1. Fluid and Electrolytes,
Balance and Disturbances
By:
Ms. katherina

2. Mechanism for fluid and
electrolyte movement
osmosis filtration
diffusion
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3. osmosis
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4. diffusion
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5. diffusion
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6. filtration
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7. Fluid and electrolyte
balances
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8. cations
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9. sodium potassium
calcium magnesium
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10. Electrolytes are measured
milliequivalent per litre
of water
(mEq / L)
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11. Equivalent refers to the chemical
combining power of a substance or
the power of cations to unite with
anions to form molecules
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12. #

13.  most abundant cat ion in the
extracellular fluid
 sodium is regulated by
Salt intake Aldosterone
Urinary output
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14. functions
Maintain balance of extracellular fluid, thereby
it controls the movements of the water between
fluid compartments
Transmission of nerve impulses
Neuro muscular and myocardial impulse
transmission
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15. Normal concentration
of sodium
135 to 145
mEq/L
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16. #

17. Main intracellular cat ion
Helps in maintaining fluid balance of
the intracellular fluid
Potassium is regulated by
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18. functions
Regulates neuromuscular excitability and muscle
contraction
Needed for glycogen formation and protein
sunthesis
Correction of acid base imbalances. Potassium
ion can be exchanged with hydrogen ion (H+)
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19. Normal concentration
of potassium
3.5 to 5.3
mEq/L
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20. #

21. Calcium is the most abundant element
in the body
Calcium is extracellular fluid
Regulated by the action of
Thyroid gland parathyroid gland
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22. Parathyroid hormone (PTH) controls
the balance among bone calcium,
gastrointestinal absorption and
kidney excretion of calcium.
Thyrocalcitonin from the thyroid
gland inhibits the release of calcium
from bones, thus playing a minor
role in determining serum calcium
levels.
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23. functions
Maintenance of cell membrane, its integrity and
structure
Conduction of nerve impulses in the skeletal
muscle
Stimulation and depolarization and contraction
of cardiac muscles
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24. functions
Aids in blood coagulation
Growth and formation of bones
Muscle relaxation
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25. Normal concentration
of calcium
4 to 5
mEq/L
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26. #

27. Magnesium is the second most
important cat ion in the
intracellular fluid
It has an inhibitory effect on
skeletal muscles.
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28. functions
Precipitation of metabolic activities of cells
Enzyme activity
Neuro chemical activity
Muscular excitability
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29. Normal concentration
of magnesium
1.5 to 2.4
mEq/L
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30. anions
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31. chloride
phosphate
bicarbonate
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32. #

33. Phosphate is a buffer anion in
extracellular and intracellular fluid
Phosphate absorption is through
gastrointestinal tract in a range of 3 to
12 mg/100 ml
Calcium and phosphate are inversely
proportional.
When one rises the other falls
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34. Serum phosphate is regulated by
kidneys
Parathyroid hormone
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35. Activated vitamin D
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36. functions
Development and maintenance of bones and
teeth
Promotes normal neuromuscular action
Participates in carbohydrate metabolism
Assist in acid base regulation
Maintains levels of ATP ( Adenosine
Triphosphate) and thus energy levels #

37. Normal concentration
of phosphate
2.5 to 4.5
mEq/L
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38. #

39. Chlorides are found in extracellular and
intracellular fluids
The chloride ion balances the cations
within the extracellular fluid
The ion exchange helps to maintain the
electrical neutrality
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40. Chloride is regulated through
kidneys
The dietary intake of chloride and
the amount excreted in urine are
closely related
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41. Normal concentration
of chloride
100 to 106
mEq/L
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42. #

