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Chapter 22
Fluids and Electrolytes
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Fluids (Water)
 Functions
 Provides an extracellular transportation route to deliver
nutrients to the cells and carry waste products from the
cells
 Provides a medium in which chemical reactions, or
metabolism, can occur within the cell
 Acts as a lubricant for tissues
 Aids in the maintenance of acid-base balance
 Assists in heat regulation via evaporation
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Slide 2
Fluids (Water)
 Percentage of body weight that is water depends on
several factors.
 Age
 Premature infant: 90%
 Newborn: 70% to 80%
 Twelve years to adult: 50% to 60%
 Older adults: 45% to 55%
 In an adult, a loss of 10% body fluid is serious and 20%
is fatal.
 In an infant a loss of 5% is serious, 10% is very serious,
and 15% is fatal.
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Slide 3
Figure 22-1
(From Phipps, W.J., Monahan, F.D., Sands, J.K., Marek, J.F., Neighbors, M. [2003]. Medical-surgical
nursing: health and illness perspectives. [7th ed.]. St. Louis: Mosby.)
Proportions of extracellular total body fluid throughout growth and
development.
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Slide 4
Fluids (Water)
 Amount of Fat
 Fat contains relatively little water.
 The female has proportionately more body fat than the
male, which means that the female has less body fluid.
 The more obese an individual, the lesser the percentage
of body water.
 Extracellular fluid is lost from the body more rapidly
than intracellular fluid.
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Slide 5
Fluid Compartments
 Intracellular Fluid
 Largest of the two compartments (66% of bodies fluid)
 Contains the fluid inside the billions of cells within the
body
 Extracellular Fluid
 Contains any fluid outside the cell
 Divided into interstitial and intravascular
compartments
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Slide 6
Fluid Compartments
 Extracellular Fluid
 Interstitial fluid



Between the cells or in the tissue
Accounts for approximately 27% of the fluid in the body
Examples: lymph, cerebrospinal fluid, and gastrointestinal
secretions
 Intravascular fluid


Plasma within the vessels
Makes up 7% of fluid volume
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Slide 7
Figure 22-2
(Redrawn from Long, B.C., Phipps, W.J., Cassmeyer, V.L. (1993). Medical surgical nursing: a nursing
process approach. [3rd ed.]. St. Louis: Mosby.)
Volumes of body fluids in each fluid compartment.
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Slide 8
Fluids
 Hypovolemia (low volume of extracellular fluid)
 Clients at risk are those that are
 Lethargic, depressed
 Vomiting, fever, diarrhea
 Have dementia
 Difficulty swallowing or communicating
 Eat poor
 Require assistance to drink or eat (due to weakness,
paralysis, or limited ROM)
 Take diuretics, laxatives, or drugs with anticholinergic
properties or receive tube feedings w/o additional water.
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Slide 9
Hypovolemia
 Signs and Symptoms
WEIGHT
WEIGHT LOSS OF 2 LB OR MORE/24 HOUR
BLOOD PRESSURE
LOW
TEMPERATURE
ELEVATED
PULSE
RAPID, WEAK, THREADY
RESPIRATION
RAPID SHALLOW
URINE
SCANT, DARK YELLOW
STOOL
DRY SMALL VOLUME
SKIN
WARM, FLUSHED, DRY
SKIN TURGOR
POOR TENTS
MUCOUS MEMBRANES
DRY, STICKY
EYES
SUNKEN
LUNGS
CLEAR
BREATHING
EFFORTLESS
ENERGY
WEAK
JUGULAR NECK VEIN
FLAT
COGNITION
REDUCED
MENTAL STATE
SLEEPY
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Slide 10
Fluids (Water)
 Dehydration
 Obese and older adults have greater risk of dehydration.
 Older considerations:






