Fluid & Electrolyte Imbalances

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Learning Outcomes
Safe and Effective Care Environment
1Assess the patient with a fluid or electrolyte imbalance for falls, especially older adults. 2Use safety precautions to prevent injury or death when administering parenteral potassium-containing solutions. 3Supervise the oral fluid therapy and intake and output measurement aspects of care delegated to unlicensed assistive personnel.

Health Promotion and Maintenance
4Teach healthy adults and patients how to prevent dehydration. 5Assess patients for factors that increase the risk for fluid and electrolyte imbalances, especially for older adults. 6Teach patients at risk for fluid or electrolyte imbalances as a result of drug therapy about the manifestations of the imbalance.

Physiological Integrity
7Explain the relationship between weight gain or loss and fluid imbalances. 8Apply knowledge of the anatomic and physiologic responses to aging when assessing hydration status of an older adult. 9Use laboratory data and clinical manifestations to determine the presence of fluid or electrolyte imbalances. 10Interpret blood chemistry laboratory results to determine whether the patient has a fluid or electrolyte imbalance and to determine effectiveness of interventions. 11Assess the breathing effectiveness of any patient with skeletal muscle weakness from an electrolyte imbalance. 12Prioritize interventions for patients who have dehydration or fluid overload. 13Prioritize interventions for patients who have specific electrolyte imbalances.

HOMEOSTASIS
* The body has many control mechanisms, called homeostatic mechanisms to prevent fluctuations in fluid and electrolytes.

* Water is the most common substance in the body, making up about 55% to 60% of total body weight for healthy younger adults and 50% to 55% of total body weight for healthy older adults. * This water (fluid) is divided into two main spaces or compartments: 1. Extracellular fluid (ECF): The portion of total body water (about one third/ 15 L) that is in the space outside the cells. This space also includes interstitial fluid, blood, lymph, bone, and connective tissue water, and the transcellular fluids. 2. Intracellular fluid ( ICF): The portion of total body water (about two thirds/ 25 L) that is found inside the cells. 3. Transcellular fluid: Any of the fluids in special body spaces, including cerebrospinal fluid, synovial fluid, peritoneal fluid, and pleural fluid. * Water is needed to deliver dissolved nutrients, electrolytes, and other substances to all organs, tissues, and cells. * For proper function, the volume of all body fluids and the types and amount of dissolved substances must be carefully balanced. ANATOMY AND PHYSIOLOGY REVIEW: PHYSIOLOGIC INFLUENCES ON FLUID AND ELECTROLYTE BALANCE * Body fluids are composed of water and particles dissolved or suspended in water. * The solvent is the water portion of fluids.

* Solutes are the particles dissolved or suspended in the water. * When solutes express an overall electrical charge they are known as electrolytes. * Body function depends on keeping the correct balance of fluid and electrolytes within each body fluid space. * Specific processes control normal fluid and electrolyte balance so the internal environment remains stable even when the external environment changes. * These processes are filtration, diffusion, osmosis, and active transport. a. Filtration: The movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of the membrane. b. Diffusion: The spontaneous, free movement of particles (solute) across a permeable membrane down a concentration gradient; that is, from an area of higher concentration to an area of lower concentration. * They determine how, when, and where fluids and particles move across cell membranes.

FLUID BALANCE: BODY FLUIDS
* A person’s age, gender, and amount of fat...