Nutrition Electrolyte

1. Nutrition & Electrolyte Lilley, Harrinton, Snyder (2006) Chapter 26, 52 & 53

2. Objectives: Fluid balance Dehydration IV solutions Blood products Electrolytes Vitamins Minerals Enteral nutrition Hyperalimentation

3. Physiology of Fluid balance 60% of adult bodies are water (TBW) and is distributed to 3 main compartments: Intracellular fluid: 67% Interstitial fluid: 25% Plasma volume: 8%

4. Fluid locations Intravascular Extra vascular: Plasma: Other: Extra cellular fluid: Intra cellular fluid:

5. Regulation of volume compositions The daily amount of water gained should = the daily amount of water lost. When Imbalances occur: Edema: Dehydration: The regulation of the volume and composition of body water is essential for life because it tis the medium in which metabolic reactions occur. The body maintains a balance by intake and excretion. The amount of water gained each say is equal to the amount of water lost. TThe regulation of the volume and composition of body water is essential for life because it tis the medium in which metabolic reactions occur. The body maintains a balance by intake and excretion. The amount of water gained each say is equal to the amount of water lost. T

6. Conditions that cause dehydration

8. Understanding IV fluids ISOTONIC Having the same concentration of a solute as another solution, hence exerting the same osmotic pressure as that solution HYPOTONIC Having less pressure: a solution with less osmotic pressure HYPERTONIC Having more pressure:a solution with more osmotic pressure

9. Classification of IV solutions Crystalloids Colloids Lipids Blood & blood products

10. CrystalloidsN/S, Ringers Lactate (R/L) D5W, Plasma lyte Fluids that supply water and sodium to maintain the osmotic gradient between the extravascular and intravascular compartment Contain fluid and electrolytes that are normally found in the body. Has the capacity to expand the plasma volume related to its sodium content.

11. IV FluidNursing Considerations Administer the fluids accurately and according to the hospital�s policy Monitor intake and output Monitor blood work (electrolytes, Hgb Monitor S&S of fluid overload Communicate findings

12. CrystalloidsN/S, Ringers Lactate (R/L) D5W, Plasma lyte Indications: as maintenance fluids Replace fluids and to compensate for insensible fluid losses S/E : They do not contain any large particles such as proteins, therefore do not stay within the blood vessels and can leak out of the plasma into the tissues and cells. Interactions: rare

13. NACLSodium Chloride Available in various concentrations: 0.9 % Normal Saline (isotonic saline) 0.45 % (Hypotonic saline) 3 % Hypertonic saline)

14. ColloidsDextran, Albumin, Pentaspan Substances that increase the colloid oncotic pressure (COP) and effectively move fluid from the interstitial compartment to the plasma compartment by pulling the fluid into the blood vessels therefore ? blood volume This task is normally done by albumin, globulin, fibrinogen

15. ColloidsDextran, Albumin, pentaspan Indications:They are superior to crystalloids in their ability to expand the plasma volume Contraindications: drug allergy, hypervolemia S/E can alter the coagulation times, have no oxygen carrying capacity and no clotting factors. Interactions: rare

16. Blood Products Oxygen carrying resuscitation fluids. Only class of �drug� that can carry oxygen related to it�s hemoglobin content. Increase plasma volume Improve tissue oxygenation Natural, require human donor Expensive

17. Blood Products Costly Thresholds have increased More emphasis on blood conservation programs

18. Blood Products Increase the colloid oncotic pressure and the plasma volume Plasma expanders with the ability to carry O2 Indications: Contraindications:no absolute contraindications S/E : Interactions:

19. Blood Products Whole blood: Fresh Frozen Plasma: Packed red blood cells: Platelets:

20. Blood Products:Nursing Considerations Patient history: know your patient Consent Baseline vitals Double check blood with patients blood work Inspect the unit of blood Follow the institution�s policy Monitor for S&S of reaction to blood

21. Review policy procedure:Blood products NBGH

22. Electrolytes Vital to the normal function of all systems in the body and are controlled by the rennin-angiotensin-aldosterone system, ADH system, SNS. Potassium Sodium Calcium Magnesium Chloride and phosphorus (phosphate)

23. Potassium (K+)Normal: 3.5-5.0 mmol Primary intracellular electrolyte Affects muscle contractions, transmission of nerve impulses, cardiac conduction,etc. In healthy adults, dietary intake is sufficient in maintaining adequate levels.