Fat replaces lean muscle with aging
Aging kidney is less able to concentrate urine
decreases in mobility and diminished sense of thirst often result in
decreased fluid intake
Incontinent older individuals restrict fluids to decrease incontinency
Manifests as mild disorientation, constipation, increase risk of
orthostatic hypotension
Monitor CBC carefully for changes in H/H. Decreased plasma volume
increases hematocrit and hemoglobin level remains constant.
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Slide 11
Dehydration
 Signs and Symptoms
 Thirst
 Dry mucous membranes
 Increased heart rate
 Decreased blood pressure
 Poor skin turgor (aging decrease skin elasticity, may be
ineffective in detecting fluid volume deficit in older
adults)
 Flat neck veins
 In some cases disorientation
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Slide 12
Hypovolemia
 Nursing Management
 Respond to thirst because it is an early indication of
reduced fluid volume
 Consume at least 8-10 (8 oz) glasses of fluid daily and
more in warmer/humid weather
 Avoid beverages with alcohol and caffeine because they
increase urination and contribute to fluid deficits
 Do not restrict salt or sodium intake
 Rise slowly from a sitting or laying position to avoid
dizziness and potential injury r/t orthostatic shift
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Slide 13
Fluids
 Hypervolemia means there is a high volume of water




in the intravascular fluid compartment.
Fluid intake is greater than fluid loss
Is a consequence of heart failure when the heart
cannot adequately distribute fluid to the kidneys for
filtration.
Kidney disease (ESRD) tx is dialysis
Fluid retention: r/t excessive salt intake, corticosteriod
drugs (ex. Prednisone)
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Slide 14
Hypervolemia
 Clients at risk for hypervolemia:
 Have altered cardiac or kidney function
 Have increased ADH production (sometimes accompanied by brain
trauma)
 Receiving corticosteroid therapy, large rapid volume of
IV fluid, or IV colloid solutions (e.g. albumin).
 Consume large amounts of fluid (e.g. schizophrenia
patients can develop water intoxication)
 Ingest highly salted foods or foods that contain large
sodium content
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Slide 15
Hypervolemia
 Signs and Symptoms
WEIGHT
WEIGHT GAIN 2 LBS OR MORE/ 24 HOURS
BLOOD PRESSURE
HIGH
TEMPERATURE
NORMAL
PULSE
FULL, BOUNDING
RESPIRATION
MOIST, LABORED
URINE
LIGHT YELLOW
STOOL
BUKY
SKIN
COOL, PALE, MOIST
SKIN TURGOR
PITTING AND DEPENDENT EDEMA
MUCOUS MEMBRANES
MOIST
EYES
SWOLLEN
LUNGS
CRACLES, GURGLES
BREATHING
DYSPNEA (SOB), ORTHOPNEA (SOB when lying flat)
ENERGY
FATIGUES EASILY
JUGULAR NECK VEIN
DISTENDED
COGNITION
REDUCED
MENTAL STATE
ANXIOUS
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Slide 16
Hypervolemia
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Slide 17
Hypervolemia
 Third Spacing: is the translocation of fluid from the
intravascular or intercellular space to tissue
compartments where it becomes trapped and useless.
 Associated with loss of colloids, hypoalbuminemia
(low level of albumin in the blood) or burns, and
severe allergic reactions that alter capillary and cellular
membrane permeability.
 Fluid translocation follows the shift in osmotic
pressure to other locations.
 Can lead to hypotension, shock, and circulatory
failure.
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Slide 18
Hypervolemia
 FOODS HIGH IN SALT OR SODIUM
 Processed meats (hot dogs and cold cuts)
 Most fast-food choices
 Most frozen convenience meals
 Salted and smoked fish
 Cheeses, especially processed varieties
 Powdered cocoa and hot chocolate mixes
 Canned vegetables
 Foods preserved in brine (pickles, olives, sauerkraut)
 Tomato and tomato vegetable juices
 Canned soup and instant soups or bouillon
 Boxed casserole mixes
 Salted snack foods
 Seasonings: catsup, gravy mixes, soy sauce, MSG, pickle relish,
tarter sauce, mustard, horseradish, BBQ sauce, steak sauce
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Slide 19
Hypervolemia
 Medical Management: Restore circulatory volume in
clients with hypotension and eliminate the trapped
fluid.
 Done by administering IV solutions – sometimes at
rapid rates—and blood products, such as albumin, to
restore colloidal osmotic pressure. Albumin pulls the
trapped fluid back into the intravascular space. Be
cautious as this can cause a patient who is hypovolemic
to become hypervolemic very quickly. IV diuretic may be
ordered to reduce potential for circulatory overload. (ex.
Furosemide (Lasix)). No more than 10 mg/min IV.
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Slide 20
Hypervolemia
 Nursing Management: Based on assessment and
your states nurse practice act regarding IV
therapy (4723.17)
 Ohio Board of Nursing
 http://codes.ohio.gov/orc/4723
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Slide 21
Intake and Output
 The normal daily loss of fluids must be met by the




