NCM112

FLUIDS AND ELECTROLYTES

Assignment 1

Instructions:

1. Study about the causes of acid base imbalances and the body organs involved,
the effects to the body and the plausible interventions. Follow the table format
below:

DISORDER CAUSES EFFECTS TO THE BODY INTERVENTIONS

RESPIRATORY  COPD  increase PR, RR,  Treatment aimed at
ACIDOSIS  emphysema BP improving
 asthma  Mental cloudiness, ventilation
 pneumonia dizziness,  Bronchodilators
 Acute pulmonary disorientation  Antibiotics for infec
edema  Feeling of fullness  Thrombolytics or
 aspiration in the head anticoagulants
 Foreign object  Decrease LOC,  Pulomnary hygiene
 atelectasis drowsiness measures
 Pneumothorax  Dysrhythmias,  Adequate hydration
 OD of sedatives Ventricular  Mechanical
 Sleep apnea fibrillation ventilation
 ARDS  Papilledema  Semi-fowler’s
 Muscular  vasodilation position
dystrophy  Hyperkalemia,
 GBS muscle weakness
 Mysanthenia  cyanosis
gravis  Tachypnea —
rapid, shallow
respirations
RESPIRATORY  hyperventilation  Lightheadedness  Breathe into a paper
ALKALOSIS  Extreme anxiety due to bag
 hypoxemia vasoconstriction  Treat underlying
 Salicylate  Inability to condition
intoxication concentrate
 Gram-negative  Numbness and
bacteremia tingling
 Inappropriate  Tinnitus
ventilator  Loss of
settings consciousness
 Chronic  tachycardia
hypocapnia  Ventricular and
 Chronic hepatic atrial
insufficiency dysrhythmias
 Cerebral tumors  N/V
 Seizures
  Deep rapid
breathing
METABOLIC  Normal anion - headache  Tx directed at
ACIDOSIS gap metabolic - confusion correcting the
acidosis - drowsiness metabolic
(hyperchloremic - Increased imbalance, fixing
acidosis) Causes: respiratory the cause of
- Results from rate, depth metabolic
direct loss of - N/V acidosis
bicarbonate - Hypotension  Bicarbonate
- Diarrhea - Cold, clammy admin.
- Lower skin
intestinal - Dysrhythmias  NaHCO3- admin
fistulas and shock during cardiac
- Ureterostomy arrest may lead
- Early renal tot paradoxical
insuff. intracellular
- Exc admin of acidosis
chloride  Monitor serum
- Administratio K+ closely
n of  In chronic
parenteral metabolic
nutrition acidosis: treat
without serum Ca+ levels
bicarbonate first to prevent
or tetany
bicarbonate  Alkalizing agents
producing  Dialysis
solutes
 High anion gap
Causes:
- Results from
excessive
accumulation
of organic
acid
- ketoacidosis
- Lactic acidosis
- Salicylate
poisoning
- uremia
- Methanol
- Ethylene
glycol toxicity
- ketoacidosis
with
starvation
METABOLIC  Vomiting  Tingling of fingers  Monitor I&O
 ALKALOSIS  Gastric suction and toes carefully
 Pyloric stenosis  dizziness  Administer sodium
 Hypokalemia  Hypertonic chloride fluids
from diuretic muscles  In patients with
therapy  Depressed hypokalemia, KCl is
(thiazide, respirations given
furosemide),  Atrial tachycardia  Cimetidine (H+
ACTH secretion  Decreased motility receptor antagonists
(Cushing’s and paralytic ileum — reduce production
syndrome,  U-waves of gastric hydrogen
Addison’s (premature chloride, dec.
disease) ventricular alkalosis caused by
contractions) on gastric suctioning
 kidneys conserve EKG  Carbonic anhydride
potassium —> inhibitors— treat
H+ excretion metabolic alkalosis
increases (H+ in patients who can’t
o HCO3 = tolerate rapid vol
alkalosis) expansion (HF)
 Potassium shifts
from inside the
cell to outside,
making H+ ions
enter the cell to
maintain
neutrality. Less
H+ ions in
plasma = greater
number of
bicarbonate ions
= alkalosis `
 Villous adenoma,
chronic ingestion
of milk and
calcium
carbonate.

