Lecture 2A
Fluid & electrolytes (Chapter 7)
Integumentary System (chapters 4446)
Homeostasis
• The body’s tendency
to maintain a state of
physiologic balance in
constantly changing
conditions.
Body Fluids
• Volume
• Electrolyte composition
• pH
What is the primary component of
body fluid?
A. Red blood cells
B. White blood cells
C. Electrolytes (i.e. sodium, potassium, calcium,
etc.)
D. Water
E. Oxygen
Water
• 60% of body weight is
water
• Elderly 
• 45 – 50% of body
weight is water
Water in & out
• Water intake and
output should be about
equal.
• Average daily
intake/output
– 2500 mL
• Table 7-1 pg 101
Electrolytes
• Substances that
dissociate in solution to
form ions.
• Ion =
– Electrically charged
particle
Function of Electrolytes
• Regulate water
• Neuro-muscular activity
Key electrolytes
• Sodium (Na)
– 135-145 mEq/L
• Potassium (K+)
– 3.5 – 5.3 mEq/L
• Calcium (Ca)
– 4.5 – 5.5 mEq/L
• Magnesium (Mg)
– 1.5 – 2.4 mEq/L
• Chloride (Cl-)
– 95 – 105 mEq/L
Distribution of Body Fluid
• Intracellular fluid (ICF)
– Fluid inside the cells
– 40% of body weight
• Extracellular fluid (ECF)
– Outside of cells
– 20% body fluid
– Where?
• Interstitial fluid
– Between the cells
• Intravascular fluid
– In the blood vessels
• Transcellular
– Body fluids
Body Fluid Movement
• Compartments
separated by selectively
permeable membranes
• 4 ways to move
–
–
–
–
Osmosis
Diffusion
Filtration
Active transport
Osmosis
• Water moves from an
area of lower solute
concentration to an
area of higher solute
concentration
Osmosis
• Water moves towards a higher solute
concentration
Isotonic solution
• Have the same
concentration of solutes
as plasma
Hypertonic solution
• Have a great
concentration of solutes
than plasma
Hypotonic solution
• Have a lower
concentration of solutes
than plasma
Diffusion
• Solutes move from an
area of high solute
concentration to an
area of low solute
concentration
Filtration
• Water & Solutes move
across membranes
driven by fluid pressure
• Figure 7-6 pg 104
Active transport
• Allows molecules to
move into areas of high
solute concentration
but requires cellular
energy
– Adenosine triphosphate
or ATP
In osmosis what moves, and how?
A. Water moves from an area of high solute
concentration to an area of low solute concentration
B. Water moves from an area of low solute
concentration to an area of high solute concentration
C. Solutes moves from an area of high solute
concentration to an area of low solute concentration
D. Solute moves from an area of low solute
concentration to an area of high solute concentration
In Diffusion what moves, and how?
A. Water moves from an area of high solute
concentration to an area of low solute concentration
B. Water moves from an area of low solute
concentration to an area of high solute concentration
C. Solutes moves from an area of high solute
concentration to an area of low solute concentration
D. Solute moves from an area of low solute
concentration to an area of high solute concentration
Nrs. Dx: Fluid Volume Deficit
• AKA:
– Dehydration
Common Causes of
Fluid Volume Deficit
•
•
•
•
GI fluid loss
Excess urine output
Hemorrhaging
Inadequate fluid intake
S&S of Fluid Volume Deficit
• Fatigue
• Alt. mentation
• BP?
– Postural hypotension
• Pulse?
– Tachycardia
– Weak
• Weight?
– loss
• Skin
– Dry
– Poor turgor
• Urine output
– Decreased
– Dark
Lab Test for Fluid Volume Deficit
• Serum osmolality
–h
• Hematocrit
–h
• Urine specific gravity
–h
Nursing
Plan: Fluid Volume Deficit
• I&O
– <30 mL / hr REPORT!
• Vital Signs
– BP
• i
– Pulse rate
• h
– Pulse strength
• i
Nursing
Plan: Fluid Volume Deficit
• Assess urine
– Color
• Dark
– Specific gravity
• Weight of urine compared
to a drop of distilled
water
• h = FVD
Nursing
Plan: Fluid Volume Deficit
• Daily weight
– Same…
• Time
• Scale
• Clothing
– FVD 
• i wt
Nursing
Plan: Fluid Volume Deficit
• Assess mental status &
breath sounds
• Assess skin
– Dry
– Turgor
– Warm
• Assess mucus
membranes
– Moist
Nursing
Plan: Fluid Volume Deficit
• PUSH FLUIDS!!!
–
–
–
–
–
#1 water
Variety
Available
Appealing
Intravenous fluids (I.V.)