normal daily intake.
Daily water intake and output is approximately
2500 mL.
Fluid leaves the body through the kidneys, lungs, skin,
and GI tract.
Homeostasis is relative constancy in the interal
environment of the body, naturally maintained by
adaptive responses that promote healthy survival.
Water loss is replenished by ingestion of liquids and
foods and by metabolism of food and body tissues.
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Slide 22
Intake and Output
 Intake includes all fluids entering the body.
 Fluids can be liquids taken orally or consumed in food,
including foods that assume a liquid consistency at
room temperature.
 This also includes tube feedings and parenteral intake
such as intravenous fluids, blood components, and total
parenteral nutrition.
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Slide 23
Intake and Output
 Output includes all fluids leaving the body.
 Examples are urine, diarrhea, vomitus, nasogastric
suction, and chest tube drainage.
 Also included is drainage from surgical wounds and
drainage collected in surgical receptacles such as the
Jackson-Pratt, Davol, or Hemovac systems.
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Slide 24
Intake and Output
 The kidneys play an extremely important role in fluid balance.
 If the kidneys are not functioning properly, the body has great difficulty
in regulating fluid balance.
 The Nephrons are the functioning units of the kidney
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Slide 25
Intake and Output
 Glomerular Filtration Rate
 Nephrons filter blood at a rate of 125 mL per min, or about 180 L per
day.
 This leads to output of 1 to 2 L of urine per day.
 Nephrons reabsorb the remaining 178 L or more of fluid.
 KIDNEYS MUST EXCRETE A MINIMUM OF 30 ML/HR OF
URINE (720mL/24 hr) to eliminate waste products from the body
 https://www.youtube.com/watch?v=Hlg7oh2OcOc
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Slide 26
Intake and Output
 The kidneys must excrete a minimum of 30 mL/hour
of urine to eliminate waste products from the body.
 The kidneys react to fluid excesses by excreting a more
dilute urine; this rids the body of excess fluid and
conserves electrolytes.
 A simple and accurate method of determining water
balance is to weigh the patient under exact conditions.
 1 L of fluid equals 1 kg (2.2 lb); a weight change of
1 kg will reflect a loss or gain of 1 L of body fluid.
 Measuring Intake and Output skills 22-1
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Slide 27
Intake and Output
Fluid Intake
Fluid Output
Ingested Water
1300 ml
Kidneys
Ingested Food
1000 ml
Skin
Insensible Loss 600-900 ml
Sensible Loss
0-5000 ml
Metabolic Oxidation
300 ml
Lungs
Gastrointestinal
Total
2600 ml
Total
1500 ml
400 ml
100 ml
2600-2900 ml
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Slide 28
Movement of Fluid and Electrolytes
 Substances entering the body begin their journey in
the extracellular fluid.
 To carry out their functions, they must cross the
semipermeable membrane surrounding each body cell
to enter the cell.
 The fat and protein molecules that make up the
membrane are arranged so that some substances can
enter the cells and others cannot.
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Slide 29
Movement of Fluid and Electrolytes
 Several methods are used by the body to move fluids,
electrolytes and other solutes, or dissolved substances into
and out of cells.
 Passive transport processes
 No cellular energy is required to move substances from a high
concentration to a low concentration.
 Active transport processes
 Cellular energy is required to move substances from a low
concentration to a high concentration.
 Energy required for active transport processes is obtained from an
important chemical substance called adenosine triphosphate
(ATP).
 ATP is produced by the mitochondria and releases energy to allow the
cell to work.
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Slide 30
Passive Transport
 Diffusion
 This is the movement of particles in all directions
through a solution or gas.
 Solutes move from an area of higher concentration to
an area of lower concentration, which eventually
results in an equal distribution of solutes within the two
areas.
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Slide 31
Passive Transport
 Osmosis
 This is the movement of water from an area of lower
concentration to an area of higher concentration.
 It equalizes the concentration of ions or molecules on both
sides of the membrane.
 The flow of water will continue until the number of ions or
molecules on both sides are equal.
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Slide 32
Passive Transport
 Osmosis
 Hypertonic solutions


