Fluid Electrolytes and Acid Base Balance
Fluid Electrolytes and Acid Base Balance
Fluid Electrolytes and Acid Base Balance
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 2
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 3
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
NATRIURETIC PEPTIDES
DIAGNOSTIC AND LABORATORY TESTING
● hormone-like substances that act in opposition to the
renin-angiotensin-aldosterone system CBC
ACID AND BASES • test the hematocrit and hemoglobin
● Acids release hydrogen into fluid
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 4
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
NURSING MANAGEMENT
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 5
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
HYPERVOLEMIA
ASSESSMENT
PATHOPHYSIOLOGY
• Blood Test
• Urine Specific Gravity
• CVP
RESULTS
PHARMACEUTICAL MANAGEMENT
DIAGNOSTIC FINDINGS
• PRIORITY: Restore circulation volume and remove
• Blood cell count and hematocrit level are low as a result
retained fluid
of hemodilution – a reduced ratio of blood components
o Accomplished by delivering IV fluids at times at
to watery plasma
high rates and blood components such as
albumin to restore colloidal osmotic pressure • Urine Specific Gravity – low = reflecting the larger
proportion of water
• IV diuretic may be ordered
• CVP – elevated above its normal range of 2 to 9 mmHg
NURSING MANAGEMENT
ELECTROLYTE IMBALANCES
• Monitor the patients I&O hourly or every 8 hrs SODIUM IMBALANCE
• Assess the patient’s vital signs
• Monitor the patient’s skin and tongue turgor • Sodium
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 6
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
ASSESSMENT
PATHOPHYSIOLOGY
MANAGEMENT
• Monitor I&O
• Monitor body weight
• Sodium Replacement
• Water restriction
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 7
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
SOURCE OF POTASSIUM
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 8
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
• When human blood has too little potassium, hypokalemia • Diet rich in potassium is recommended such as
develops. This could occur for a number of reasons: a. bananas, oranges, avocados, spinach, potatoes,
Not Enough in Food: Low levels might result from not tomatoes, meat, seafood, milk, and yogurt
consuming enough potassium in our diets. b. Our
kidneys occasionally eliminate too much potassium from NURSING MANAGEMENT
our bodies, which can cause renal problems. c. Certain
Drugs: Some drugs might increase the amount of • Taking potassium supplements along with potassium-
potassium we lose through urine. d. Digestive Issues: sparing diuretics is not recommended
Issues like vomiting or diarrhea can lead to potassium • If taking of parenteral potassium has ended, consume
loss. Muscle weakness, irregular heartbeats, and potassium-rich diet
potentially serious cardiac problems can result from low • Take potassium supplements with meals
potassium levels. In an effort to compensate, our body • Never use salt-substitutes when consuming potassium
attempts to deal with this by transferring potassium from since the former is potassium-based
cells into the bloodstream, but this may not be sufficient. • Monitor patient for complications
• Inform the patient's family on how to prevent, spot, and
handle hypokalemia
HYPERKALEMIA
ASSESSMENT
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 9
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
• When there is too much potassium in the blood, it is • To find out if there is acidosis, ABGs are assessed.
called hyperkalemia and is frequently caused by: a. issues • To assess the impact of hyperkalemia on cardiac
with the kidneys that impact potassium regulation. b. conduction and rhythm, an ECG is acquired and ongoing
excessive potassium intake from food or supplements. c. ECG monitoring is implemented.
potassium is released into the blood due to cell
destruction. d. Some drugs affect how potassium is PHARMACOLOGIC AND MEDICAL CARE
handled. Heart rhythm problems and muscle weakness
might result from high potassium levels. By putting • Hemodialysis or peritoneal dialysis both removes waste
potassium into cells and removing it through the kidneys. products from our blood by filtering it with a machine.
• Cation-exchange resin (Kayexalate) binds potassium in
exchange for sodium where it can be administered orally
or rectally.
• Calcium gluconate counters the effects of hyperkalemia
on cardiac conduction system.
• Potassium leaves the ECF by being taken up by the cells
through the actions of insulin and glucose.
• Albuterol may be given through a nebulizer to push
potassium into the cells temporarily
• If acidosis is present, sodium bicarbonate allows the
blood pH level to return to normal promoting the
collection of the released potassium back into the cell.
• If renal function is normal, furosemide may be given to
promote excretion of potassium.
