Fluid and electrolyte Acid-Base imbalance and its management
what is fluid and electrolyte imbalance
Excessive amount of fluid and electrolyte loss from the body due to diaphoresis (sweat) in the skin or burns etc.
Fluid and electrolyte imbalances occur in the body due to many reasons.
Fluid imbalance is an abnormality in the level of fluid in the body.
Fluid related complications are more common mainly in elderly people.
Excessive amount of dehydration or fluid overload is seen in the elderly.
Fluid volume imbalance is seen due to hypovolemia, hypervolemia.
Trauma is one of the main causes of any dehydration because trauma causes an excessive amount of fluid loss from the body and causes a condition of dehydration.
And another major cause of dehydration is excessive sweating from the body due to which the body fluid is reduced.
Due to continuous dehydration, the blood volume decreases, and the venous return also decreases and due to this the condition of hypo tension is produced.
The normal osmolarity of body fluid is 300 mol/liter (moles per liter).
If the osmolarity of a solution is the same as the osmolarity of the body fluid (300 mol/liter), then it is called an isotonic fluid.
(isotonic solutions:=osmolarity is equal to 300 mol/liter)
If the osmolarity of a fluid is greater than the body fluid osmolarity, it is called a hyper tonic solution.
(hypertonic solutions:=osmolarity is greater than 300 mol/ liter).
If the osmolarity of a fluid is less than that of the body fluid, it is hypotonic
(hypotonic solutions) are called solutions.
(hypotonic solutions:=
osmolarity is less than 300 mol/liter)
1) Explain the fluid volume deficit (hypervolemia).
2) Explain Etiology, Clinical manifestation, and diagnostic evaluation of hypervolemia. (Describe the causes of hypovolemia, its signs and symptoms, and diagnostic evaluation.)
3) Explain the management of hypo volemia. (Write management of hypovolemia.)
1) Explain the fluid volume deficit: When there is too much fluid loss from the body, the condition of dehydration occurs in the body.
Its sign for a normal person is that the person feels very thirsty.
If a person is not able to take food on their own, antidiuretic hormone is activated due to which osmotic pressure and extracellular fluid are regulated in the body.
The condition of dehydration occurs when the body does not have sufficient amount of fluid.
In this, if the same amount of fluid is excreted from the body, if the intake is not done, then the condition of dehydration or hypovolemia is produced in the body.
Etiology/cause of dehydration
The main reason is that more fluid is excreted from the body.
Staying on Nill per oral (NPO) for a long time.
Internal bleeding or hemorrhage.
Sweat profusely.
Ectopic pregnancy (ectopic pregnancy),
Due to taking any diuretic therapy.
Due to drainage from any hole.
diarrhea,
Gastrointestinal
suctioning,
vomiting,
If you have difficulty swallowing,
systemic infection,
renal failure,
fever,
Diabetic acidosis
burns,
Frequent enemas,
Ileostomy (opening in the ileum),
chronic illness,
cecostomy,
Low fluid intake.
Diabetes
Insipidus.
certain types of medicine,
Accident or trauma,
cirrhosis of liver,
Explain clinical manifestation/sign and symptoms.
very thirsty,
weight loss,
rapid, weak pulse,
low blood pressure,
decrease tear formation,
dry skin,
dry mucous membrane,
poor skin turgor,
increase body temperature,
decreased urine output,
dehydration,
dark urine,
Constipation,
dry mouth,
Changes in mental status,
weakness,
sunken eyeballs,
restlessness,
dry eyes,
decrease jugular venous pressure.
diagnostic evaluation
history taking and physical examination.
selection of blood urea nitrogen (BUN) level,
increase hematocrit level.
increase the specific gravity of urine greater than 1.030.
medical management
The main priority of a patient with dehydration is to replace fluid in his body
So providing intravenous fluid to the patient.
If the patient has suffered any kind of injury or trauma and is experiencing excessive fluid loss, applying pressure to the area where the blood is being lost can be applied to prevent excessive blood loss.
Administer isotonic fluid to the patient (ex: ringer lactate, 0.9% normal saline).
nursing management
assessment
Assess the patient for any signs and symptoms of dehydration.
Assessing the patient’s skin integrity.