43. Bicarbonate is found in extracellular
and intracellular fluids
It is a major chemical buffer in the
body
Regulation is through kidneys
It is an essential component of the
carbonic acid-bicarbonate buffering
system essential to acid base balance
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44. Normal arterial
bicarbonate value
22 to 26
mEq/L
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45. Normal venous
bicarbonate value
24 to 30
mEq/L
In venous blood, bicarbonate
is measured as
carbondioxide content
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46. FLUID VOLUME
DISTURBANCES
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47. Fluid
volume deficit
hypovolemia
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48. Fluid Volume Deficit
Mild – 2% of body weight loss
Moderate – 5% of body weight loss
Severe – 8% or more of body
weight loss
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49. Pathophysiology
results from loss of
body fluids and occurs
more rapidly when coupled
with decreased fluid
intake
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50. Clinical manifestations
Acute Weight loss
Decreased skin turgor
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51. Concentrated urine
flattened neck veins
Postural hypotension
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52. Weak, rapid, heart rate
 Oliguria
Increased temperature
Decreased central venous pressure
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53. Nursing Diagnosis
Fluid volume Deficit r/t
Insufficient intake, vomiting, diarrhea,
hemorrage, m/b dry mucous membranes
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54. Nursing management
Restore fluids by oral or IV
Treat underlying cause
Monitor I & O at least every 8
hours
Daily weight
Vital signs
Skin turgor
Urine concentration
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55. Fluid
volume excess
hypervolemia
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56. Pathophysiology
may be related to
fluid overload or
diminished function of the
homeostatic mechanisms
responsible for regulating
fluid balance
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57. Contributing factors
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58. Clinical manifestations
Edema
Distended neck veins
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59. Tachycardia
Increased blood
Pressure
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60. Increased weight
crackles
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61. Nursing Diagnosis
Fluid volume excess r/t
CHF, excess sodium intake,
renal failure
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62. Nursing management
Preventing FVE
Detecting and Controlling FVE
Teaching patients about edema
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63. Electrolyte Imbalances
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64. SODIUM
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65. Sodium
Normal range – 135 to 145 mEq/L
Primary regulator of ECF
volume (a loss or gain of sodium is
usually accompanied by a loss or
gain of water)
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66. HYPONATREMIA
Sodium level less
than 135 mEq/L
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67. causes
Vomiting Diarrhea
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68. Sweating Diuretics
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69. Clinical manifestations
Poor skin
turgor Dry mucosa
Decreased
saliva production Anorexia
vomiting
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70. Clinical manifestations
Nausea/
Orthostatic
abdominal
hypotension
cramping
Confusion &
Altered mental lethargy
status
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71. Nursing interventions
 Assess clinical manifestations
 Monitor fluid intake and output, vital
signs and lab data.
 Encourage food and fluids high in Na
 Limit water intake.
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72. HYPERNATREMIA
Sodium level more
than 145 mEq/L
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73. CAUSES
Loss of fluids
Water deprivation
Excessive salt intake
Conditions like Diabetes insipidus,
heatstroke
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74. Pathophysiology
- Fluid deprivation in patients who
cannot perceive, respond to, or
communicate their thirst
- Most often affects very old, very
young, and cognitively impaired
patients
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75. Clinical manifestations
- Thirst
- Sticky mucous membranes
- Flushed skin
- Postural hypotension
- Dry, swollen tongue
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76. Nursing interventions
Monitor intake and output
Monitor behavioural changes
Monitor lab findings
Encourage fluids
Monitor diet as ordered(salt
restriction)
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77. POTASSIUM
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78. Normal serum potassium
concentration is 3.5 to 5.5 mEq/L
Major Intracellular electrolyte
and 98% of the body’s potassium is
inside the cells
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79. HYPOKALEMIA
Potassium level less
than 3.5 mEq/L
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80. CAUSES
Loss of K+ in the form of
vomittings ,GI suction
poor K intake
diuretics
steroid administration
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81. Clinical manifestations
 Muscle weakness
 Leg cramps
 Fatigue
 Lethargy
 Anorexia
 Nausea, vomitting
 Decreased bowel sounds
 Decreased bowel motility
 Cardiac dysrhythmias
 Depressed deep tendon reflex #

82. Nursing interventions
Monitor heart rate and rhythm
Monitor clients receiving DIGITALIS
Administer oral K+ as ordered with
food /fluids
Administer IV K+ as ordered ,flow
rate not more than 10-20 meq/hr
Teach patients about potassium rich
diet and to reduce potassium wastage
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83. HYPERKALEMIA
Potassium level more
than 5.5 mEq/L
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84. Causes
 Decreased renal potassium excretion as
seen with renal failure and oliguria
 High potassium intake
 Renal insufficiency
 Shift of potassium out of the cell as
seen in acidosis #