NURSING MANAGEMENT
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 10
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
• Hypocalcemia can be caused by a variety of medical • Extracellular calcium serves to stabilize neuromuscular
disorders, but it is frequently caused by low amounts of cell membranes. This action is diminished in
parathyroid hormone (PTH) or vitamin D in your body. hypocalcemia, increasing neuromuscular irritability. The
• It can be mild or severe, temporary or chronic threshold of activation of sensory nerve fibers is also
decreased, resulting in paresthesias (alternate
POSSIBLE CAUSES sensations). The neurological system becomes more
excitable, and muscular spasms ensue. This shift in cell
• Hypoparathyroidism, infusion of citrated blood, acute membranes in the heart can result in dysrhythmias such
pancreatitis, hyperphosphatemia, inadequate dietary as ventricular tachycardia and cardiac arrest.
intake of vitamin D, or continuous or long term use of Hypocalcemia reduces the contractility of cardiac muscle
laxatives fibers, resulting in a reduction in cardiac output.
• Magnesium deficiency, medullary thyroid carcinoma, low
serum albumin levels, or alkalosis
• Use of aminoglycosides, caffeine, calcitonin,
corticosteroids, loop diuretics, nicotine, phosphates,
radiographic contrast media, or aluminum-containing
antacids
ASSESSMENT
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 11
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 12
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
PHARMACEUTICAL MANAGEMENT
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 13
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 14
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
o Magnesium Chloride
o Magnesium Lactate
NURSING MANAGEMENT
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 15
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
HYPERMAGNESEMIA
ASSESSMENT
NURSING MANAGEMENT
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 16
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 17
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
RESPIRATORY ALKALOSIS
CAUSE
• ABG- pH is less than 7.35 and PaCO2 is greater than ● Hyperventilation exceeding 40 breaths/ minute
45 mmHg ● Cardiac arrhythmias that fail to respond to conventional
o Bicarbonate level starts off normal but rises to treatment
more than 26 mEq/L ● Twitching (possibly progressing to tetany)
• Serum electrolytes may demonstrate hypochloremia ● pH above 7.45 and normal HCO3 − level (during an
(chloride level 98 mEq/L acute episode); normal pH and HCO3 − below 22
• Pulmonary function test mEq/L (during compensation in an acute episode); and
normal pH, HCO3 − below 22 mEq/L, and PaCO2
PHARMACOLOGIC AND MEDICAL CARE below 32 mm Hg (during a chronic episode)
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 18
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
● If anxiety is the cause, the patient is told to breathe ● Evaluate the patient for signs and symptoms of
more slowly to let CO2 build up or to breathe into a metabolic acidosis, which may include rapid and
closed system (like a paper bag). shallow breathing (tachypnea), confusion, lethargy,
● In highly anxious people, an anti-anxiety medication weakness, fatigue, nausea, vomiting, and abdominal
could be necessary to stop hyperventilation pain.
● Provide oxygen when hypoxia is the cause of ● Assess vital signs, including blood pressure, heart rate,
hyperventilation respiratory rate, and body temperature.
● Teach the patient and family how to perform relaxation ● Rapid Breathing or shortness of breath
techniques and prevent, recognize, and treat ● Weakness and Fatigue
hyperventilation. ● Dehydration signs
● Teach the patient and family about safety precautions ● Hyperventilation (Kussmaul’s respirations)
for household medications. ● Nausea and Vomiting
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 19
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
● Monitor vital signs regularly hydrogen ions to restore ECF potassium levels. Urinary
● Assess respiratory status chloride levels may be normal or greater than 250
● Monitor ABG results mEq/24 hours
● Administer intravenous (IV) fluids ● Serum electrolytes - often demonstrate decreased
● Monitor electrolyte levels serum potassium (< 3.5 mEq/L) and decreased chloride
(< 95 mEq/L) levels. The serum bicarbonate level is
METABOLIC ALKALOSIS high.
● Diuretic use such as loop diuretics (e.g., furosemide) ● Monitor vital signs regularly
and thiazide diuretics (e.g., hydrochlorothiazide), can ● Assess the patient's level of consciousness,
cause excessive loss of chloride and potassium ions, neuromuscular function, and any signs of
leading to metabolic alkalosis neuromuscular irritability
● Excessive Antacid Use ● Monitor the patient's respiratory status
● Excessive Alkali Ingestion ● Monitor electrolyte levels, particularly potassium (K+),
sodium (Na+), and chloride (Cl-), as imbalances are
ASSESSMENT common with metabolic alkalosis.
● Watch for complications related to metabolic alkalosis,
● Obtain a detailed medical history
such as cardiac arrhythmias, seizures, or muscle cramps,
● Evaluate the patient for signs and symptoms a and intervene promptly if they occur.
