocalories for the patient in the short term
❑ Dextrose 10% in Water (D10W)
❑ used in the treatment of ketosis of starvation and provides calories (380 kcal/L), free water, and no
electrolytes
❑ Dextrose 20% in Water (D20W)
❑ osmotic diuretic that causes fluid shifts between various compartments to promote diuresis.
❑ Dextrose 50% in Water (D50W)
❑ used to treat severe hypoglycemia and is administered rapidly via IV bolus
Nursing Considerations for Hypertonic Solutions
❑ Document baseline data
❑ Watch for signs of hypervolemia
❑ Monitor and observe the patient during administration
❑ Verify order
❑ Assess health history
❑ Prevent fluid overload
❑ Do not administer peripherally
❑ Monitor blood glucose closely
COLLOIDS
❑ contain large molecules that do not pass through semipermeable
membranes.
❑ contain solutes of high molecular weight, technically, they are
hypertonic solutions, which when infused, exert an osmotic pull of
fluids from interstitial and extracellular spaces.
❑ useful for expanding the intravascular volume and raising blood
pressure.
❑ indicated for patients in malnourished states and patients who cannot
tolerate large infusions of fluid
COLLOIDS
❑ Human Albumin
❑ 5% Albumin
❑ used to increase the circulating volume and restore protein levels in conditions such
as burns, pancreatitis, and plasma loss through trauma
❑ 25% Albumin
❑ used together with sodium and water restriction to reduce excessive edema
❑ are considered blood transfusion products and uses the same protocols and nursing
precautions when administering albumin
COLLOIDS
❑ Dextrans
❑ Low-molecular-weight Dextrans (LMWD)
❑ used to improve the microcirculation in patients with poor peripheral circulation
❑ contain no electrolytes and are used to treat shock related to vascular volume loss (e.g.,
burns, hemorrhage, trauma, or surgery)
❑ Dextran 40
❑ High-molecular-weight Dextrans (HMWD)
❑ used for patients with hypovolemia and hypotension
❑ contraindicated in patients with hemorrhagic shock
❑ Dextran 70, Dextran 75
COLLOIDS
❑ Etherified Starch
❑ are used to increase intravascular fluid but can interfere with normal coagulation
❑ Eg: EloHAES, HyperHAES, and Voluven
❑ Gelatin
❑ have lower molecular weight than dextrans and therefore remain in the circulation
for a shorter period of time
❑ Eg: Gelofusine
❑ Plasma Protein Fraction (PPF)
❑ solution that is also prepared from plasma, and like albumin, is heated before
infusion
❑ recommended to infuse slowly to increase circulating volume.
❑ Eg: Plasma Plex, Plasmanate, Plasmatein, and Protenate
Nursing Considerations for Colloid Solutions
❑ Assess allergy history
❑ Use a large-bore needle (18-gauge)
❑ Document baseline data
❑ Monitor the patient’s response
❑ Monitor coagulation indexes
Fluid volume deficit
(HYPOVOLEMIA)
CAUSES
❑ VOMITING
❑ DIARRHEA
❑ GI SUCTIONING
❑ SWEATING
❑ DECREASE INTAKE
❑ NAUSEA OR INABILITY TO GAIN ACCESS TO FLUIDS
CAUSES
❑No water (hypertonic) -profuse sweating,
hyperventilation, fevers, diarrhea, renal failure, DI
❑No salt (hypotonic) -water intoxication, chronic illness,
malnutrition, renal failure
❑Both (isotonic) -NPO, poor intake, hemorrhage
 RISK FACTORS
• DIABETES INSIPIDUS- pituitary gland increase thirst and excreting large amount of urine
• ADRENAL INSUFFICIENCY- glucocorticoid, mineralocorticoid and androgenic hormone
• OSMOTIC DIURESIS- increase in urine
• HEMORRHAGE- increase in bleeding
• COMA
• THIRD SPACE FLUID SHIFTS, OR THE MOVEMENT OF FLUID FROM VASCULAR
SYSTEM TO OTHER BODY SPACES( EDEMA FORMATION IN BURNS AND ASCITIS
WITH LIVER FUNCTION)
 Signs and Symptoms
• Acute weight loss
• Decreased skin turgor
• Oliguria
• Concentrated urine
• Weak, rapid pulse
• Capillary filling time elongated
• Decreased BP
• Increased pulse
• Sensations of thirst, weakness,
dizziness, muscle cramps
Hypo= BP
Tachy= cardiac
Tachy= respiratory rate
 LABORATORY
❑ Increased HCT (For men, 38.3 to 48.6%; For women, 35.5 to 44.9 %)
❑ THE RED BLOOD CELLS BECOME SUSPENDED IN A DECREASE PLASMA VOLUME
❑ Increased BUN (7 to 20 mg/dL)
❑ DUE TO HYDRATION OR DECREASE RENAL PERFUSION AND FUNCTION
❑ SERUM ELECTROLYTE CHANGES
❑ HYPOKALEMIA- GI AND RENAL LOSSES
❑ HYPER KALEMIA- ADRENAL INSUFFICIENCY
❑ HYPONATREMIA- INCREASE THIRST AND ADH RELEASE
❑ HYPERNATREMIA- RESULT FROM INCREASE INSENSIBLE LOSSES AND DIABETES
INSIPIDUS
❑ URINE specific gravity INCREASE(1.005 to 1.030)
❑ Decreased urine volume, dark color
 DIAGNOSTIC findings
HYPOKALEMIA GI AND RENAL LOSSES