Nursing
Plan: Fluid Volume Deficit
• Educate
– I&O
– Avoid sun/heat
– Vomiting 
• Small frequent sips
• Tea, ginger ale, flat cola
– Caffeine & sugar 
• urination
– If diarrhea 
• drink fruit juice or
bouillon not just water
Nrs. Dx: Fluid Volume Excess
• Usually due to sodium
& water retention
• AKA
– Hypervolemia
Common causes of
Fluid Volume Excess
•
•
•
•
Renal failure
Heart failure
Too much water intake
Too much sodium
intake
• Medications
S&S of Fluid Volume Excess
• BP
–h
– Hypertension
• Pulse rate
–h
– Tachycardia
• Pulse strength
– Full bounding pulse
S&S of Fluid Volume Excess
• Respiratory
– Rate
• h
– Cough
– Dyspnea
• Weight
–h
• Edema
– Excess fluid in the body
tissues
Lab tests for
Fluid Volume Excess
• Serum osmolarity
–i
• Hematocrit
–i
• Specific gravity of urine
–i
Interdisciplinary Care for
Fluid Volume Excess
• Medications
– Diuretics
• Fluid restriction
– Rx by MD
• Sodium restriction
• Action:
– Increase water excretion
– “Water pills”
Nursing
Plan: Fluid Volume Excess
• Baseline weight
• Baseline vital signs
• Monitor
–
–
–
–
I&O
VS
Skin turgor
Edema
Nursing
Plan: Fluid Volume Excess
• Report
–
–
–
–
Dizziness
Orthostatic hypotension
Tachycardia
Muscle cramping
Nursing
Plan: Fluid Volume Excess
• Monitor labs
– K*
– Glucose
– Notify MD for abnormal
Nursing
Plan: Fluid Volume Excess
• Administer meds per
MD order
• Fluid restrictions
• Sodium restrictions
Nursing
Plan: Fluid Volume Excess
• Provide
–
–
–
–
Oral hygiene
Rest
Elevate feet
Semi-fowler position
Nursing
Plan: Fluid Volume Excess
• Educate (about
diuretics)
–
–
–
–
–
–
–
Increase urine
Take in AM
Change position slowly
Weight daily
Decrease salt
h potassium
Report to MD
With fluid Volume deficit you
would expect the blood pressure
to be what?
A. Increased (hypertension)
B. Decreased (hypotension)
Why are respiratory problems
common with Fluid Volume
deficit?
A. The blood flows to the feet
B. There is no blood to circulate the oxygen
C. Increased respiratory rate causes a decreases
in effective breathing
D. It is not common with fluid volume deficit, it
is common with fluid volume excess
Why are respiratory problems
common with Fluid Volume
excess?
A. Excess fluid pools into the lungs
B. The blood does not circulate as well
C. Oxygen can not be carried in watery
blood
D. Peripheral edema causes their feet to
swell
Kidney failure usually leads to
which of the following nursing
diagnosis?
A. Fluid volume deficit
B. Fluid volume excess
Sodium Imbalance
• What is the chemical sign for sodium?
A. So
B. Sa
C. S
D. N
E. Na
What is the normal serum sodium
level
A.
B.
C.
D.
E.
135 – 145 mEq/L
13 – 15 mEq/L
3.5 – 5.3 mEq/L
35 – 45 mEq/L
Uh, what??
Sodium imbalance
• Sodium and fluid volume frequently go
together.
Hyponatremia
• Low serum sodium level
– < 135 mEq/L
Common causes of hyponatremia
• Water retention
– Kidney disease
– Heart disease
– Syndrome of
inappropriate secretion
of antidiuretic hormone
(SIADH)
• Sodium loss
– Vomiting
– Diarrhea
– diuretics
S&S of Hyponatremia
• Anorexia
– N/V
– Diarrhea
•
•
•
•
H/A
Mental changes
Convulsions
Coma
Lab Tests: hyponatremia
• Serum electrolyte levels
– < 135 mEq/L
If a client has hyponatremia, what do
they need?
• More Sodium
– Foods high in sodium
– IV fluids
• Less water
– diuretics
Hypernatremia
• High serum sodium
levels
– > 145 mEq/L
Common Causes of Hypernatremia
• Water loss
–
–
–
–
Not drinking
Sweating
Diarrhea
Diabetes
• Sodium retention
– Tube feedings without
water
– IV with Na
S&S of hypernatremia
• Thirst
• Alt. mental status
• Dry mucous
membranes
• Postural hypotension
• Skin
– Hot, dry
Interdisciplinary Care:
Hypernatremia
• Increase water
– Push fluids
– IV
– SLOWLY!
Potassium imbalance
• What is the chemical sign for potassium?