● Assess the patient's hydration status
● Examine for muscle weakness or spasms CUT DOWN / CVP INSERTION
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 20
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 21
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
o Hemoglobin: This measures the amount of bicarbonate to carbonic acid ratio back to 20:1, full
hemoglobin, the protein responsible for compensation (and thus normal pH) will be achieved.
carrying oxygen to your cells, in your blood.
o Oxygen saturation (O2Sat): This measures how pH > 7.45 (alkalosis)
much hemoglobin in your blood is carrying pH < 7.35 (acidosis)
oxygen. Hemoglobin is a protein in your red pH = 7.4 (normal)
blood cells that carries oxygen from your lungs 2. The next step is to determine the primary cause of the
to the rest of your body. disturbance. This is done by evaluating the PaCO2 and
o Partial pressure of oxygen (PaO2): This HCO3− in relation to the pH.
measures the pressure of oxygen dissolved in
your blood. It helps show how well oxygen Example: pH > 7.45 (alkalosis)
moves from your lungs to your bloodstream.
a. If the PaCO2 is less than 35 mm Hg, the primary disturbance is
o Partial pressure of carbon dioxide (PaCO2): This
respiratory alkalosis. (This situation occurs when a patient
measures the amount of carbon dioxide in your
hyperventilates and “blows off” too much CO2. Recall that CO2
blood and how well carbon dioxide can move
dissolved in water becomes carbonic acid, the acid side of the
out of your body.
“carbonic acid–bicarbonate buffer system.”)
o pH: This measures the balance of acids and
bases in your blood, known as your blood pH b. If the HCO3− is greater than 27 mEq/L, the primary disturbance
level. The pH of blood is usually between 7.35 is metabolic alkalosis. (This situation occurs when the body gains
and 7.45. If it’s lower than that, your blood is too much bicarbonate, an alkaline substance. Bicarbonate is the
considered too acidic. If it’s higher than that basic or alkaline side of the “carbonic acid–bicarbonate buffer
range, your blood is considered too basic system.”)
(alkaline).
o Bicarbonate (HCO3): This is calculated using Example: pH < 7.35 (acidosis)
the measured values of pH and PaCO2 to
determine the amount of the basic compound c. If the PaCO2 is greater than 40 mm Hg, the primary disturbance
made from carbon dioxide (CO2.) is respiratory acidosis. (This situation occurs when a patient
hypoventilates and thus retains too much CO2, an acidic
substance.)
ASSESSING ABG d. If the HCO3− is less than 24 mEq/L, the primary disturbance is
metabolic acidosis. (This situation occurs when the body’s
The following steps are recommended to evaluate arterial blood bicarbonate level drops, either because of direct bicarbonate loss
gas values. They are based on the assumption that the average or because of gains of acids such as lactic acid or ketones.)
values are:
3. The next step involves determining if compensation has begun.
pH = 7.35–7.45 This is done by looking at the value other than the primary
PaCO2 = 35–45 mm Hg disorder. If it is moving in the same direction as the primary value,
HCO3− = 24 to 27 mEq/L compensation is under way. Consider the following gases:
1. First, note the pH. It can be high, low, or normal, as follows:
The first set (1) indicates acute respiratory acidosis without
A normal pH may indicate perfectly normal blood gases, or it compensation (the PaCO2 is high, the HCO3− is normal). The
may indicate a compensated imbalance. A compensated second set (2) indicates chronic respiratory acidosis. Note that
imbalance is one in which the body has been able to correct compensation has taken place—that is, the HCO3− has elevated
the pH by either respiratory or metabolic changes (depending to an appropriate level to balance the high PaCO2 and produce a
on the primary problem). normal pH.
pH PaCO2 HCO3−
For example, a patient with primary metabolic acidosis starts
out with a low bicarbonate level but a normal CO2 level. Soon (1) 7.2 60 mm Hg 24 mEq/L
afterward, the lungs try to compensate for the imbalance by
exhaling large amounts of CO2 (hyperventilation). (2) 7.4 60 mm Hg 37 mEq/L
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
Page | 22
PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
changes. When the PaCO2 is ↑ and the HCO3 is ↓, respiratory • Another isotonic solution is normal saline solution, which
acidosis and metabolic acidosis coexist. When the PaCO2 is ↓ and includes solely the electrolytes sodium and chloride.
the HCO3 is ↑, respiratory alkalosis and metabolic alkalosis Other isotonic fluids resemble ECF more.
coexist. • Ringer's solution, for example, comprises sodium,
Example: Metabolic and respiratory acidosis potassium, calcium, and chloride. Lactated Ringer's
a. pH 7.2 decreased pH (indicates acidosis) solution contains these electrolytes as well as lactate,
which is converted to bicarbonate by the liver.
