Interventions for
Clients
with Fluid and
Electrolyte imbalances
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Body Fluid Compartments
• 2/3 (65%) of TBW is intracellular (ICF)
• 1/3 extracellular water
– 25 % interstitial fluid (ISF)
– 5- 8 % in plasma (IVF intravascular fluid)
– 1- 2 % in transcellular fluids – CSF,
intraocular fluids, serous membranes, and in
GI, respiratory and urinary tracts
(third space)
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• Fluid compartments are separated by
membranes that are freely permeable to
water.
• Movement of fluids due to:
– hydrostatic pressure
– osmotic pressure\
• Capillary filtration (hydrostatic) pressure
• Capillary colloid osmotic pressure
• Interstitial hydrostatic pressure
• Tissue colloid osmotic pressure
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Balance
• Fluid and electrolyte homeostasis is
maintained in the body
• Neutral balance: input = output
• Positive balance: input > output
• Negative balance: input < output
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Solutes – dissolved particles
• Electrolytes – charged particles
– Cations – positively charged ions
• Na+, K+ , Ca++, H+
– Anions – negatively charged ions
• Cl-, HCO3- , PO43-
• Non-electrolytes - Uncharged
• Proteins, urea, glucose, O2, CO2
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Regulation of body water
• ADH – antidiuretic hormone + thirst
– Decreased amount of water in body
– Increased amount of Na+ in the body
– Increased blood osmolality
– Decreased circulating blood volume
• Stimulate osmoreceptors in hypothalamus
ADH released from posterior pituitary
Increased thirst
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Result:
increased water consumption
increased water conservation
Increased water in body, increased
volume and decreased Na+ concentration
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Fluid Volume Excess
Occurs when the body retains both water and
sodium in similar proportions to normal ECF. It is
also called hypervolemia.
Common causes include:- Excessive intake of sodium chloride
- Administering sodium-containing infusions too
rapidly
Disease processes that alter regulatory mechanisms
such as heart failure, renal failure.
Edema

Excess interstitial fluid.
Edema typically is most apparent in areas where the tissue
pressure is low, such as around the eyes, and in dependent
tissues (known as dependent edema), where hydrostatic
capillary pressure is high.
Pitting edema: edema that leaves a small depression or pit
after finger pressure is applied to the swollen area.
Electrolyte Imbalances
Hyponatremia
RISK FACTOR
Assessments
Nursing interventions
-Monitor fluid losses and
Loss of sodium, as in:
Anorexia
gains.
Loss of GI .fluids
Nausea and vomiting
-Monitor for presence of GI
and CNS symptoms.
Use of diuretics
Lethargy
- Monitor serum Na levels.
Gains of water, as in:
Confusion
- Check urine specific gravity.
-If able to eat, encourage
Excessive administration of
Muscle cramps
foods and fluids with high
D5W
Fingerprinting over sternum sodium content.
-Be aware of sodium content
Water intoxication
Muscular twitching
of common
Disease states associated with Seizures
-IV fluids.
-Avoid giving large water
SIADH (a form of
Coma
supplements to
hyponatremia)
Serum Na below 135 mEq/L -Patients receiving isotonic
Pharmacologic agents that
Urine specific gravity <1.010 tube feedings.
-Take seizure precautions
may impair water excretion
when hyponatremia is severe
Hypernatremia
RISK FACTOR
Assessments
Nursing interventions
- Monitor fluid losses and
Water deprivation
Thirst
gains.
Increased sensible and
Elevated body temperature - Observe for excessive
intake of high sodium foods.
insensible water loss
Tongue dry and swollen,
- Monitor for changes in
Ingestion of large amount of sticky mucous Membranes behavior such as
restlessness, lethargy, and
salt
Severe hypernatremia
disorientation.
Excessive parenteral
Disorientation
- Look for excessive thirst
and elevated body
administration of sodiumHallucinations
temperature.
containing solutions
Irritable and hyperactive
- Monitor serum Na levels.
Profuse sweating
Focal or grand mal seizures - Check urine specific
gravity.