Check the patient’s weight daily.
Intake and output of the patient should be done every eight hours.
To perform patient’s vital signs.
Assess the mucous membrane of the patient.
Assess the patient’s pulse and temperature.
Nursing diagnosis
1) Fluid volume deficit related to fluid loss or inadequate fluid intake.
2) Decrease cardiac output related to insufficient blood volume.
3) Impaired oral mucous membrane related to inadequate oral secretion.
4) ineffective tissue percussion related to insufficient blood volume.
5) Constipation related to decrease body fluid.
nursing interventions
To check the patient’s vital signs.
Ask the patient to increase fluid intake.
Checking the patient’s intake output.
If the patient is able to take fluids orally, provide fluids orally.
Ask the patient to take fluids little by little.
If patient is unable to intake fluid orally, provide fluid by parenteral route.
Provide fluid to patient like ringer lactate, 0.9 normal saline and dextrose 5% etc.
If the patient’s dehydration is due to severe diarrhea, provide the patient with antidiarrheal medicine.
If the patient has dehydration due to vomiting, give him anti-emetic medicine.
If the patient has any type of infection, provide antibiotic medicine.
Checking the patient’s level of consciousness like anxiety, restlessness, confusion etc.
Checking the patient’s skin integrity.
Changing the position of the patient every two hours.
If the patient has a mild amount of dehydration, the dehydration can be removed by providing treatment at home.
A patient with severe amount of dehydration requires immediate hospitalization.
complications
If dehydration is not treated immediately, the amount of blood in the body may decrease and due to this the function of the main organs of the body may also be altered.
Like brain, kidney, heart, these organs cannot function properly.
prevention
Instruct the patient to maintain proper fluid intake to prevent dehydration.
And if the patient is high such as an infant in high wrist, to take more fluid.
patient education
Provide health education to patients and their family members about the signs and symptoms of dehydration.
Ask the patient to intake adequate amount of fluid.
Provide health education to the patient or ingest frequent amounts of fluid.
Providing education to the patient that when doing excessive hard work, fluid intake should be done in between so that the condition of dehydration can be prevented.
Define hypervolemia
2) Explain Etiology, Clinical manifestation, and diagnostic evaluation of hypervolemia. (Describe the causes of hypervolemia, its clinical manifestations, and diagnostic tests.)
3) Explain the management of hypervolemia. Write the management of hypervolemia.
INTRODUCTION
Hypervolemia is called fluid overload or overhydration.
This is a condition in which a large amount of fluid collects in the body.
Due to fluid overload, many people have a lot of fluid in their body and due to this, the electrolyte and red blood cells become diluted.
A condition of hypervolemia occurs when the body’s sodium content and water content…
electrolyte balance
Electrolyte is such a charge.
that has a positive (+) or negative (-) charge and conducts electrical impulses.
In addition, there are solid substances in body fluid and water which dissolve in body fluid and blood and form solutes.
Some solutes are electrolytes and some solutes are non-electrolytes.
An electrolyte is a chemical that dissolves in water and conducts electricity.
Some of them are intracellular and some are extracellular.
Electrolyte is measured in (milliequivevalent/liter)meq/liter and Milliequivalents/dl.
There are two types of electrolyte
1) cation ( it has positive electric charge +),
2)anion (it has negative electric charge -) .
And they are dissolved in water.
Cation (positive charge electrolyte) are sodium,
Potassium,
magnesium,
And hydrogen ion.
Anion (negative charge) chloride,
Bicarbonate,
Phosphate,
Sulphate,
And protein ion.
Na+ is present in the extracellular fluid.
K+ is an intracellular fluid.
The body needs to have a proper balance of fluids and electrolytes.
Acid-base coordination is involved in muscle regulation, heart function,
Fluid absorption and excretion,
Maintains nerve function and concentration etc.
define electrolyte imbalance
Sodium, potassium and calcium play an important role in the transmission of nerve impulses.
If a substance increases or decreases from any of these substances, it causes muscle stimulation and causes imbalance.
sodium imbalance
Sodium imbalance occurs when the concentration of sodium in the plasma is increased or decreased.
Normal sodium concentration is 135 to 145 meq/liter.
