Fluid and Electrolytes 2

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Passive Transport Mechanisms: 1. Osmosis
2. Filtration
3. Diffusion
Osmosis: -All body water moves through osmosis
-During osmosis SOLUTES (water) move from an area of lower SOLUTE (salt) concentration to higher solute concentration. This equalizes the strength of the solution on both sides.
Diffusion: Solutes move from an area of high solute concentration to low solute concentration
Filtration: Hydrostatic pressure moves water (and some solutes) together through the cell membrane.
Active Transport: -Sodium-Potassium pump is an example
***Main idea: Uses energy to equalize strength of solution on either side of the membrane
The young child: -Young children have a higher percentage of water than adults
-Organ immaturity in the young child will affect the metabolism of electrolytes
The older adult: -Older adults have a lower percentage of water than younger adults
-Decrease in organ function (bowel, kidneys) in the older adult will affect the metabolism and absorption of electrolytes
Illness and Medications: A Clientâ€™s chronic and acute illnesses will have an impact on fluid electrolyte balance -Diseases or medications that cause increased respirations (hyperventilation), decreased oral intake (anorexia, bulimia), increased urinary/fecal output(diuretics, laxatives, Crohnâ€™s disease, SIADH) and massive fluid loss (burns, crush injuries, hemorrhage) will affect the clients fluid volume.

-Diseases that affect the bowel may cause malabsorption of electrolytes.

-Some treatments may affect electrolyte balance (gastric suctioning, dietary restrictions, hormonal therapy (steroids), electrolyte replacement therapy)

-Diseases/medications that affect the kidneys may cause over excretion of necessary electrolytes (Na+, K+) or prevent reabsorption of necessary electrolytes (Ca+). Renal dysfunction can lead to retained fluid, electrolytes and wastes.

