Basic Fluid & Electrolytes

2. Basic Fluid & Electrolytes Dr. Sheryl Cornelius, EdD, MSN, RN

3. Objectives for the Module… • Describe the function, distribution, and regulation of fluids and electrolytes in the body. • Identify factors affecting normal fluid and electrolyte balance. • Collect assessment data related to normal fluid and electrolyte status, across the lifespan. • Determine normal laboratory data related to fluid and electrolyte balance. • Apply the nursing process to provide culturally competent care, across the lifespan, to clients in maintaining fluid and electrolyte balance.

4. Describe the function, distribution, and regulation of fluids and electrolytes in the body. • Read pages assigned • Know the key terms of fluid shift and balance • Know the normal lab values and assessment criteria

5. Function • A medium for metabolic reactions within the cells • Transporter for nutrients, waste products, and other substances • One means of regulating and maintaining body temperature • A lubricant • An insulator and shock absorber

6. Distribution Extracellular • Interstitial fluid • Intravascular fluid • Trans cellular fluid Intracellular • In the cell

7. Movement of Body Fluids • Osmosis • Diffusion • Filtration • Active Transport

8. Regulation of Body Fluids • Fluid intake (adult: 2200 to 2700 ml/day) • Hormonal regulation: ADH, aldosterone, renin-angiotensin • Fluid output

9. Can you drink too much water?

10. Identify factors affecting normal fluid and electrolyte balance. • Intake & output • Age/gender/body size • Temperature/weather • Metabolic rate • Temperature/Vital Signs • Physical activity level • Chronic disease • Physical state • Mental state

11. Collect assessment data related to normal fluid and electrolyte status, across the lifespan. (NC Concept-Based Learning Editorial Board, 2011)

12. Assessment • Skin • Mucus membranes • Eyes • Fontanels • Respiratory system • Cardio vascular system • Neurologic

13. Determine normal laboratory data related to fluid and electrolyte balance. (NC Concept-Based Learning Editorial Board, 2011)

14. Apply the nursing process to provide culturally competent care, across the lifespan, to clients in maintaining fluid and electrolyte balance. • An elderly gentleman comes to the emergency department driven by a neighbor that picked him up off the front lawn. He has been mowing for 2+ hours, 96 degrees F outside, he presents slightly confused, normally healthy for age. Skin red, warm to touch, mucus membranes dry, eyes sunken, skin turgor inelastic, no reported urine output in last 6-8 hours. • Let’s get into groups and we will make a care plan!

15. The 154-pound adult client has had vomiting and diarrhea for 4 days secondary to a viral infection. The nurse has been monitoring intravenous fluids and urine output. What hourly urine measurement would indicate to the nurse that efforts to rehydrate this client have not yet been successful and should continue? A) 35 mL per hour B) 80 mL per hour C) 50 mL per hour D) 25 mL per hour Q1

16. The 154-pound adult client has had vomiting and diarrhea for 4 days secondary to a viral infection. The nurse has been monitoring intravenous fluids and urine output. What hourly urine measurement would indicate to the nurse that efforts to rehydrate this client have not yet been successful and should continue? A) 35 mL per hour B) 80 mL per hour C) 50 mL per hour D) 25 mL per hour A1

17. Which assessment finding obtained while taking the history of an older individual should alert the nurse to the possibility of fluid and electrolyte imbalance? A) I am often cold and need to wear a sweater, even when others are warm. B) I seem to urinate more when I drink coffee. C) In the summer, I feel thirsty more often. D) My rings are tighter this month. Q2

18. Which assessment finding obtained while taking the history of an older individual should alert the nurse to the possibility of fluid and electrolyte imbalance? A) I am often cold and need to wear a sweater, even when others are warm. B) I seem to urinate more when I drink coffee. C) In the summer, I feel thirsty more often. D) My rings are tighter this month. A2

19. What is the nurse's best action for the individual whose serum sodium level is 138 mEq/L? A) Document the findings as the only action. B) Assess the individual's deep tendon reflexes. C) Urge the individual to increase water intake. D) Notify the physician. Q3

20. What is the nurse's best action for the individual whose serum sodium level is 138 mEq/L? A) Document the findings as the only action. B) Assess the individual's deep tendon reflexes. C) Urge the individual to increase water intake. D) Notify the physician. A3

21. What is the single best indicator of fluid status in the nurse's assessment? A) Lungs B) Intake and output C) Serum electrolyte levels D) Daily body weight Q4

22. What is the single best indicator of fluid status in the nurse's assessment? A) Lungs B) Intake and output C) Serum electrolyte levels D) Daily body weight A4

23. In reviewing the results of the individual's blood work, the nurse recognizes which value that should be reported to the physician? A) Calcium 3.9 mEq/L B) Sodium 140mEq/L C) Potassium 3.8 mEq/L D) Magnesium 2.1mEq/L Q5

24. In reviewing the results of the individual's blood work, the nurse recognizes which value that should be reported to the physician? A) Calcium 3.9 mEq/L B) Sodium 140mEq/L C) Potassium 3.8 mEq/L D) Magnesium 2.1mEq/L A5

25. Post op abdominal surgery client is ordered a clear liquids diet. Mid AM the client begins to vomit, NPO status is enacted and an NG tube is placed to Low wall suction. Calculate the fluid balance for this client for a 24 hour period: IV NS at 80 ml/hr, 600 ml urine, 30 ml drainage from Jackson Pratt drain, 8 ounces of tea, 300 mL vomit, 4 ounces of coke, 8 ounces of apple juice, 1000 ml from NG tube. A) -1830 B) -1250 C) -590 D) +590 Q6

26. Post op abdominal surgery client is ordered a clear liquids diet. Mid AM the client begins to vomit, NPO status is enacted and an NG tube is placed to Low wall suction. Calculate the fluid balance for this client for a 24 hour period: IV NS at 80 ml/hr, 600 ml urine, 30 ml drainage from Jackson Pratt drain, 8 ounces of tea, 300 mL vomit, 4 ounces of coke, 8 ounces of apple juice, 1000 ml from NG tube. A) -1830 B) -1250 C) -590 D) +590 A6

27. A client is prescribed 0.9% sodium chloride (normal saline). What is the primary goal of this intravenous therapy? A) Expand the volume of fluid in the vascular system B) Pull fluid from the cells C) Keep protein levels normal D) Move fluid into the cells Q7

28. A client is prescribed 0.9% sodium chloride (normal saline). What is the primary goal of this intravenous therapy? A) Expand the volume of fluid in the vascular system B) Pull fluid from the cells C) Keep protein levels normal D) Move fluid into the cells A7

29. Which food will have the greatest impact on the water balance of the person consuming it? A) A pickle B) A banana C) A milkshake D) A spinach salad Q8

30. Which food will have the greatest impact on the water balance of the person consuming it? A) A pickle B) A banana C) A milkshake D) A spinach salad A8

31. References North Carolina Concept-Based Editorial Board, (2011). Nursing: A Concept Based Approach. Upper Saddle River, New Jersey: Pearson Education, Inc. Marquis, B. L. & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application. (6th ed.). Philadelphia : Lippincott, Williams & Wilkins. Taylor, C., Lillis, C., Lemone, P., (2011). Fundamentals of Nursing: The Art & Science of Nursing Care. (7th ed.) Philadelphia, Lippincott, Williams & Wilkins.