1) Define sodium deficit (hyponatremia). Define hyponatremia
2) Explain etiology, clinical manifestation, and signs and symptoms of sodium deficiency. (Write the causes of sodium deficiency sheet, its clinical manifestations, and diagnostic evaluation)
3) Explain the management of hyponatremia. Write the management of hyponatremia
1) definition of hyponatremia.
Sodium is an extracellular electrolyte.
It plays an important role in water distribution.
Sodium plays an important role in muscle contraction and transmission of nerve impulses.
The normal concentration of sodium in the blood is 135 to 145 meq/liter.
Hyponatremia is a metabolic condition in which the level of sodium in the blood is lower than the normal sodium level.
(in hyponatremia sodium concentration is (less than )<135 meq/liter).
three types of hyponatremia:=
1) euvolemic hyponatremia. (euvolemic hyponatremia).
2) hypervolemic hyponatremia ( hypervolemic hypo natremia.
3) hypovomic hyponatremia ( hypovolemic hyponatremia ).
1)euvomic hyponatremia:=
The water content of this body increases.
But sodium level remains constant.
And this condition is caused by chronic heat condition, cancer and some medication.
2) hypervolemic hyponatremia. (hypervolemic hyponatremia)
Both water and sodium content increases in this body.
But the amount of water is more.
Too much water dilutes the sodium.
And lowers sodium levels.
This is mainly due to kidney failure, heart failure or liver failure.
3) Hypovolemic hyponatremia. (hypovolemic hyponatremia)
In this, the level of water and sodium from the body is reduced.
But sodium levels are lost more than water.
Etiology/cause
Due to drinking too much water during exercise.
Vomiting.
Hormonal imbalance.
Diarrhea.
(Due to reduced amount of thyroid)
Hypothyroidism.
syndrome of inappropriate antidiuretic hormone (SIADH).
g.i. biliary drainage.
Due to excessive thirst.
nothing by mouth (NPO).
lithium therapy.
Diuretic.
certain medicine like diuretic, anti depression, pain medication.
chronic or severe dehydration.
a low sodium. High water diet.
Cirrhosis of liver.
kidney failure.
kidney disease.
congestive heart failure (congestive heart failure).
burns.
age.
If a person is on a low sodium diet, they may develop hyponatremia.
Due to drinking too much water during exercise.
climate.
Clinical Manifestation (Signs and Symptoms)
headache,
muscles weakness.
feel tired
Restlessness.
irritation.
Decrease in interest.
Muscle twitching and weakness.
Tachycardia (increased heart rate more than 100 beats/min).
Nausea.
Vomiting.
Abdominal cramps.
Decreased urine output.
postural hypotension.
Loss of appetite.
mental confusion.
delirium.
coma.
shock.
Confusion.
to be startled
coma.
cellular swelling with cerebral edema leading to headache.
Diagnostic evaluation
history taking and physical examination.
serum electrolyte level ex:= sodium, potassium, chloride.
serum sodium <135 meq/liter.
decrease urine specific gravity.
decrease serum osmolarity.
Urine sodium >100 meq/24 hours.
medical management
Cancer is the cause of some hyponatremic conditions.
So providing radiation, chemotherapy, and surgery to remove it.
So sodium imbalance can be corrected.
If there is a condition of mild hyponatremia, it can be treated through diet, lifestyle, and medication.
If the condition is severe hyponatremia, treat the patient with electrolyte and fluid administration.
Administer a solution such as 0.9% normal saline fluid to the patient.
Provide steroid therapy to reduce intracranial swelling.
Checking patient’s intake output and daily weight check.
If the patient is lethargic, provide supplementary oxygen.
Provide IV fluid to the patient as needed.
nursing management
Taking a proper health history of the patient to find out the cause of the patient’s condition.
Ask the patient to take sodium rich food.
Provide education to patient to include sodium rich fluid in diet.
If the patient’s sodium level does not increase by 12 meq/liter in 24 hours, the patient should
Ringer’s lactate and isotonic solution to be administered intravenously.
Maintain intake output chart of patient every 24 hours.
Check the patient’s weight daily.
Administer hyper tonic normal saline to the patient.