A solution of higher osmotic pressure
Pulls fluid from the cells
 Isotonic solutions


A solution of same osmotic pressure
Expands the body’s fluid volume without causing a fluid shift
 Hypotonic solutions


A solution of lower osmotic pressure
Moves into the cell, causing them to enlarge
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Slide 33
Passive Transport
 Filtration
 This is the transfer of water and dissolved substances
from an area of higher pressure to an area of lower
pressure.
 A force behind filtration is called hydrostatic
pressure, or the force pressing outward on a vessel wall.
 The pumping action of the heart is responsible for the
amount of force of the hydrostatic pressure that causes
water and electrolytes to move from the capillaries to the
interstitial fluid.
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Slide 34
Active Transport
 Requires energy
 Force that moves molecules into cells without regard for
their positive or negative charge and against
concentration factors that would prevent entry via
diffusion
 Moves fluid and electrolytes from an area of low
concentration to an area of high concentration
 Substances actively transported through the cell
membrane include sodium, potassium, calcium, iron,
hydrogen, amino acids, and glucose.
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Slide 35
Active Transport
 Electrolytes
 Electrolytes develop tiny electrical charges when they
dissolve in water and break up into particles known as
ions.
 Ions develop either a positive or negative electrical
charge.


Cations have a positive charge.
Anions have negative charge.
 A balance exists between the electrolytes; for each
positively charged cation, there must be a negatively
charged anion.
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Slide 36
Active Transport
 Sodium
 A cation
 Most abundant electrolyte in the body
 Normal level: 135 to 145 mEq/L
 Major source is from the diet; frequently must be limited
 Functions of sodium: regulates water balance, controls
extracellular fluid volume, increases cell membrane
permeability, stimulates conduction of nerve impulses
and helps maintain neuromuscular irritability, controls
contractility of muscles
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Slide 37
Figure 22-3
(Redrawn from Long, B.C., Phipps, W.J., Cassmeyer, V.L. (1993). Medical surgical nursing: a nursing
process approach. [3rd ed.]. St. Louis: Mosby.)
Sodium-containing internal secretions produced every day.
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Slide 38
Active Transport
 Sodium (continued)
 Hyponatremia





Less than normal concentration of sodium in the blood
Sodium level of 134 mEq/L or less
Can occur when there is a sodium loss or a water excess.
Causes can include: profuse diaphoresis, excessive ingestion of
plain H2O, profuse diuresis, loss of GI secretions (vomiting,
GI suctioning, draining fistulas) and Addison’s disease.
Body attempts to compensate by decreasing water excretion
Patient likely to also have a potassium imbalance due to fluid
being moved into the cells and potassium shifting out of the
cells
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Slide 39
Hyponatermia
 Signs and Symptoms
 Mental confusion, Headache, irritability, fatigue, postural hypotension,
abdominal cramps muscular weakness, anorexia, restlessness, elevated body
temperature, tachycardia, nausea, vomiting, and personality changes.
 If severe: convulsions or coma
 Medical Management
 Treat the cause: mild – oral admin of foods high in sodium. Severe deficit –
IV solutions containing sodium chloride
 Nursing Management
 Early detection especially in patients at high risk.
 Accurate I&Os
 Assess vital signs every 1-4 hours (notify physician if s&s worsen or labs show
significant changes).
 Monitor LOC for changes
 Fluid restriction and replace fluids lost with fluids containing sodium, not
plan water.
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Slide 40
Active Transport
 Sodium
 Hypernatremia