2. Study and summarize the causes and effects of fluids and electrolytes
imbalances in the body and its plausible interventions. Follow the table format
below:

ELECTROLYTES CAUSES EFFECTS TO THE INTERVENTIONS

IMBALANCES BODY
HYPOVOLEMIA  Contributing  Weight  Monitor I&O
Factors loss  Monitor VS
- Vomiting  Flattene  weak rapid pulse
- Decreased d neck  orthostatic
 intake veins  hypotension
- Diarrhea  Poor  ↓ temp
- Anorexia skin  Daily weights
- Fistulas turgor  Monitor skin turgor
- Nausea  Weaknes  sternum
- Excess s  inner thigh
sweating  Oliguria  forehead
- Inability to  Thirst  Monitor tongue turgor
gain access  Concentr  ↑ longitudinal furrows
to fluid ated  smaller in size DT fluid
- Burns urine loss
- Diabetes  Confusio  dry mucous membranes
insipidus n  Monitor mental function
- Blood loss  >3 cap.  delirium
- Uncontrolle Refill  cold extremities
d DM  Sunken  Encourage/assist with
- GI suction eyes oral hygiene
- Third  Low CVP  Administer IV fluids
spacing  Cool
clammy
skin
 ↑ HBG,
HCT,
serum &
urine
osmolalit
y,
specific
gravity,
BUN,
creatinin
e ↓
 Urine
sodium,
CVP
HYPERVOLEMIA Contributing Factors: - Weight gain - Administer diuretics
- Kidney injury - Peripheral (loop, thiazide, K
- Heart failure (pitting) sparing)
- Cirrhosis edema - Restrict sodium
- Excess admin. - Ascites intake
Of Na+ - Distended - Monitor RR,
containing jugular symmetry, and
fluids veins effort
- Interstitial to - Crackles, - Monitor edema,
plasma fluid cough ascites, measure
shifts - ↑ BP, abdominal girth
(hypertonic bounding - Weight daily
fluids, burns) pulse, RR, - Strict I&O
 - Corticosteroid UO - Monitor VS
therapy - ↓ HGB, HCT, - Reposition regularly
- Severe stress BUN, serum - Semi-fowlers
- Hyperaldoster and urine position if dyspnea
onism osmolality, occurs
urine - Elevate swollen
sodium, and extremities
specific - Limit fluid intake
gravity
- CXR:
pulmonary
congestion
- Shortness
of Breath
- Dyspnea
HYPONATREMIA Contributing factors: - Anorexia - Monitor I&O
- Diuretics - N/V - Daily weights
- GI fluid loss - Headache - Monitor laboratory
- Renal disease - Lethargy values: urine specific
- Adrenal - Dizziness gravity, serum
insufficiency - Papilledema sodium levels
- Gain of water: - Dry skin - Encourage food and
excess. Admin - Abdominal fluids with high
of D5W, & cramping sodium content
H2O - ↑ Pulse - Water restriction in
supplement for - Confusion pts with normal or
pt receiving - Muscle excess fluid volume
hypotonic tube cramps - Administer fluids:
feedings /twitching Lactated ringers or
- SIADH - Weakness / 0.9 NaCl
- Medications fatigue, - SIADH: Furosemide
that retain lethargy + hypertonic sol’n +
water - Muscular lithium (observe for
(oxytocin, twitching toxicity)
tranquilizers) - Seizures - Highly hypertonic
- Psychogenic - Weight gain sol’n should be given
polydipsia - Edema slowly and pt
- Hyperglycemia - Alt. Mental monitored closely
- Heart Failure status, and because only small
coma volumes are needed
- ↓ BP, serum to elevate the Na+
and urine conc. From a low
sodium, level
urine - Pt c CV dse: assess
specific for signs of
gravity and circulatory overload
osmolality — cough dyspnea,
puffy eyelids,
 dependent edema,
excess weight gain.
Auscultate lungs for
crackles
- Monitor CNS
changes: lethargy,
confusion, muscle
twitching seizures
HYPERNATREMIA Contributing factors:  Thirst  Obtain medication hx
 Fluid deprivation  ↑ Body temp,  Monitor I&O
in pt who cannot pulse, BP  Daily weights
respond to thirst  Swollen, dry  Monitor laboratory
 Hypertonic tube tongue values: urine specific
feedings w/o  Sticky mucous gravity, serum sodium
water supplement membranes levels, serum osmolality
 Diabetes insipidus  Halucinations  Administer hypotonic
 Heat stroke  Restlessness electrolyte solution or
 Hyperventilation  Irritability isotonic non saline
 Watery diarrhea  ↑ serum Na+, solution (D5W)