b. PaCO2 52 increased pH (indicates respiratory acidosis)
c. HCO3 13 decreased HCO3 (indicates metabolic acidosis) HYPOTONIC FLUIDS
5. If metabolic acidosis exists, then calculate the anion gap (AG) to • Because fluid flows from the extracellular space into cells,
determine the cause of the metabolic acidosis (AG vs. non-AG): causing them to swell, hypotonic solutions should be
used with caution. Because of vascular fluid loss, this
AG = Na − (Cl- + HCO3-)
fluid transfer might trigger cardiovascular collapse. Fluid
Normal AG = 10−14 mmol/L moving into brain cells can potentially produce increased
intracranial pressure (ICP).
6. Evaluate the patient to determine if the clinical signs and • Hypotonic solutions shouldn’t be given to a patient at
symptoms are compatible with the acid–base analysis. risk for increased ICP for example, those who have had a
stroke, head trauma, or neurosurgery. Signs of increased
ICP include a change in the patient’s level of
PARENTERAL FLUID THERAPY consciousness, motor or sensory deficits, and changes in
the size, shape, or response to light in the pupils.
• In patients who are NPO, parenteral fluid therapy, also
• Hypotonic solutions also shouldn’t be used for patients
termed IV fluid therapy, is used to administer fluids.
who suffer from abnormal fluid shifts into the interstitial
• The choice of an IV solution depends on the purpose of space or the body cavities for example, as a result of liver
its administration. Generally, IV fluids are given to disease, a burn, or trauma
achieve one or more of the following goals:
• Have an osmolality less than 275 mOsm/kg.
o To provide water, electrolytes, and nutrients to
• Examples:
meet daily requirements
o half-normal saline solution
o To replace water and correct electrolyte deficits
o 0.33% sodium chloride solution
o To administer medications and blood products
o dextrose 2.5% in water
FLUID REPLACEMENT
HYPERTONIC FLUIDS
• The balance of fluids and electrolytes in the intracellular
• Hypertonic fluids include 3% NaCl and IV mannitol.
and extracellular areas must be generally consistent to
ensure health. I.V. is used if a person has a disease or a • If a patient is sodium depleted, a hypertonic sodium IV
condition that inhibits regular fluid intake or causes solution might be used.
excessive fluid loss. Fluid replenishment may be • If a patient is experiencing acute cerebral edema, IV
required. mannitol is often used.
• I.V. Therapy that supplies the patient with life-sustaining • Hypertonic solutions pull water from the interstitial and
fluids, electrolytes, and drugs has the benefit of intracellular compartments into the bloodstream.
delivering quick and predictable therapeutic results. • These solutions draw water out of intracellular
• When a patient suffers GI malabsorption, this method compartments causing cellular dehydration.
also allows for fluid intake. I.V. Therapy allows for precise • Examples:
dose titration of analgesics and other drugs. o dextrose 5% in half-normal saline solution
o dextrose 5% in normal saline solution
TYPES OF INTRAVENOUS SOLUTIONS o dextrose 5% in lactated Ringer’s solution
o dextrose 10% in water
ISOTONIC FLUIDS
COLLOIDS
• Isotonic solutions, such as D5W, have an osmolality (or
concentration) of 275 to 295 mOsm/kg. The dextrose • Colloids attract fluid to the circulation. If the capillary
metabolizes quickly, however, acting like a hypotonic lining is normal, the effects of colloids linger for several
solution and leaving water behind. days. During a colloid infusion, the patient should be
• Large amounts of the solution may cause hyperglycemia. continuously watched for symptoms of hypervolemia
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA
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PLM BS
NURSING MEDICAL-SURGICAL NURSING I Course Code:
NRS 3113
1ST SEMESTER LECTURE
(AY. 2023-2024)
TOPIC: FLUID & ELECTROLYTES AND ACID-BASE BALANCE
REFERENCE: BSN 3-9 Grp. 3 Written Report CLINICAL INSTRUCTOR: Prof. Joshua Nathaniel V. Ellano
DELIVERY METHODS
PERIPHERAL LINES
CENTRAL LINES
COMPLICATIONS OF IV THERAPY
• Infiltration
• Infection
• Phlebitis and Thrombophlebitis
• Extravasation
• Air Embolism
L.M. ALEJAGA | G.A.A. GARCIA | K.C. PEREZ | J.C. RACHO | K.A.E. TABUZO | K.G.L. TAN | A.B. VALDEHUESA