If the patient has fluid restriction, ask the patient to take less fluid.
Checking the patient’s level of consciousness.
To see if the patient is in a state of confusion, lethargy or not.
Assess whether the patient is oriented to time, place and person.
Assess the patient’s deep tendon reflexes, muscle tone and strength.
prevention
Treating conditions that cause low sodium levels early.
To alert the person taking diuretic medicine for adverse signs and symptoms ex:= hyponatremia.
A person who exercises excessively should drink only as much water as needed, which is lost from the body through sweating, and should not drink more than one liter of water in an hour.
Ask the patient to take sodium rich food.
Ask the patient to drink plenty of water.
Tell the patient to drink enough water but to avoid fluid overload.
and asking the patient to take a sodium replacement diet.
1) Define sodium excess (hypernatremia).
2) Explain Etiology, Clinical manifestation, And diagnostic evaluation of hypernatremia. List the causes of hypernatremia, its signs and symptoms, and diagnostic evaluation.
3) Explain the management of hypernatremia. Write the management of hypernatraemia.
1) Definition of hypernatremia:=
Hyponatremia is an electrolyte imbalance.
In which the amount of sodium increases in the blood.
When the amount of fluid in our body is less and if salt is more,
And if the renal function is low, then the amount of sodium in the body increases.
The normal sodium level in the body is 135 to 145 meq/liter.
If the value of sodium in the body exceeds the normal value, it is called hypernatremia.
(in hypernatremia the level of sodium is (more than )>145 meq/liter).
Etiology/ cause
Due to loss of fluid from the body,
vomiting,
diarrhea,
sweating,
high fever,
dehydration,
Due to not drinking enough water,
Some types of drugs like steroids, licorice and certain blood pressure lowering drugs,
of some kind
Due to endocrine diseases such as diabetes and aldosteronism,
Due to excessive salt intake.
hyperventilation.
Due to excessive consumption of sodium bicarbonate.
uncontrolled diabetes.
Due to heavy exercise.
renal dysphagia.
obstructive uropathy.
osmotic diuretic.
clinical manifestation/sign and symptoms
feeling thirsty
Mucous membrane becoming dry and sticky.
restlessness and agitation.
Decreased urine output.
Weight loss.
Feeling weak.
The tissue becomes firm.
Disorientation.
dilutions and hallucinations.
Tachycardia.
Confusion and personality change.
Decreased level of consciousness.
Loss of appetite.
Nausea.
Vomiting.
Fluid and electrolyte imbalance.
Pulmonary oedema.
In a pitting eddy.
Abnormal skin turgor.
postural hypotension.
Difficulty breathing.
Diagnostic evaluation
history taking and physical examination.
serum electrolyte:=serum sodium level >145meq/liter.
Urinary sodium <40 meq/liter.
high serum osmolarity.
increase urine specific gravity.
management
Intravenously infuse a hypotonic electronic solution to the patient.
Asking the patient to have adequate water intake.
Provide diuretic medicine to the patient.
Maintaining patient’s intake output chart.
Monitor fluid loss or gain in patients who are at risk of increasing sodium levels in the body.
Maintain and assess intake output chart of patient.
Ask the patient to take a low sodium diet.
Noting the amount in which the patient feels good.
To see if the patient’s body temperature is elevated or not
To see whether the patient’s vital signs are altered or not.
To check the consciousness level of the patient.
Checking the patient for headache, nausea, vomiting and any changes in the patient’s vital signs.
Monitor patient’s intake output chart and assess sodium level.
If the patient is convulsing, lower the bed and raise the side rails above the bed.
Ask a patient who has diabetes incipitus to drink plenty of water.
Tell the patient to avoid sweet foods, shoalert tablets, sweet liquids and spot drinks.
Giving saint education or drinking a lot of water during exercise.
Tell the patient to drink plenty of water while taking diuretic medicine.
Assess whether the patient’s sodium level increases or decreases.
Maintain aseptic technique while providing intravenous fluid.
Careful monitoring of patients with flu or uncontrollable warming.
To condition hydration and prevent immediate hospital admission of a person who is vomiting profusely.
Checking whether the patient is oriented to time, place and person.
Providing reassurance to the patient.