HYPERKALEMIA ADRENAL INSUFFICIENCY

HYPONATREMIA INCREASE THIRST AND ADH RELEASE

HYPERNATREMIA INCRESEASED INSENSIBLE LOSSESS AND

DIABETES INSIPIDUS

URINE SPECIFIC GRAVITY INCREASED

 GERIATRICS CONSIDERATION

❑SKINTURGOR- OVER THE FOREHEAD AND STERNUM

❑MENTALLY ILL PERSON
❑ABLE TO AMBULATE AND USE OF BOTH ARMS TO REACH
❑PATIENT IS ABLE TO SWALLOW
❑RESTRICTION OF FLUIDS- INCONTINENCE
 MEDICAL MANAGEMENT
❑ MILD- ENCOURAGE TO DRINK ORALLY
❑ ACUTE-SEVERE
❑ IV ROUTE- ISOTONIC SOLUTION (LACTATED RINGER’S SOLUTION OR 0.9% SODIUM
CHLORIDE) TO TREAT HYPOTENSIVE PATIENT WITH FVD-EXPAND PLASMA
VOLUME
❑ NORMOTENSIVE- HYPOTONIC SOLUTION (0.45% SODIUM CHLORIDE) BOTH
ELECTROLYTES AND WATER
❑ PRERENAL AZOTEMIA- REDUCED RENAL BLOOD FLOW 2NDARY TO FVD
❑ CHALLENGE TEST- ADMINISTERING 100-200ML NSS OVER 15 MINUTES- ATTAIN
ADEQUATE TISSUE PERFUSION W/O COMPROMISING CARDIOVASCULAR SYSTEM-
IN RESPONSE INCREASE URINE OUTPUT; INCRESE BLOOD PRESSURE AND
CENTRAL VENOUS PRESSURE.
NURSING MANAGEMENT
❑MONITORS AND MEASURE
FLUID INTAKE AND OUTPUT
❑DAILY BODY WEIGHT
❑VITAL SIGNS MONITORING
❑ASSESS FOR SKIN OR
TONGUE TURGOR
❑MEASURING URINE
SPECIFIC GRAVITY
Fluid volume EXCESS
(HYPERVOLEMIA)
 HYPERVOLEMIA
Na

Na INTRACELLULAR Na

Na
SIGNS AND SYMPTOMS
• EDEMA
• DISTENDED NECK VEINS
• CRACKLES
• TACHYCARDIA
• INCREASE BLOOD PRESSURE
• INCREASE PULSE PRESSURE
• INCREASE VENOUS PRESSURE
• INCREASE URINE OUTPUT
• SHORTNESS OF BREATHING
AND WHEEZING
 CAUSES
❑ HEART FAILURE
❑ inability to pump/ inadequate blood pressure (cardiac patients)
❑ RENAL FAILURE
❑ diminished urine output (renal patients)
❑ CIRRHOSIS OF THE LIVER
❑ long term corticosteriod therapy (sodium and fluid retention)
❑ water intoxication via ocd or obsessive compulsive disorder
❑ medications can cause excessive thirst
❑ ADDITIONAL
❑ CONSUMPTION OF EXCESSIVE AMOUNT OF TABLE SALT
❑ IMPAIRED REGULATORY MECHANISM
❑ excess ADH antidiuretic hormone (water reabsorption into blood) -can be due
to head injury (ADH secretion controlled by the pituitary gland)
❑ EXCESSIVE ADMINISTRATION OF SODIUM CONTAINING FLUIDS
 CAUSES
❑hypervolemia (isotonic)
❑Too much IV fluid, kidney failure, corticosteroids
❑water intoxication (hypotonic)
❑SIADH, IV fluids, psych problems, wound irrigation
❑too much sodium intake (hypertonic)
❑Too much salt, 3%saline IV, too much Na. HCO 3
LABORATORY
❑ DECREASE HCT
❑ THE RED BLOOD CELLS CAN INCREASE
PLASMA VOLUME
❑ DECREASE BUN
❑ PLASMA DILUTION
❑ SERUM Na
❑ URINE specific gravity DECREASE
❑ CHEST E-RAYS
❑ INCREASE urine volume, COLORLESS
 PHARMACOLOGICAL THERAPY
❑PHARMACOLOGIC THERAPY
❑HEMOLDIALYSIS
❑NUTRITIONAL THERAPY
 MEDICAL MANAGEMENT
❑DISCONTINUING THE SOLUTION
IF THE CAUSE IS THE EXCESSIVE
ADMINISTRATION OF SODIUM
CONTAINING FLUIDS
❑SYMPTOMATIC
❑ADMINISTERING DIURETICS
❑RESTRICTING FLUIDS AND
SODIUM
NURSING MANAGEMENT
• MONITORS AND MEASURE FLUID
INTAKE AND OUT PUT
• DAILY BODY WEIGHT
• VITAL SIGNS MONITORING
• ASSESS FOR EDEMA
• MEASURING URINE SPECIFIC
GRAVITY
• MAINTAING THE DIET
• HEALTH TEACHING