 Burns urine specific  Restrict sodium intake
 Diaphoresis gravity,  Provide oral hydration
 Exc. osmolality at regular intervals
Corticosteroid,  Pulmonary  Enteral feedings—
sodium edema sufficient water
bicarbonate,  Hyperreflexia supplementation
sodium chloride  Twitching  Pts c DI— need
administration.  N/V adequate hydration
 Salt water, near  Anorexia  Monitor neurologic
drowning victims  Lethargy signs, symptoms should
 Partial/tonic- improve as the serum
clonic seizures sodium gradually
 ↓ urine sodium, reduces.
CVP  Monitor for signs of
cerebral edema
HYPOKALEMIA Contributing factors:  Lethargy, low  Encourage potassium
 Diarrhea and shallow intake through diet
 Vomiting respirations,  Monitor I&O
 Gastric suction lethal cardiac  Monitor ECG
 Corticosteroid changes, loss  Adequate urine output
admin. of urine, leg must be established
 Hyperaldosteronis cramps, limp before admin. K+ via IV
m: increases muscles, low  K+ is never given by IV
renal K+ wasting BP and HR push or IM, to avoid
 Carbencillin  Anorexia replacing K+ too
 Amphotericin B  N/V quickly. IV K+ must be
 Bulimia  Muscle admin. Through infusion
 Osmotic diuresis weakness pump.
 Alkalosis  Polyuria  < 2.5 mEq/L
  Starvation  dec. bowel  Watch for phlebitis or
 Diuretics— motility infiltrates
thiazide and loop  Ventricular  Monitor for worsening
 Digoxin toxicity asystole or signs of hypokalemia or
 Cushing’s fibrillation hyperkalemia, watch
syndrome— inc.  Paresthesias magnesium, glucose,
cortisol = dec. K+  Dysrhythmias sodium, and calcium
 Ileus, levels
abdominal  Admin KCl, potassium
distension acetate, or potassium
 Hypoactive phosphate as ordered.
reflexes  Give oral K+ with 1/2
 ECG: flattened glass of fluid to avoid
T waves, irritating gastric mucosa
prominent U  Oral K+ can produce
waves, ST small bowel lesions —
depression, monitor for abdominal
 prolonged PR dissension, pain, or GI
interval bleeding.
 Hold lasix, thiazide, or
K wasting diuretics and
hold digoxin
 Sprinolactone,
aldactone - K sparring
diuretics.
HYPERKALEMIA Contributing factors:  Muscle  Monitor I&O
 Pseudohyperkale weakness  Monitor EKG—
mia  Tachycardia Bradycardia → stop IV
 Kidney injury →Bradycard infusion of K+
 K+ sparing ia  Take apical pulse
diuretics  Dysrhythmi  Monitor serum K+,
 Metabolic acidosis as BUN, creatinine,
 Addison dse /  Flaccid glucose and ABG
hypoaldosteronis paralysis  Potassium restriction
m — deficient  Paresthesia  IV calcium gluconate if
adrenal hormones s serum K+ is
lead to Na+ loss  Intestinal dangerously elevated,
and K+ retention colic monitor for
 Crush injury  Cramps hypotension.
 Burns  Abdominal  Sodium bicarbonate in
 Stored blood bank distension severe metabolic
transfusions  Irritability acidosis — monitor for
 Rapid IV admin of  Anxiety s/sx of circulatory
K+  ECG: tall overload and
 ACE inhibitors tented T hypernatremia.
 NSAIDs waves,  IV admin regular insulin
 Cyclosporine prolonged + hypertonic dextrose
PR interval sol’n to shift K+ back
 and QRS into cells
duration,  Caution pts to use salt
absent P substitutes sparingly
waves, ST  Monitor solution
depression, concentration & rate of
Shortened administration via
QT interval infusion pump.
HYPOMAGNESEMIA Contributing factors:  Neuromuscular  Dietary sources of Mg
 Chronic irritability  Administer magnesium
alcoholism  (+) Trosseau’s salts as indicated
 Hyperparathyroidi sign  Monitor VS during mag
sm carpopedal su administration
 Hyperaldosteronis spasm induced  Monitor urine output,
m by inflating bp refer if <100ml over 4
 Kidney injury cuff 20 mmHg hours
 Malabsorption over systolic  Seizure precautions
disorders BP  Safety precautions
 Diabetic  (+) Chvostek’s  Screen for dysphagia
ketoacidosis sign
 Referring after contraction of
starvation facial muscles
 Parenteral by tapping on
nutrition facial nerve in
 laxatives, front of ear.
diarrhea  insomnia
 Acute MI, HF  Mood changes