Greater than normal concentration of sodium in the blood
Sodium level greater than 145 mEq/L
Can occur when there is a sodium excess or a water loss. Causes
include profuse watery diarrhea, excessive salt intake without
sufficient water intake, high fever, decreased water intake,
excessive administration of solutions that contain sodium,
excessive water loss without an accompanying loss of sodium
and severe burns.
Body attempts to correct the imbalance by conserving water
through renal reabsorption
Causes fluid to shift from the cells to the interstitial spaces,
resulting in cellular dehydration
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Slide 41
Active Transport - Hypernatermia
 Signs and Symptoms
 Thirst, dry, sticky mucous membranes, decreased urine output, fever,
rough, dry tongue, firm rubbery tissue turgor lethargy, which can
progress to coma or death
 Medical Management
 Dependent on cause: includes or admin of plan H2O, IV hypotonic
solutions (0.45 NS or 5% Dextrose)
 Nursing Management
 Early detection especially in patients at high risk.
 Accurate I&Os
 Assess vital signs every 1-4 hours (notify physician if s&s worsen or labs
show significant changes)
 Monitor serum labs
 Decrease sodium intake
 Weigh daily
 Nursing Dx
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Slide 42
Active Transport
 Potassium
 Dominant intracellular cation
 Normal level is 3.5 to 5 mEq/L.
 Well-balanced diet usually provides adequate potassium;
approximately 65 mEq is required each day.
 The routes of potassium excretion are the kidneys, in the
feces, and through perspiration.
 The kidneys control the excretion of potassium.
 The main function is regulation of water and electrolyte
content within the cell.
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Slide 43
Active Transport
 Potassium
 Hypokalemia





Decrease in body’s potassium to a level below
3.5 mEq/L
The major cause of loss is renal excretion. Other causes decreased
potassium intake, increased potassium loss (GI vomiting,, diarrhea,
suctioning), diuretic, ileostomy, diaphoresis, treatment of acidosis,
metabolic alkalosis, villous adenoma (tumor of the intestine that
produces potassium containing mucous).
The kidneys do not conserve potassium and excrete it even when the
body needs it.
Potassium can be depleted due to excessive GI losses from gastric
suctioning or vomiting and the use of diuretics.
This can affect skeletal and cardiac function.
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Slide 44
Active Transport - Hypokalemia
 S&S
 Skeletal muscle weakness (especially the legs); Paresthesia (sensation of
tingling, tickling, pricking, or burning of a person's skin with no apparent longterm physical effect.)
 Decreased BS, cramps, and constipation, anorexia, n&v, diminished deep
tendon reflexes, lethargy, confusion; paralysis involving the respiratory muscle,
coma,
 Orthostatic hypotension, Cardiac dysrhythmias, weak, irregular pulse, ECG
changes, Polyuria
 SEVERE OR PROLONGED DEFICIT

Flaccid paralysis, kidney damage, paralytic ileus, cardiac or respiratory arrest
 Medical Management
 Replace lost potassium and find cause.
 Nursing Management
 Careful assessment, admin K+, IV K+ must be diluted, burns
 Nursing Dx
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Slide 45
Active Transport
 Potassium
 Hyperkalemia





Increase in the body’s serum potassium level above
5 mEq/L
Gained through intake and lost by excretion
The major cause of excess potassium is renal disease; severe
tissue damage causes potassium to be released from the cell.
Excessive increase in foods high in potassium can cause serum
levels to increase.
This can cause cardiac arrest.
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Slide 46
Active Transport- Hyperkalemia
 S&S
 Typically non-specific. ECG changes best indicator, cardiac
dysrhythmias, irregular pulse rate, hypotension
 Irritability, N&V, diarrhea, colic, numbness, tingling, paralytic ileus
(Obstruction of the intestine due to paralysis of the intestinal
muscles), skeletal muscle weakness (lower legs)
 Cardiac and Respiratory arrest
 SEVERE OR PROLONGED EXCESS
 Flaccid paralysis
 Cardiac arrest
 Anuria (failure of the kidneys to produce urine)
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Slide 47
Active Transport- Hyperkalemia
 Medical Management
 Emergency treatment may include:






