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King Saud University
College of Nursing
Medical Surgical Department
Application of Adult Health Nursing Skills
( NUR 317 )
Care for patients with fluid and electrolytes
imbalance
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Fluid and Electrolytes Imbalance Cheat Sheet, Cheat Sheet of Personal Health
Have a look at tables in care for patients with fluid and electrolytes imbalance
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2020/2021
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King Saud University
College of Nursing
Medical Surgical Department
Application of Adult Health Nursing Skills
( NUR 317 )
Care for patients with fluid and electrolytes
imbalance
Outline of lecture;
Introduction Fluid and electrolytes balance
Fluid and electrolytes imbalance Assessment of Edema, Dehydration
Measuring intake and output IVF ( intravenous fluids)
Sodium (Na)
Normal rang: 135-145 mEq/L
Causes of elevation (Hypernatremia) Causes of decline (Hyponatremia)
Water loss, inadequate water intake, excessive sodium intake, Diabetes Insipidus (DI), certain diuretics, corticosteroid use, antihypertensive drug.
Inadequate sodium intake, Excessive water gain caused by inappropriate administration of I.V. solutions, heart and renal failure, cirrhosis, laxatives, nasogastric suctioning, Medications such as antidiabetics, diuretics. Signs/Symptoms Signs/Symptoms
Thirst, dry sticky mucous membranes; Restlessness, disorientation, Muscle weakness and irritability
Confusion Orthostatic hypotension Nausea, vomiting Weight gain, Edema Muscle spasms, convulsions Nursing Intervention Nursing Intervention Identify patients at risk for hypernatremia. Assess the patient for fluid losses. Assess the patient for signs and symptoms ofhypernatremia. Consult with a nutritionist to determine Encourage the patient to increase his fluidintake but decrease his sodium intake. Teach the patient and his family how to prevent,recognize, and treat hypernatremia
Identify patients at risk for hyponatremia. Assess fluid intake and output. Assess the patient for signs and symptoms ofhyponatremia. Restrict fluid intake. Administerisotonic I.V. fluids. that ensure appropriate fluid and sodium intake.
Potassium ( K) Normal Level 3.5 - 5 mEq/L
Causes of elevation (Hyperkalemia) Causes of decline (Hypokalemia)
High potassium intake related to the improper use of oral supplements, excessive use of salt substitutes, or rapid infusion of potassium solutions.
GI losses from diarrhea, laxative abuse, prolonged gastric suctioning, prolonged vomiting.
Signs/Symptoms Signs/Symptoms
arrhythmias, decreased strength of contraction,and cardiac arrest Nausea, vomiting, diarrhea, intestinal colic, uremic enteritis, decreased bowel sounds, abdominal distention.
fatigue, muscle weakness orthostatic hypotension cardiac arrest Suppressed insulin release and aldosterone secretion Respiratory muscle weakness slightly elevated glucose level Nursing Intervention Nursing Intervention
Identify patients at risk for hyperkalemia. Assess for signs and symptoms of hyperkalemia. Have emergency equipment available. Administer calcium gluconate to decrease myocardial irritability. Administer insulin and I.V. glucose to move potassium back into cells. Carefully monitor serum glucose levels. Administer sodium polystyrene sulfonate (Kayexalate) with 70% sorbitol to exchange sodium ions for
potassium ions in the intestine
Identify patients at risk for hypokalemia. Assess the patient’s diet for a lack of potassium. Assess the patient for signs and symptoms of hypokalemia. Administer a potassium replacement asprescribed. Encourage intake of high-potassium foods,such as bananas, dried fruit, and orange juice. Monitor the patient for complications. Have emergency equipment available for cardiopulmonary resuscitation and cardiac defibrillation.
Calcium Normal Level 4.5 – 5.5 mEq/L Causes of elevation (hypercalcemia) Causes of decline (hypocalcemia)
Metastatic bone cancer, hyperparathyroidism,High calcium intake, Hyperthyroidism or hypothyroidism
acute pancreatitis, inadequate dietary intake of vitamin D, longterm use of laxatives, thyroid carcinoma, loop diuretics. Signs/Symptoms Signs/Symptoms Muscle weakness and lack of coordination Anorexia, constipation, abdominal pain, nausea, vomiting, peptic ulcers, and abdominal distention Confusion, impaired memory,slurred speech, and coma Cardiac arrest
Tingling around the mouth and in the fingertips and feet, numbness, painful muscle spasms. Positive Chvostek’s signs or Positive trousseau's sings Seizures confusion, and hallucinations Skeletal fractures resulting from osteoporosis
Nursing Intervention Nursing Intervention Assess the patient for signs and symptoms of hypercalcemia. Encourage ambulation. Move the patient carefully to prevent fractures. Administer phosphate to inhibit GI absorption of calcium. Administer a loop diuretic to promote calcium excretion. Reduce dietary calcium.
Assess the patient for signs and symptoms of hypocalcemia, especially changes in cardiovascular and neurologic status and in vital signs. Administer I.V. calcium as prescribed. Administer a phosphate-binding antacid. Take seizure or emergency precautions as needed. Encourage the patient to increase his intake of foods that are rich in calcium and vitamin D.