 hypokalemia &  anorexia
hypocalcemia  vomiting
 Pharmacologic  Increased
agents tendon reflexes
 ↑BP
 ECG: PVCs, flat
or inverted T
waves,
depressed ST
segment,
prolonged PR
interval,
widened QRS
HYPERMAGNESEMIA Contributing factors:  flushing  Restrict Mg
 Kidney injury  hypotension  IV calcium gluconate
 Adrenal  Muscle and ventilation in
isufficiency wekness respiratory depression
 Excess IV  drowsiness or defective cardiac
magnesium  Hypoactive conduction
admin: PIH or reflexes  Hemodialysis with a
hypomagnesemia  Depressed magnesium free
 Diabetic respirations dialysate
 ketoacidosis:  Cardiac arrest  Loop diuretics and NaCl
catabolism causes  Diaphoresis or LR in pts with
the release of  Coma adequate renal func
cellular  Tachycardia →  Monitor VS
magnesium that bradycardia  Note shallow
can’t be excreted  ECG: respirations and
bc of a profound Prolonged PR hypotension
fluid volume interval and  Assess DTR and
depletion and QRS, peaked T changes in LOC
resulting oliguria waves  Tell pt to consult with
 Hypothyroidism their provider before
taking any OTC meds
(kidney injury/
compromised renal
function)
HYPOCALCEMIA Contributing factors:  Tetany  Dilute IV Calcium in
 Hypoparathyroidis  Numbness D5W and give as a slow
m: PTH releases  (+) Trosseau’s bolus or via IV infusion.
Ca stores from sign  Observe for signs of
the GI tract, renal carpopedal infiltration —
tubule, and spasm induced extraversion results in
bones. by inflating bp cellulitis or necrosis
 Malabsorption cuff 20 mmHg  Monitor BP during
 Pancreatitis — over systolic infusion — postural
 Ca+ ions bind BP hypotension
with fatty acids,  (+) Chvostek’s  Seizure precautions
forming soaps sign  Safety precautions as
 Pancreas releases contraction of indicated
glucagon which facial muscles  Educate pt about foods
inc. calcitonin by tapping on rich in Ca-
prod = dec Ca- facial nerve in  Oral form of Ca- with
 Alkalosis front of ear. Vit D supplement. After
 Vitamin D  Seizures — meal or at bedtime with
deficiency CNS and PNS full glass of water
 Massive irritability
subcutaneous  Irritability,
infection depression,
 Peritonitis impaired
 Massive memory,
transfusion of confusion,
citrated blood — delirium,
citrate + ionized hallucinations.
calcium removes  Bronchospasm,
Ca from the dyspnea,
circulation. laryngospasm
 Chronic diarrhea  Anxiety
 Diuretic phase of  Impaired
kidney injury: clotting time,
 Hyperphosphatem brittle hair and
ia = drop in Ca- nails,
levels hyperactive
 Burns bowel signs
 Alcoholism  Diarrhea
 ↓ BP,
prothrombin
time, Mg++
 ECG:
prolonged QT
interval,
lengthened ST.
HYPERCALCEMIA Contributing factors:  Muscular  Ca- restriction
 Hyperparathyroidi weakness: ↑Ca  Administer fluids: 0.9%
sm = ↓act. At NaCl, IV phosphate,
 Malignant myoneural Calcitonin (skin test
neoplastic dse junction. before admin. Salmon
 Prolonged  Constapation / calcitonin for reax)
immobilization: Diarrhea  Administer diuretics:
bone mineral is  Anorexia furosemide
lost = ↑Ca- in BS  N/V  Increasing pt mobility,
 Calcium supp.  Polyuria early ambulation
 Vit D excess  polydipsia  Encourage fluid intake,
 Oliguric phase of  dehydration fluids containing Na+
renal failure  Hypoactive unless CI
 Acidosis deep tendon  Adequate fiber
 Corticosteroid reflexes  Safety precautions
therapy  Lethargy, when confusion is
 Thiazide diuretic confusion, present
use: potentiate coma  Monitor for s/sx of
action of PTH on  Deep bone digitalis toxicity
kidneys = ↓ pain  Monitor vital signs esp
 Ca- urinary  Flank pain cardiac rate & rhythm
excretion.  Calcium  Admin calcitonin per dr.
 Digoxin toxicity: stones, HTN order
↑Ca aggravates  ECG:
D.T shortened ST
segment and
QT interval,
bradycardia,
heart block
HYPOPHOSPHATEMI Contributing factors:  parenthesias  Prevent infection
A  Refeeding after  Muscle  Monitor serum
starvation weakness phosphorous levels
 Alcohol  Bone pain  Monitor for infiltration
