2a FE, ABG - Paul Biluan

8/3/2019 2a FE, ABG - Paul Biluan

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FLUIDS AND

ELECTROLYTESChristian Paul S. BiluanRN,USRN,MANc


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FLUID SPACES

Intracellular Extracellular

Intravascular Interstitial Transcellular does not

participate in homeostasis

HOMEOSTASIS balance andequilibrium of fluids andelectrolytes


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Osmosis

Diffusion

Active Transport

Filtration

F/E TRANSPORT


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OSMOSIS fluid movement from lowerto higher concentration


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DIFFUSION solute movement fromhigher to lower concentration


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ACTIVE TRANSPORT ion movementfrom lower to higher concentration


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FILTRATION movement of fluidsand solutes by hydrostaticpressure


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Isotonic Solutions PNSS,D5W, PLR

Hypotonic Solutions 0.45NaCl, 0.3NaCl

Hypertonic Solutions D10W, D5NSS, D5LR

IV SOLUTIONS


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INTAKE Oral Liquids

1300ml Water in food

1000ml Water

produced bymetabolism

300ml

Total 2600ml

OUTPUT Urine

1500ml Stool 200ml

Skin 600ml Lungs 300ml

Total 2600ml

AVERAGE DAILY I/O


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Kidney filters andregulates f/e retention andexcretion

Aldosterone causessodium and water retentionand potassium loss

ADH causes reabsorptionof water

HOMEOSTASIS


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FLUID IMBALANCES


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Dehydration occurs whenthe fluid intake of the bodyis not sufficient to meet the

fluid needs of the body

Goal of treatment: restore fluid volume replace electrolytes eliminate the cause of

FVD.

FLUID VOLUME DEFICIT


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ASSESSMENTS INCREASED PR, RR DECREASED BP, LOC, Temp,

UO, Peristalsis

Increased urinary specificgravity

Dry, Poor skin turgor Thirst Decreased body weight Decreased GI motility and

bowel sounds.


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LABORATORY FINDINGS Increased serum osmolality Increased hematocrit

Increased blood ureanitrogen(BUN) level

Increased serum sodiumlevel.


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INTERVENTIONS Initiate IVF Increase OFI Monitor

VS NVS Input/Output Electrolyte levels Weight.


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Description Fluid intake or fluid

retention exceeds the fluid

needs of the body Fluid volume excess is also

called overhydration Goal of treatment:

restore fluid balance correct electrolyte

imbalance

eliminate or control the

FLUID VOLUME EXCESS


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ASSESSMENTS

INCREASED BP, PR, RR, UO,Peristalsis

Distended neck and handveins

Elevated central venous

pressure Moist crackles upon

auscultation Headache, LOC Changes,

Visual Disturbances Skeletal muscle weakness Paresthesias

Pitting edema in dependent


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LABORATORY FINDINGS Decreased serum osmolality Decreased hematocrit

Decreased BUN level Decreased serum sodium

level Decreased urine specific

gravity.


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INTERVENTIONS Prevent further fluid

overload, and restorenormal fluid balance

Administer diuretics Restrict fluid and sodium

intake Monitor

VS NVS Input/Output Electrolyte levels Weight


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ELECTROYTEIMBALANCES


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SODIUM (Na)

135-145 mEq/L

Controls ECF osmotic

pressure Necessary for

neuromuscular functioning Determines intracellular

reactions Maintains acid base balance


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HYPONATREMIA

ETIOLOGY tx with diuretics Na restriction GI loss decreased aldosterone third space loss diaphoresis


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ASSESSMENT Generalized skeletal muscle

weakness Diminished DTR Headache

Confusion, LOC Changes Seizures Increased motility and

hyperactive bowel sounds Abdominal cramping and

diarrhea Decreased urinary specific

gravity


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MANAGEMENT IVF 0.9 NaCl/IV Replace other electrolytes

as needed Salty foods in diet Safety precaution.


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ETIOLOGY Hyperventilation high Na intake

salt tablets rapid saline infusion water deprivation

diarrhea

HYPERNATREMIA


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ASSESSMENT Early: spontaneous muscle

twitches, irregular musclecontractions

Late: skeletal muscleweakness, deep tendon

reflexes diminished orabsent LOC Changes Increased urinary specific

gravity Decreased urinary output Dry skin, dry sticky buccal

mucosa


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MANAGEMENT Restrict Na in diet Monitor I & O and

behavioral changes Increase oral fluids or

D5W/IV Diuretics Dialysis


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3.5-5.1 mEq/L

Excitability of nerves and

muscles ICF osmotic pressure Maintains acid-base balance

K deficit:alkalosis K excess: acidosis

POTASSIUM (K+)


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ETIOLOGY

Decreases intake Increased loss Intracellular shift.

HYPOKALEMIA


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ASSESSMENT DTR, RR Thready, weak, irregular pulse Anxiety, lethargy, confusion,

coma Skeletal muscle weakness,

eventual flaccid paralysis N/V, constipation, abdominal

distention Decreased urinary specific

grav, Increased urinary output

ECG changes: ST depression,shallow, flat or inverted T-waves and rominent U wave.