Calcium given into your veins (IV) to treat the muscle and heart
effects of high potassium levels
Glucose and insulin given into your veins (IV) to help lower
potassium levels long enough to correct the cause
Kidney dialysis if your kidney function is poor
Medications that help remove potassium from the intestines
before it is absorbed (Lactulose)
Sodium bicarbonate if the problem is caused by acidosis
Water pills (diuretics) to decrease total potassium
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Slide 48
Active Transport- Hyperkalemia
 Nursing Management
 Careful assessment, decrease intake of foods high in K+
(Limit or avoid asparagus, avocados, potatoes, tomatoes or tomato sauce,
winter squash, pumpkin, and cooked spinach. Limit or avoid oranges and
orange juice, nectarines, Kiwis, raisins, or other dried fruit, bananas,
cantaloupe, honeydew, prunes, and nectarines. Avoid taking salt substitutes if
you are asked to eat a low-salt diet). Admin loop diuretics, decrease or stop
medications associated with high K+, assess vital signs, monitor telemetry,
monitor I&O, monitor serum K+, monitor BS and number and character of
bowel movements
 Nursing Dx
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Slide 49
Active Transport
 Chloride
 An extracellular anion
 Normal level is 96 to 105 mEq/L.
 It is the chief anion in interstitial and intravascular
fluid.
 It has the ability to diffuse quickly between the
intracellular and extracellular compartments and
combines easily with sodium to form sodium chloride or
with potassium to form potassium chloride.
 Daily requirement is equal to that of sodium.
 The main route of excretion is the kidneys.
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Slide 50
Active Transport
 Chloride
 Hypochloremia


It usually occurs when sodium is lost, because sodium and
chloride are frequently paired.
The most common causes of hypochloremia are vomiting and
prolonged nasogastric or fistula drainage.
 Hyperchloremia

It rarely occurs but may be seen when bicarbonate levels fall.
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Slide 51
Active Transport
 Calcium
 A positively charged ion
 Normal level is 4.5 mEq/L.
 Of calcium in the body, 99% is concentrated in the
bones and teeth.
 Calcium is deposited in the bones and mobilized as
needed to help keep the blood level constant during any
period of insufficient intake.
 Vitamin D, calcitonin, and parathyroid hormone are
necessary for absorption and utilization of calcium.
 The best food sources are milk and cheese.
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Slide 52
Active Transport
 Calcium
 Hypocalcemia



Develops when the serum level is below 4.5 mEq/L
A deficiency may be caused by infusion of excess amounts of
citrated blood, excessive loss through diarrhea, inadequate
dietary intake, surgical removal of parathyroid function,
pancreatic disease, or small bowel disease.
Signs and symptoms are neuromuscular irritation and
increased excitability and tetany.
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Slide 53
Figure 22-4, A & B
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and
management of clinical problems. [6th ed.]. St. Louis: Mosby.)
Tests for hypocalcemia. A, Chvostek’s sign.
B, Trousseau’s sign.
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Slide 54
Active Transport
 Calcium
 Hypercalcemia




It occurs when calcium levels exceed 5.8 mEq/L.
It may occur when calcium stored in the bones enters the
circulation; occurs with immobilization.
An increased intake of calcium or vitamin D also may be a
cause.
Neuromuscular activity is depressed and renal calculi may
develop.
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Slide 55
Active Transport
 Phosphorus
 Chiefly an intracellular anion
 Normal level is 4 mEq/L.
 Phosphorus and calcium have an inverse relationship in
the body; an increase in one causes a decrease in the
other.
 The majority is found in bones and teeth combined with
calcium.
 Dietary intake is usually 800 to 1500 mg per day.
 An adequate intake of vitamin D is necessary for the
absorption of both calcium and phosphorus.
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Slide 56
Active Transport
 Phosphorus
 Hypophosphatemia


Can occur from a dietary insufficiency, impaired kidney
function, or maldistribution of phosphate
Muscle weakness possible
 Hyperphosphatemia


Most commonly occurs as a result of renal insufficiency; also
can occur with increased intake of phosphate or vitamin D
Signs and symptoms: tetany, numbness and tingling around
the mouth, and muscle spasms
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Slide 57
Active Transport
 Magnesium
 The second most abundant cation in the intracellular
fluid
 Normal level is 1.5 to 2.4 mEq/L.
 Although only small amounts are in the blood, it is
important in maintaining normal body function.
 The majority is found in bone, muscle, and soft tissue.
 Dietary intake is usually 200 to 400 mg per day.
 It is commonly distributed in foods: whole grains, fruits,
vegetables, meat, fish, legumes, and dairy products.
 The major route of excretion is the kidneys.
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Slide 58
Active Transport
 Magnesium
 Hypomagnesemia




Develops when blood levels fall below 1.5 mEq/L
A decreased level often parallels decreased potassium.
Signs and symptoms: increased neuromuscular irritability
similar to those observed with hypocalcemia
Major causes are increased excretion by the kidneys, impaired
absorption from the GI tract, and prolonged malnutrition.
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Slide 59
Active Transport
 Magnesium
 Hypermagnesemia