withdrawal  tenderness during IV phosphorus
 DKA  Chest pain admin.
 R&M alkalosis  confusion  Foods rich in
  Dec Mg++, K+,  cardiomyopath phosphorous:
and y
hyperparathyroidi  RF  Milk and milk products,
sm  seizures organ meats, nuts, fish,
 Acute volume  Tissue hypoxia poultry, whole grains
expansion,  Susc. To
osmotic diuresis, infections
carbonic  Nystagmus —
anhydrase eyes make
inhibitors repetitive,
 vomiting uncontrolled
 diarrhea movements
 hyperventilation
 Vitamin D def.
assoc c
malabsorptive
disorders
 Acid-base
disorders,
respiratory
alkalosis
 Parenteral
nutrition
 Burns, diuretic
and antacid use.
 Hepatic
encephalopathy
HYPERPHOSPHATEM Contributing factors:  tetany  Low phosphorus diet:
IA  Kidney injury/dse  tachycardia avoid
 Exc. intake of  Anorexia Milk and milk products,
HPO4-  N/V organ meats, nuts, fish,
 Vitamin D excesss  Muscle poultry, whole grains,
 Respiratory and weakness sardines, dried
metabolic acidosis  S/sx of fruits/vegetables, cream
 Hypoparathyroidis hypocalcemia:  Avoid phosphorus
m soft tissue containing laxatives and
 Volume depletion calcifications in enemas
 Leukemia, lungs, heart,  Educate about s/sx of
lymphoma kidney, and impending
treated with cornea hypocalcemia and
cytotoxic agents  Decreased monitoring for changes
 Inc tissue urine output in U/O
breakdown  Impaired vision Medical Mgmt.
 Rhabdomyolysis:  palpitations  Treat underlying
death of muscle condition
fibers and release  Vitamin D (calcitirol)
of their contents  Calcium binding
into the BS antacids (calcium
 carbonate, calcium
citrate)
 Amphojel
 Restrict dietary
phosphate
 Forced diuresis with
loop diuretic
 Volume replacement c
saline
 dialysis
 Surgery to remove
large Ca- deposits
HYPERCHLOREMIA Contributing factors:  Tachypnea  Monitor I&O, ABG,
 Exc. NaCl  Lethargy serum electrolytes
infusions with  Weakness  Report changes in LOC,
waterloss  Deep, rapid muscle strength, and
 Head injury (Na+ respirations movement promptly
retention)  Decline in  V/S monitoring
 hypernatremia cognitive  Respiratory assessment
 Kidney injury status, coma  Educate about avoiding
 corticosteroids  Dec cardiac foods high in chloride
 dehydration output, HTN content: Tomato juice,
 Severe diarrhea  Dyspnea bananas, dates, eggs,
(loss of  Tachycardia cheese, milk, salty
bicarbonate)  Hypervolemia, broth, canned
 Respiratory fluid retention vegetables, processed
alkalosis — Pitting meats
 Diuretics edema Medical Mgmt.:
 Overdose of  Dysrhythmias  Hypotonic IV sol’n
salicylates,  ↑ serum Cl-,  LR: converts lactate
kayexalate, K+, Na+ urine to HCO3 in the liver
acetazolamide, Cl- ↓ serum  IV NaHCO3 -
phenylbutazone, HCO3, normal increase bicarbonate
and ammonium anion gap levels, dec chloride
chloride use levels
 Hyperparathyroidi  Diuretics
sm  Na, Cl, and fluids
 Metabolic acidosis restriction
HYPOCHLOREMIA Contributing factors:  aggitation  Monitor I&O, ABG,
 Addison’s dse  Irritability serum electrolytes
 Reduced  Tremors  Report changes in LOC,
intake/absorption  Muscle cramps muscle strength, and
 Diabetic  Hyperactive movement promptly
ketoacidosis DTR  V/S monitoring
 Chronic  hypertonicity  Respiratory assessment
respiratory  tetany  Educate about foods
acidosis  Slow, shallow high in chloride
 Excessive respi content: Tomato juice,
 sweating  Seizures, coma bananas, dates, eggs,
 Vomiting &  Dysrhythmias cheese, milk, salty
diarrhea  ↑ serum HCO3, broth, canned
 NG suction, GI total CO2 ↓ vegetables, processed
drainage, gastric serum Cl-, meats
surgery Na+, K+, urine Medical Management:
 Burns, fever Cl-  Normal saline 0.9%
 Na+ and K+ NaCl
deficiency  Half strength saline
 Metabolic 0.45% NaCl
alkalosis  D/c or change diuretic
 Diuretics (loop,  Ammonium chloride tx
osmotic, thiazide) for metabolic alkalosis
 IVF that lack Cl-
 HF, CF
 Admin of
aldosterone,
corticosteroids,
bicarbonate, or
laxatives.