85. Clinical manifestations
Skeletal muscle weakness/paralysis
ECG changes – such as peaked T waves,
widened QRS complexes
Heart block
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86. Nursing interventions
Monitor ECG changes – telemetry
Administer Calcium solutions to
neutralize the potassium
Monitor muscle tone
Give Kayexelate
Give Insulin and D50W
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87. CALCIUM
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88. Normal serum calcium level is 4
to 5 mEq/L
More than 99% of the body’s
calcium is located in the skeletal
system
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89. HYPOCALCEMIA
Calcium level less
than 4 mEq/L
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90. Causes
- Vitamin D/Calcium deficiency
- Primary/surgical
hyperparathyroidism
- Pancreatitis
- Renal failure
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91. Clinical Manifestations
Tetany and cramps in muscles of
extremities
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92. Trousseau’s sign – carpal
spasms
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93. Chvostek’s sign – cheek
twitching
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94. Seizures, mental changes
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95. ECG shows prolonged QT
intervals
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96. Nursing interventions
- IV/PO Calcium Carbonate or Calcium
Gluconate
- Encourage increased dietary intake
of Calcium
- Monitor neurlogical status
- Establish seizure precautions
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97. HYPERCALCEMIA
Calcium level more
than 5 mEq/L
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98. Causes
- Hyperparathyroidism
- Prolonged immobilization
- Thiazide diuretics
- Large doses of Vitamin A and D
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99. Clinical manifestations
- Muscle weakness, nausea and
vomiting
- Lethargy and confusion
- Constipation
- Cardiac Arrest
(high level)
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100. Nursing interventions
- Eliminate Calcium from diet
- Monitor neurological status
- Increase fluids (IV or PO)
- Calcitonin
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101. MAGNESIUM
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102. Normal serum magnesium level
is 1.5 to 2.4 mEq/L
Thought to have a direct
effect on peripheral arteries
and arterioles
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103. HYPOMAGNESEMIA
magnesium level less
than 1.5 mEq/L
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104. Causes
- Chronic Alcoholism
- Diarrhea, or any disruption in small
bowel function
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105. - TPN
- Diabetic ketoacidosis
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106. #

107. Clinical manifestations
- Neuromuscular irritability
- Positive Chvostek’s and Trousseau’s
sign
- EKG changes with prolonged QRS,
depressed ST segment, and cardiac
dysrhythmias
- May occur with hypocalcemia and
hypokalemia
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108. • Starved – possible cause of
hypomagnesemia
• Seizures
• Tetany
• Anorexia and arrhythmias
• Rapid heart rate
• Vomiting
• Emotional lability
• Deep tendon reflexes increased
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109. Nursing interventions
- IV/PO Magnesium replacement,
including Magnesium Sulfate
- Give Calcium Gluconate if
accompanied by hypocalcemia
- Monitor for dysphagia, give soft
foods
- Measure vital signs closely
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110. Foods high in Magnesium:
Green leafy vegetables
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111. Nuts
Legumes
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112. Seafood
Chocolate
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113. HYPERMAGNESEMIA
magnesium level
more than 2.4 mEq/L
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114. Causes
- Renal failure
- Untreated diabetic ketoacidosis
- Excessive use of antacids and
laxatives
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115. Clinical manifestations
- Flushed face and skin warmth
- Mild hypotension
- Heart block and cardiac
arrest
- Muscle weakness and even paralysis
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116. RENAL
• Reflexes decreased (plus weakness
and paralysis)
• ECG changes (bradycardia and
hypotension)
• Nausea and vomiting
• Appearance flushed
• Lethargy (plus drowsiness and
coma)
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117. Nursing interventions
- Monitor Mg levels
- Monitor respiratory rate
- Monitor cardiac rhythm
- Increase fluids
- IV calcium for emergencies
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118. PHOSPHORUS
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119. Normal serum phosphorus
level is 2.5 to 4.5 mg/100 ml
- Phosphate levels vary inversely
to calcium levels
- High Calcium = Low Phosphate
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120. HYPO
PHOSPHOTEMIA
Phosphorus level
less than 2.5 mEq/L
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121. Causes
- Most likely to occurs with
overzealous intake or
administration of simple
carbohydrates
- Severe protein-calorie
malnutrition (anorexia
or alcoholism)
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122. Clinical manifestations
- Muscle weakness
- Seizures and coma
- Irritability
- Fatigue
- Confusion
- Numbness
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123. Nursing interventions
- Prevention is the goal
- IV Phosphorus for severe
- Prevention of infection
- Monitor phosphorus levels
- Increase oral intake of
phosphorus rich foods
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124. Foods rich in phosphorus
- Milk and milk products
- Poultry
- Whole grains
- Organ meats
- Nuts
- Fish
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125. HYPER
PHOSPHOTEMIA
Phosphorus level
more than 4.5 mEq/L
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126. Causes
- Renal failure
- Chemotherapy
- Hypoparathyroidism
- High phosphate intake
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127. Clinical manifestations
- Tetany
- Muscle weakness
- Similar to Hypocalcemia because
of reciprocal relationship
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128. Nursing interventions
- Treat underlying cause
- Avoid phosphorus rich foods
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129. #

130. #