Magnesium ( Mg)
Normal level 1.5 - 2.5 mEq/L
Causes of elevation ( Hypermagnesemia ) Causes of decline ( Hypomagnesemia )
Renal failure, adrenal insufficiency, or diuretic abuse Excessive magnesium replacement or excessive use of milk of magnesia.
malnutrition, malabsorption anorexia, intestinal bypass for obesity, diarrhea, diuretics or antibiotics, such as gentamicin, Overdose of vitamin D or calcium, burns, pancreatitis, or diabetic ketoacidosis Signs/Symptoms Signs/Symptoms
Peripheral vasodilation with decreased blood pressure, Facial flushing and sensations of warmth and thirst Lethargy or drowsiness, apnea, and coma Loss of deep tendon reflexes, paresis. Cardiac arrest
Muscle weakness, tremors, Seizure. Decreased blood pressure, ventricular fibrillation, tachyarrhythmias, depression, agitation, confusion, and hallucinations Nausea, vomiting, and anorexia Decreased calcium level
Nursing Intervention Nursing Intervention
Review all medications for a patient with renal failure. Assess the patient for signs and symptoms of hypermagnesemia. Assess reflexes; if absent, notify the practitioner. Administer calcium gluconate.
Assess the patient for signs and symptoms of hypomagnesemia. Administer I.V. magnesium as prescribed. Encourage the patient to consume magnesium-rich foods.
Fluid Volume Deficit (Hypovolemia) Fluid Volume Excess (Hypervolemia )
Signs/Symptoms;
Mild Fluid Loss:
Orthostatic hypotension, Increased heart rate
Restlessness, anxiety
Weight loss
Moderate Fluid Loss:
Confusion, dizziness, irritability
Extreme thirst
Nausea -Cool, clammy skin
Rapid Pulse
Decreased urine output (10-30 ml/hr)
Severe Fluid Loss:
Decreased cardiac output
Unconsciousness
Hypotension
Weak or absent peripheral pulses
Signs/Symptoms;
Tachypnea ,Dyspnea, crackles
Rapid or bounding pulse
Hypertension (unless in heart failure)
Distended neck and hand veins
Acute weight gain
Edema
Pulmonary edema
- Dyspnea
-Orthopnea (diff. breathing when supine)
-crackles
Assessing fluid balance
There are three elements to assessing fluid balance and hydration status:
Review of fluid balance charts; Clinical assessment; Review of blood chemistry.
1 - Review of fluid balance charts; Fluid balance means the amount of fluid intake equal the amount of fluid excreted. Intake include; water, juice, tea and coffe, IV fluid , NG feeding Output include; urine, emesis, NG drainage, and blood drainage. Record all fluid intake in the sheet and calculate the total at the end of each shift Record all fluid output remember if patients on urine catheter each shift empty urine from catheter. IF Intake ( I ) more than Output (O) look for signs of edema IF Intake ( I ) less than Output (O) look for signs of dehydration
2 - Nursing assessment for dehydration
Observations Vital signs, such as pulse, blood pressure and respiratory rate, will change when a patient becomes dehydrated
Skin elasticity The elasticity of skin, or turgor, is an indicator of fluid status in most patients. However, this assessment can be an unreliable indicator of dehydration in older people as skin elasticity reduces with age
2 - Nursing assessment for edema
Medical treatment
Treatment involves determining the cause (such as diarrhea or decreased fluid intake) and replacing lost fluids either orally or I.V.
Most patients receive hypotonic, low sodium fluids such as dextrose 5% in water (D5W).
Medical treatment
Treatment involves determining the cause and treating the underlying condition.
Typically, patients require fluid and sodium restrictions Diuretics therapy may be ordered if renal failure is not the cause.
I.V. fluid replacement
The doctor may order I.V. fluid to maintain or restore fluid balance. I.V. fluid replacement fall into the broad categories of crystalloids and colloids;
A. Colloids - contain larger insoluble molecules (blood, albumin, plasma) used to increase the blood volume following severe loss of blood (haemorrhage) or loss of plasma ( severe burns).
B. Crystalloids – contains aqueous solutions of mineral salts or other water-soluble molecules ( salts and sugar.) to correct body fluids and electrolyte deficit
Isotonic
A solution that has the same salt concentration as the normal cells of the body and the blood.
Examples:
Ringer Lactate. 0.9% NaCl (0.9% NSS ) D5W. Normal saline same tonicity as body
Indication: Hypotension (increases BP), Hypovolemia Complications of Isotonic IV fluid overload
- Infiltration; fluid may leak from the vein into surrounding Tissue, If you see infiltration,
stop the infusion, elevate the extremity, and apply warm soaks.
- Infection ; Adhering to aseptic technique is vital in the prevention of intravenous related
infections. Swab the site for culture and remove the catheter as ordered.
- Anaphylaxis/ Allergic reactions (Itching, rash, shortness of breath)
What the Nurse should do?
- STOP INFUSION and treat as indicated by Pharmacy, Medication package insert or drug reference book.
- Notify MD and document