Develops when blood levels exceed 2.5 mEq/L
It rarely occurs when kidney function is normal.
Major causes are impaired renal function, excess magnesium
administration, and diabetic ketoacidosis when there is severe
water loss.
An excess of magnesium severely restricts nerve and muscle
activity.
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Slide 60
Active Transport
 Bicarbonate
 A main anion of the extracellular fluid
 Normal level is 22 to 26 mEq/L.
 It is an alkaline electrolyte whose major function is the
regulation of the acid-base balance.
 It acts as a buffer to neutralize acids in the body and
maintain the 20:1 bicarbonate/carbonic acid ratio
needed to keep the body in homeostasis.
 The kidneys selectively regulate the amount of
bicarbonate retained or excreted.
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Slide 61
Acid-Base Balance
 Acid-base balance means homeostasis of the hydrogen




ion concentration in the body fluids.
The hydrogen ion concentration is determined by the
ratio of carbonic acid to bicarbonate in the
extracellular fluid.
The ratio needed for homeostasis is 1 part carbonic
acid to 20 parts bicarbonate.
The symbol used to indicate hydrogen ion balance is
pH.
Arterial blood gases determine whether a solution is
acid, neutral, or alkaline; the more hydrogen ions in a
solution, the more acid is the solution, and the fewer
hydrogen ions, the more alkaline is the solution.
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Slide 62
Acid-Base Balance
 The body has three systems that work to keep the pH
in the narrow range of normal.
 Blood buffers: Buffers circulate throughout the body in
pairs, neutralizing excess acids or bases by contributing
or accepting hydrogen ions.
 Lungs: By speeding up or slowing down respirations, the
lungs can increase or decrease the amount of carbon
dioxide in the blood.
 Kidneys: They excrete varying amounts of acid or base.
 The three systems work closely together to maintain a
normal hydrogen ion concentration.
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Slide 63
Acid-Base Imbalance
 Respiratory Acidosis
 This is caused by any condition that impairs normal
ventilation.
 A retention of carbon dioxide occurs with a resultant
increase of carbonic acid in the blood.
 As the pH falls, the Pco2 level increases.
 Shallow respirations result because of the retained
carbon dioxide.
 Treatment is aimed at improving ventilation and
correcting the primary condition responsible for the
imbalance.
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Slide 64
Acid-Base Imbalance
 Respiratory Alkalosis
 This is caused by hyperventilation.
 Respirations that increase in rate, depth, or both can
result in loss of excessive amounts of carbon dioxide
with a resultant lowering of the carbonic acid level in
the blood.
 The pH rises because of the decrease in carbonic acid
being blown off with each exhalation.
 Treatment is sedation and reassurance; breathing into a
paper bag will cause rebreathing of the exhaled carbon
dioxide.
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Slide 65
Acid-Base Imbalance
 Metabolic Acidosis
 This can result from a gain of hydrogen ions or a loss of
bicarbonate: retaining too many acids or losing too
many bases.
 Without sufficient bases, the pH of the blood falls below
normal; the bicarbonate level will also drop.
 The effect is hyperventilation, as the lungs attempt to
compensate by blowing off carbon dioxide to lower the
Pco2 level.
 Treatment is the administration of sodium bicarbonate.
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Slide 66
Acid-Base Imbalance
 Metabolic Alkalosis
 This results when a significant amount of acid is lost
from the body or an increase in the bicarbonate level
occurs.
 The most common cause is vomiting gastric content,
normally high in acid.
 It can also occur in patients who ingest
excessive amounts of alkaline agents, such as
bicarbonate-containing antacids.
 The central nervous system is depressed.
 Treatment is aimed at the cause.
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Slide 67
Nursing Process
 Nursing Diagnoses
 Actual or risk for deficient fluid volume
 Imbalanced nutrition, less than body requirements
 Fluid volume excess
 Impaired or risk for impaired skin integrity
 Impaired tissue integrity
 Impaired oral mucous membrane
 Ineffective tissue perfusion
 Decreased cardiac output
 Impaired gas exchange
 Ineffective breathing pattern
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Slide 68