Diabetes insipidus
Coma
- Give sufficient water with
Serum Na above 145 mEq/L tube feedings to Keep serum
Na and BUN at normal
Urine specific gravity
limits.
>1.015
Hypokalemia
RISK FACTOR
Diarrhea
Vomiting or gastric
suction
Potassium-wasting
diuretics
Poor intake as in
anorexia nervosa,
alcoholism, potassiumfree
parenteral .fluids
Polyuria
Assessments
Fatigue
Anorexia, nausea, and
vomiting
Muscle weakness
Decreased bowel
motility
Cardiac arrhythmias
Polyuria, nocturia,
dilute urine
Postural hypotension
Serum K below 3.5
mEq/L
ECG changes
T waves flattening and
ST segment depression
on ECG
Nursing interventions
- Monitor for
occurrence of
Hypokalemia.
- Prevent Hypokalemia
by:
- Encouraging extra K
intake if possible
- Educating about abuse
of laxatives and
diuretics
-Administer oral K
supplements if ordered.
- Be knowledgeable
about danger of IV
potassium
administration.
Hyperkalemia
RISK FACTOR
Decreased potassium
excretion:
Oliguric renal failure
Potassium-sparing
diuretics
High potassium intake,
especially
in presence of renal
insufficiency
Shift of potassium out
of cells into the plasma
(acidosis, tissue trauma,
infection, burns)
Assessments
Vague muscle
weakness
Cardiac arrhythmias
Paresthesias of face,
tongue, feet, and
hands
Flaccid muscle
paralysis
GI symptoms such as
nausea, intermittent
intestinal colic, or
diarrhea may occur
Serum K above 5.0
mEq/L
Peaked T waves,
widened QRS on ECG
Nursing interventions
Monitor for
hyperkalemia, which is
life threatening.
Prevent hyperkalemia
by:
Following rules for safe
administration of K
Avoiding giving
patients with renal
insufficiency K-saving
diuretics, K
supplements,
or salt substitutes
Cautioning about foods
high in potassium
content
Hypocalcaemia
RISK FACTOR
Surgical
hypoparathyroidism
Malabsorption Vitamin
D deficiency
Acute pancreatitis
Excessive administration
of citrated blood
Alkalotic states
Assessments
Trousseau’s and
Chvostek’s signs
Numbness and
tingling of fingers and
toes
Mental changes
Seizures
Spasm of laryngeal
muscles
ECG changes
Cramps in muscles of
extremities
Total serum calcium
<8.5 mg/dL
Nursing interventions
Take seizure
precautions when
hypocalemia is severe.
Monitor condition of
airway.
Take safety precautions
if confusion is present.
Educate people at risk
for osteoporosis about
need for dietary
calcium intake.
Discuss calcium-losing
aspects of nicotine and
alcohol use.
Hypocalcemia
Hypocalcemia
A positive Trousseau's sign
Muscular contraction including flexion of the wrist and
metacarpophalangeal joints, hyperextension of the
fingers and flexion of the thumb on the palm
A positive Chvostek's sign.
Twitching or contraction of the facial muscles produced
by tapping on the facial nerve at specific point
Hypercalcaemia
RISK FACTOR
Hyperparathyroidism
Malignant neoplastic
disease
Prolonged immobilization
Large doses of vitamin D
Overuse of calcium
supplements
Thiazide diuretics
Assessments
Muscular weakness
Tiredness, lethargy ,
Constipation
Anorexia, nausea, and
vomiting
Decreased memory and
attention span
Polyuria and polydipsia
Renal stones
Cardiac arrest
Serum calcium >10.5
mg/dL
Nursing interventions
Increase mobilization
when feasible.
Encourage sufficient oral
intake.
Discourage excessive
consumption of milk
products.
Encourage bulk in the diet.
Take safety precautions if
confusion is present
Be alert for signs of
digitalis toxicity in
Hypercalcaemia patients.
Force fluids to prevent
formation of renal stones.
Hypercalcemia
Hypomagnesemia
Signs/symptoms
Causes