A. Pt
B. P
C. Po
D. K
E. Sa
What is the normal serum potassium
level?
A. 1.5 – 5.1 mEq/L
B. 2.5 – 5.2 mEq/L
C. 3.5 – 5.3 mEq/L
D. 4.5 – 5.4 mEq/L
E. None of the above
Lab tests for Hypokalemia
• Serum electrolytes
– K+
Hypokalemia
• Low potassium levels
– < 3.5 mEq/L
Common Causes of
Hypokalemia
• GI loss
–
–
–
–
Vomiting
Diarrhea
Diuretics
NPO
S&S of Hypokalemia
•
•
•
•
N&V
Anorexia
Muscle weakness
Dysrhythmias
If a client has Hypokalemia, what do
they need?
• POTASSIUM
REPLACEMENT!!
– Potassium replacement
medications
Natural sources of K+
– Fruits
• Banana
• Oranges
• Cantaloupe
– Vegetables
• Carrots
• Cauliflower
• Potato
What is Hyperkalemia?
A.
B.
C.
D.
E.
Increased sodium levels
Decreased sodium levels
Increased potassium levels
Decreased potassium levels
I have no idea!
Hyperkalemia
• High potassium levels
– > 5.3 mEq/L
Common causes of Hyperkalemia
• #1 Renal failure
S&S of Hyperkalemia
• Dysrhythmias  cardiac
arrest
• N&V / diarrhea
• Muscle weakness
REMEMBER!!!
• Both hypokalemia and hyperkalemia affect
cardiac function and can result in serious,
even fatal dysrhythmias
Lab Tests: Hyperkalemia
• Serum electrolytes
– K+
• ECG
– Electrocardiogram
• Renal function
– BUN
• Blood Urea Nitrate
HyperKalemia: Interdisciplinary Care
• Medications
– Treat the cause
– Loop diuretics
• Lasix
Nursing Plan
At risk for injury
• Monitor
– K+ levels
– S&S of K+ imbalance
• Weakness
Nursing Plan:
Decreased Cardiac output
• Monitor
– Vital signs
– Apical pulse
• Place on cardiac
monitor
Calcium (Ca)
• Hypocalcemia
– Low serum calcium
levels
• Hypercalcemia
– High serum calcium
levels
Common causes of hYPOCALCEMIA
•
•
•
•
Parathyroidectomy
i Dietary intake
Lack of sun exposure
Alcoholics
What’s so bad about not having
calcium? Why do we need it
anyway?
• Healthy bones
• Muscle contraction
& relaxation
S&S of hypocalcemia
• Tetany
– Group of symptoms that
are caused by
hypocalcemia
– Paresthesia
– Muscle spasms
S&S of Hypocalcemia
• + Chvostek’s sign
– Tap facial nerve 
– Facial spasm
S&S of Hypocalcemia
• + Trousseau’s sign
– Occlusion of brachial
artery > 3 min.
– Carpal spasm
S&S of Hypocalcemia
• Dysrhythmias
• Cardiac output
–i
• BP
–i
Interdisciplinary Care: Hypocalcemia
• Diagnostic tests
– Serum Calcium level
– PTH
• Parathyroid Hormone
levels
Interdisciplinary Care: Hypocalcemia
• If a client has a
diagnosis of
hypocalcemia – what do
they need?
• Calcium replacement!
– Oral calcium
replacement
Natural courses of Calcium
• Milk
• Milk products
HYPERCALCEMIA
• Increased serum
calcium levels
Common causes of Hypercalcemia
•
•
•
•
Hyperparathyroidism
Some cancers
Immobilization
Renal failure
What endocrine gland controls
the serum calcium level
A.
B.
C.
D.
E.
Parathyroid
Pituitary
Adrenal
Ovaries
Testis
S&S of Hypercalcemia
•
•
•
•
•
Muscle weakness
i reflexes
Confusion
Dysrhythmias
BP
–h
• Urine output
–h
REMEMBER: Calcium has a
sedative effect on neuromuscular
transmission
• HYPERcalcemia  decreased neuromuscular
excitability, muscle weakness and fatigue
• HYPOcalcemia  increased neuromuscular
excitability, muscle twitching, spasms and
tetany
Interdisciplinary care
Hypercalcemia
• Lab tests:
– Serum Calcium levels
– PTH
– ECG
Interdisciplinary care
Hypercalcemia
• Medications
– Diuretics
Magnesium Imbalance
• Mg
Hypomagnesemia
• Low serum magnesium
levels
Common Causes of
Hypomagnesemia
• #1 Alcoholism
S&S of Hypomagnesemia
• Muscle weakness
• Tetany
– + Chvostek’s
– + Troussseau’s
• Dysrhythmias
– ECG changes
• Seizures