-Diseases that affect the liver may cause the underproduction of proteins that may allow fluid shifts out of the vascular space to occur because there is less colloid osmotic (oncotic) pressure to keep and/or draw more fluid into the vascular space.
Calcium:: normal range 8.5-10.5mg/dl
Hypercalcemia: ⬢ Can be caused by malignant tumors, hyperparathyroidism, immobilization
⬢ 50% mortality rate if not treated
⬢ Treated with diuretics, calcitonin, prevent constipation (most calcium excreted in stool), avoid overuse of calcium containing antacids, ambulate clients on BR as soon as possible
Hypocalcemia: ⬢ Can be caused by removal of parathyroid glands, diuretics, renal failure
⬢ Acute hypocalcemia is a medical emergency. Causes tetany, seizures
⬢ Treated with IV push calcium.
Hypermagnesemia: ⬢ Can be caused by renal failure, IV MgSo4 admin
⬢ Can lead to coma and respiratory and cardiac arrest; depresses skeletal muscle and nerve function (This is why it prevents seizures in women with preeclampsia)
⬢ Toxicity treated with IV calcium gluconate (antagonist)
Hypomagnesemia: ⬢ Can be caused by GI tract losses, insufficient intake, ETOH withdrawl,
⬢ Neuromuscular effects can cause MS changes, seizures, dysrhythmias
⬢ Treated with IV MgSO4 if dietary replacement insufficient.
Potassium:: normal range 3.5-5.5mEq/l
Hyperkalemia: ⬢ Can be caused by medications, IV infusion of K+, tissue trauma (crush injuries, burns), renal failure
⬢ Specimens should be redrawn to r/o pseudohyperkalemia (caused by blood cells damaged during blood draw-ex-shaking blood tube)
⬢ Can cause severe EKG changes-keep patient on cardiac monitor
⬢ Treated with dialysis, electrolyte resin exchange-Kayexelate (PO/PR), calcium gluconate. IV insulin and glucose can also be used in emergency. (Causes potassium to shift into cells.)
Hypokalemia: ⬢ Can be caused by over use of loop diuretics, excess insulin, inadequate dietary intake, GI tract losses
⬢ Causes weakness, constipation, hypotension
⬢ Treated by po replacement, IV replacement if po inadequate
⬢ Always dilute IV K+. If giving more than 40 mEq should be given in central line. Avoid use in clients with impaired renal function.
Sodium:: normal range: 135-145 mEq/l
Hypernatremia: ⬢ Can be caused by gain of Na+ or loss of H2O ; diseases like diabetes insipidus
⬢ Causes MS changes in elderly, skin flushing, agitation, low grade fever, thirst (SALT), can lead to cellular dehydration if untreated
⬢ Treated with hypotonic or isotonic IV solution
⬢ Prevention: assess for use of Na+ containing products, availability of H2O, ability to recognize thirst.
Hyponatremia: ⬢ Can be caused by lack of dietary Na+, GI losses, SIADH, compulsive water drinking, over use of IV solution without electrolytes
⬢ Causes nausea, abdominal; cramping. If level below 115mEq/l neuromuscular sx increase-twitching, weakness, sz
⬢ Treated preferably po, if no concurrant Na+ loss use isotonic solution, if Na+ loss will use hypertonic Na+ solution (3-5% NaCl) These solutions must be given via IV pump. Must monitor clt closely for fluid overload
Edema: Can be caused by:: 1. Increased hydrostatic pressure
2. Increased interstitial fluid osmotic pressure
3. Decreased or blocked lymph drainage
4. Decreased blood colloid osmotic pressure
1 kg (2.2 pounds) of body weight change equals: approximately 1 liter of fluid in the body**
Edema can be observed in: dependent areas, in the lungs (as moist breath sounds) and periorbitally.
Intravenous Therapy: Complications: ⬢ Infiltration-IV: fluid enters skin surrounding vein. Caused by IV catheter dislodging from the vein. Symptoms are pallor / blanching of the skin, cool skin, edema, discomfort, and the IV fluid may stop flowing. Interventions: Discontinue IV and restart in another extremity, raise affected extremity on a pillow, wrap extremity in warm, moist towel ( if not contraindicated) for 20 minutes.
⬢ Phlebitits-: Inflammation of a vein. Symptoms are warmth redness and red streaking along path of vein. Can be dangerous since clot can form at the area where phlebitis occurs. Interventions: Discontinue IV infusion and restart in another site.
⬢ Fluid Overload/Fluid: volume excess-Client receives IV fluids too fast or at too large a volume. Symptoms are moist breath sounds, SOB tachycardia. Interventions: slow infusion, monitor vitals, raise head of bed and call MD
⬢ Bleeding at the site-: Common in clients on heparin and clients with bleeding disorders. Can occur if tubing becomes disconnected or catheter is dislodged. Interventions: If catheter is still in vein , apply pressure dressing to control bleeding. If catheter out of vein ,apply pressure and restart IV at a different site.
⬢ Infection-: Pathogen invades skin at entry point of IV catheter. Can occur during insertion or during IV site care. Symptoms are warmth, redness, purulent discharge, possibly pain. Interventions: Discontinue IV and restart in another extremity maintaining aseptic technique, culture previous IV site and provide wound care to previous site as ordered.
⬢ Air embolism: -Rare complication, occurs more often with central lines. Symptoms are low B/P, SOB, chest pain, shoulder pain. Interventions: clamp IV line, place patient in left trendelenburg, give O2, contact MD
⬢ Broken or fractured: IV catheter-Noted upon removal of catheter from the patients arm. Apply tourniquet above the insertion site to prevent broken tip from circulating in clientâ€™s body. Obtain radiographic studies to locate tip so that it can be removed
Hypertonic Solutions:: Hypertonic Solutions:
3-5% Sodium Chloride,
D5 in 0.9% Sodium Chloride,
D5 in Lactated Ringers
Whole blood, TPN, fat emulsions, 10% or higher Dextrose solutions, albumin and Potassium infusions greater than 40 mEq/l: are also considered hypertonic solutions. These solutions are usually given through central venous access.
Isotonic Solutions:: 0.9% Sodium Chloride, Lactated Ringers
Hypotonic Solutions:: Hypotonic Solutions:
0.45% Sodium Chloride
Calculating IV drip rates:

***The drop factor tells you how many drops per cc the tubing will allow you to infuse. It is expressed as gtt/cc or gtt/ml. The drop factor is printed on the outer wrapping of the IV tubing package.***: Volume to be infused X drop factor (located on outer wrap of IV tubing)
# of hours (in minutes)

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