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MANAGEMENT Potassium rich foods

Banana

dried fruits (raisins,prunes) orange raw carrot raw tomato baked potato Melon Watermelon

Potassium supplement Oral: K+ durule tab 1-3 tabs

daily KCl IV incorporation slow drip

K sparing diuretics


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ETIOLOGY Excess intake Retention of K

Extracellular shift.

HYPERKALEMIA


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ASSESSMENT Early: Muscle twitches,

cramps, paresthesia Late: profound weakness,

ascending flaccid paralysisin the arms and legs

BP, PR, RR Increased motility,

hyperactive bowel sounds,Diarrhea

ECG changes: Tall peakwaves, flat P waves,

widened QRS complexes androlon ed PR intervals


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MANAGEMENT Avoid K-rich foods Diuretic

10% glucose with regularinsulin/IV

Ca Gluconate Dialysis.


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4.5 5.8 mEq/L or 8.6 -10 mg/dL

2 types of Ca Ionized Plasma protein bound

Free Ionized Ca is needed for Blood coagulation

Muscle contraction Nerve function Bone and teeth formation

Vit D and PTH increases GI Ca

absorption

CALCIUM (K+)


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ETIOLOGY Decreased ionized Ca Inadequate intake

Excess loss Decreased bone and GI tract

absorption.

HYPOCALCEMIA


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ASSESSMENT

Irritable skeletal muscles:twitches, cramps, tetany, seizures

Irritability, Paresthesias,numbness

Positive Trosseaus andChvosteks sign

Hyperactive DTR Decreased heart rate,

Hypotension Increased gastric motility,

Hyperactive bowel sounds Abdominal cramping, diarrhea

ECG changes: Prolonged ST

interval, prolonged QT interval


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MANAGEMENT High Ca diet Ca gluconate, oral Ca salts

Phosphate binder (AL-OH) Monitor breathing

(laryngeal stridor) Seizure precaution


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ETIOLOGY Loss from bones -

immobilization

Excess intake Mobilization from bones

steroid.

HYPERCALCEMIA

SS SS


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ASSESSMENT Increased heart rate in the early

phase

Bradycardia in late phases Increased blood pressure Bounding, full peripheral pulses Profound muscle weakness

DTR, RR, PeristalsisDisorientation, lethargy or coma

Decreased motility andhypoactive bowel sounds

Increased urinary ooutput leadingto dehydration

Formation of renal calculi

ECG changes: Shortened ST


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MANAGEMENT Increase fluid intake (3-4

L/day), prevent urolithiasis

Acid-ash fruit juices (prune,cranberry), ascorbic acid

NSS/IV and diuretic Mithramycin reduces serum

Ca level Protect from injury to avoid

fracture


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1.5 2.5 mEq/L

ETIOLOGY

Decreased intake Impaired GI absorption Excessive excretion

HYPOMAGNESEMIA

ASSESSMENT


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ASSESSMENT Tachycardia, hypertension Shallow respirations DTR, Twitches,

paresthesias Positive Trousseaus and

Chvosteks signs Tetany, seizures Decreased motility,

decreased bowel sounds Irritability, Confusion

ECG changes: Tall T waves,

depressed ST segments


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MANAGEMENT Diet supplements: fruits,

green leafy vegetable,

whole grain cereals,meats, nuts, seafoods Mg salts oral/parenteral Promote safety,

prevention of injury Monitor for laryngeal

stridor.


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ETIOLOGY Renal failure Diabetic ketoacidosis

Frequent use ofmagnesium-containingantacids, cathartics

HYPERMAGNESEMIA


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ASSESSMENT Bradycardia, dysrhythmias,

Hypotension Respiratory insufficiency Diminished or absent deep

tendon reflexes

Skeletal muscle weakness Drowsiness and lethargy

that progresses to coma

ECG changes: Prolonged PRinterval, widened QRScomplexes


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MANAGEMENT Ca gluconate/IV Dialysis if with renal

failure Correct primary cause

HYPOPHOSPHATEMI


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2.5 4.5 mg/dL

ETIOLOGY

Hyperparathyroidism Hypercalcemia

HYPOPHOSPHATEMIA


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HYPERPHOSPHATEMI


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ETIOLOGY Hypoparathyroidism Hypocalcemia

ASSESSMENT Signs of hypocalcemia

HYPERPHOSPHATEMIA


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ACID-BASEIMBALANCES

ARTERIAL BLOOD


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Ph 7.35-7.45 PCO2 35 45 mmHg HCO3 22-26 mEq/L PaO2 80-100 mmHg SaO2 95-100%

ARTERIAL BLOODGASES


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To determine A/B imbalance

1. Check pH To determine acidity/alkalinity

1. Determine if Respiratory orMetabolic

Use ROME technique Respi CO2 Meta HCO3

2. Check for compensation FC if pH normalizes UC if no change in the other

indicator PC if the other indicator

fluctuates


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Exercise

Ph 7.34

PCO2 49

HCO3 26


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Exercise

Ph 7.50

PCO2 35

HCO3 30


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Exercise

Ph 7.36

PCO2 34

HCO3 15


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Exercise

Ph 7.38

PCO2 49

HCO3 22


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Exercise

Ph 7.48

PCO2 25

HCO3 28

2a FE, ABG - Paul Biluan

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