Lecture Notes: Fluid and Electrolyte Imbalances & Acid-Base Imbalances

Course Overview

• Unit 4: Covers Chapters 11 and 12
• Focus Areas:
  • Care of patients with fluid and electrolyte imbalances
  • Care of patients with acid-base imbalances
• Syllabus: Important to review the syllabus for page numbers and specific reading materials.

Fluid Imbalances

• Types:
  • Fluid Volume Deficit (Dehydration):
    • Causes: Lack of fluid intake, diuretics (e.g., Lasix), vomiting, diarrhea, fever, burns, diabetes insipidus.
    • Symptoms: Rapid weight loss, thirst, hypotension, tachycardia, dry mucous membranes, reduced skin turgor.
    • Labs: Increased osmolarity, urine specific gravity, elevated BUN.
  • Fluid Volume Overload (Hypervolemia):
    • Causes: Excess fluid intake, retention.
    • Symptoms: Distended neck veins, pitting edema, dyspnea, rapid respiration.

Electrolyte Imbalances

• Common Electrolytes: Potassium, Calcium, Magnesium, Sodium
  • Hyponatremia (<135 mEq/L):
    • Causes: Dehydration, fluid imbalances.
    • Symptoms: Headache, confusion, seizures.
  • Hypernatremia (>145 mEq/L):
    • Causes: Water loss (diarrhea), excessive sodium intake.
    • Symptoms: Increased mortality risk, dehydration.
  • Hypokalemia (<3.5 mEq/L):
    • Causes: Diuretics (e.g., Lasix), malnutrition.
    • Symptoms: Cardiac issues, respiratory failure, hypoactive bowel sounds.
  • Hyperkalemia (>5 mEq/L):
    • Causes: Kidney failure, trauma.
    • Symptoms: Cardiac dysrhythmias, muscle weakness.
  • Hypocalcemia (<4.5 mEq/L):
    • Causes: Insufficient calcium/vitamin D intake.
    • Symptoms: Muscle spasms, Chvostek's sign.
  • Hypercalcemia (>5.5 mEq/L):
    • Causes: Hyperparathyroidism.
  • Hypomagnesemia (<1.5 mEq/L):
    • Causes: Alcoholism, diabetes.
    • Symptoms: Depression, seizures.
  • Hypermagnesemia (>2.5 mEq/L):
    • Causes: Renal issues, laxatives.
    • Symptoms: Muscle weakness, drowsiness.

Acid-Base Imbalances

• Acidosis vs. Alkalosis:
  • Acidosis: pH < 7.35
  • Alkalosis: pH > 7.45
• Types of Imbalances:
  • Respiratory Acidosis:
    • Causes: Respiratory depression, airway obstruction.
    • Symptoms: Hyperkalemia.
  • Respiratory Alkalosis:
    • Causes: Hyperventilation.
  • Metabolic Acidosis:
    • Causes: Diarrhea, renal failure.
  • Metabolic Alkalosis:
    • Causes: Vomiting.
• ROME Method: Respiratory Opposite, Metabolic Equal
  • Respiratory: CO2 affects pH inversely.
  • Metabolic: HCO3 affects pH directly.

Nursing Considerations

• Assessments:
  • Monitor vital signs, daily weights, mental status.
  • Check apical pulse, respiratory depth.
  • Watch for orthostatic hypotension and ensure safe fluid management.
• Interventions:
  • Administer fluids carefully to avoid overload.
  • Educate patients about diet/lifestyle changes.
  • Report abnormal lab values to providers.

Conclusion

• Memorize critical lab values and understand their implications.
• Identify causes and symptoms of imbalances.
• Utilize knowledge in clinical assessments and interventions.