24. Potassium (K+)Normal: 3.5-5.0 mmol/L Hypokalemia: Hyperkalemia:

25. Potassium (K+)Normal: 3.5-5.0 mmol/L Indications: replacement therapy Contraindications:allergy to K+, hyperkalemia S/E: PO: diarrhea, N&V, GI bleed IV: pain at injection site

26. Sodium Na+Normal:135-145 mmol/L Usually obtained from the salt we eat in our diet Important role in the control of water distribution fluid and electrolyte balance and osmotic pressure of body fluids Causes diuresis

27. Sodium Na+Normal:135-145 mmol/L Hyponatremia: <134 mmol/L Hypernatremia:>145 mmol/L

28. Vitamins & Minerals Vitamins: an organic compound essential for normal physiological and metabolic function of the body Minerals: an inorganic substance that is ingested and attaches to enzymes, play a vital role in regulating many body functions Enzymes a specialized protein that catalyzes chemical reactions in organic matter Coenzyme:a non-protein substance that catalyzes chemical reactions in organic matter

29. Vitamins Fat-soluble vitamins Vitamins A, D, E, and K Water-soluble vitamins Vitamins B and C

30. Fat-Soluble Vitamins Vitamins A, D, E & K

31. Vitamin A Derived from animal fats such as those found in milk, butter, eggs Essential for:vision especially night vision Diet should supply an adequate amount Indicated: pregnancy, breastfeeding, night blindness, hyperkaratosis of skin, retarded infant growth, psoriasis, acne

32. Vitamin D�Sunshine vitamin� Responsible for the proper utilization of calcium and phosphorus Plays a role in the normal calcification of bones Derived from foods such as liver, eggs, salmon, milk, bread Indications: supplement, infant rickets, tetany, asteomalacia, to promote absorption of phosphorus and calcium

33. Vitamin E Derived from: fruits, grains, cereals, vegetables ,oils Protect the cellular membranes Indications: premature infants use as an antioxidant ?

34. Vitamin K Essential for the synthesis of blood coagulator factors which take place in the liver Synthesized by intestinal flora. Indications:infants at birth, to treat excessive effects of coumadin

35. Water Soluble vitamins B & C

36. Vitamin B(Thiamine) Beneficial drug is useful in treating many disorders Derived from: whole grain foods, liver, beans Indications: cases of malabsorption in alcoholism, cirrhosis, GI disease

37. Vitamin C Derived from:fruits, juices, tomatoes, green pepper, strawberries, mangoes, liver Important for collagen synthesis, tissue repair, maintenance of bone, teeth Enhances the absorption of calcium Aid in cellular respiration and resistance to infection Indications:pregnancy, lactation, fever, stress, burns

38. Minerals Ca, Mg, Phosphorus

39. Calcium Most abundant mineral element in the human body Efficient absorption of calcium requires adequate amounts of vitamin D Essential for the normal maintenance and function of the nervous, muscular and skeletal system and for cell membrane and capillary permeability hypocalcemia

40. Calcium (Ca+)Normal: 4.5-5.8 mmol/L Indication: replacement therapy Contraindications: drug allergy,hypercalcemia S/E: rare, anorexia, n&v, phlebitis from IV Interactions: none known

41. Magnesium (Mg+)Normal: 1.5-2.5 mmol/L Associated with energy metabolism, is required for muscle contraction and nerve physiology Dietary intake from vegetable is usually adequate Hypomagnesemia: malabsorption, alcoholism, diuretics, long term IV feeding, metabolic disorders

42. Magnesium (Mg+)Normal: 1.5-2.5 mmol/L Indications: supplement for TPN, anticonvulsant, pre-eclampsia, cardiac dysrythmias Contraindications: hypermagnesemia, heart block, renal failure, adrenal gland failure

43. Phosphorus Readily available in diet Required for the building block of body structures, ADP, AMP Deficiency states are usually from malabsorption, diarrhea, vomiting, hyperthyroidism

44. Phosphorus Indications: treat deficiency Contraindications: hyperphosphatemia S/E diarrhea, N&V

45. Nutritional Supplements Dietary products used to provided nutritional support Can be administered in a variety of ways Variety of preparations to treat a variety of medical conditions Classifications Enteral Parenteral:

46. Enteral Nutrition Provision of nutrients via the GI tract Indications: Supplement an oral diet Clients who are unable to consume/digest normal foods Undernourished because of disease process

47. Enteral Nutrition Side effects: Aspiration: Contraindications: Interactions:

48. Enteral Routes PO Gastrostomy Jejunostomy Nasoduodenal Nasojejunal Nasogastric

49. Parenteral Nutrition(TPN or Hyper alimentation) Intravenous administration Preferred method for clients who are unable to tolerate and maintain adequate enteral or oral intake Only instituted when PO or enteral feedings are not options Can be administered through a peripheral vein or a central vein

50. Nursing considerations Baseline wt Inspect IV site Monitor Blood sugar Monitor for fluid overload Monitor electrolytes Monitor in/out Monitor for diarrhea (enteral)

51. TPN Nutrients delivered through the clients circulatory system through a peripheral vein Temporary measure Most valuable in clients who don�t have large nutritional needs, can tolerate large fluid loads and need nutritional supplements only

52. TPN Indications: Contraindications: S/E Dosages:

53. Central TPN A large central vein is used to deliver nutrients directly into the clients circulation Usually subclavian or internal jugular artery