Fluid and Electrolyte Nursing Care Management 112

There are many ways of looking at man but nowhere in a better way than seeing than
in a fluid and electrolyte metabolism. Fluid and Electrolyte balance is a dynamic process of
equilibrium in which internal condition change and vary but always within relative narrow
limits. It is the active mechanism of the body to maintain homeostasis, thus maintaining
within the bounce of optimal wellness and health.
This unit covers the basic concepts in fluid and electrolyte balance, as well as acid
base balance, the various conditions with fluids and electrolyte imbalances, and the
approaches in nursing care management in tending patients with the said problems.
It includes evidence-based case scenarios with guided questions that encourage you
(my dear student) to develop and utilize your critical-thinking skills, to create your own
study guides, drug and laboratory analysis, and formulate nursing care plans.
Fluids
 Body Fluid is a solution of water, electrolytes, and non-electrolytes. An average
healthy adult is 60 percent made up of fluids.
 Body fluids is divided into two compartments:
o Intracellular (ICF)- fluids within the cell and is composed of water,
electrolytes, nucleic acids, lipids, and polysaccharides. These cellular contents
are enclosed by a semipermeable membrane.
o Extracellular (ECF)- fluids outside the cell, it is further divided into
interstitial, intravascular, transcellular fluid. ECF is composed of electrolytes,
water, proteins, RBCs, WBCs and platelets.
TOTAL BODY FLUIDS

60% OF TBW (42L)
INTRACELLULAR EXTRACELLULAR
40% (28L) 20% (14L)
INTRAVASCULAR TRANSCELLULAR
INTERSTITIAL
PLASMA CSF
10L
3L 1L
 The fluids in the two compartments move among cells, tissues, and blood plasma.
Electrolytes
 Electrolytes are chemicals that are cations and anions. Cations are positively charged
ions while Anions are negatively charged ions.
 Examples:
o Sodium: Na+ a cation, the major ECF electrolyte, normal values135-148
mEq/L
o Potassium: K+ a cation, major ICF electrolyte, normal values 3.5- 5 mEq/L
o Calcium: Ca+ normal values 4.5- 5.3 mEq/L
o Magnesium: Mg+ second abundant electrolyte in the ICF, normal values 1.3-
2.1 mEq/L
o Chloride: Clˉ major anion of the ECF, normal values 98 - 106 mEq/L
o Phosphorus: Pˉ major anion of the ICF, normal value 1-1.5 mEq/L
o Bicarbonate: HCO3ˉ 22 - 28 mEq/L

o Sulfate, 1.5 to 2.5 mEq/L
Milliequivalents per litre. Some medical tests report results in milliequivalents per litre
(mEq/L). An equivalent is the amount of a substance that will react with a certain number of
hydrogen ions. A milliequivalent is one-thousandth of an equivalent. A litre measures fluid
volume. It is a little bigger than a quart.
Movement of Fluids and Electrolytes
1. Diffusion is the movement of particles from an area of a greater concentration to an

area of lesser concentration as a part of random activity.
2. Active transport is the movement of particles across cell membranes against a
concentration gradient, expends energy to do so.
3. Osmosis is the passive movement of water molecule across a semipermeable
membrane from an area of higher to lower concentration until equilibrium is
achieved.
Mechanisms of Regulating Fluid and Electrolyte
1. Thirst Center
The center of thirst is in the hypothalamus, it regulates the desire of an individual to
drink water or not. Osmoreceptors cells in the hypothalamus responds to changes in the
osmolality of the ECF, it inhibits or secretes ADH (Vasopressin, also called antidiuretic
hormone - elps regulate the amount of water in your body. It works to control the amount
of water your kidneys reabsorb as they filter out waste from your blood. This hormone is
also called arginine vasopressin) when there is a decrease or increase in ECF osmolality.
2. Renal
The kidneys are the major regulators of sodium and water balance in the ECF through
two mechanisms renin-angiotensin-aldosterone system and sodium-potassium pump
system.
The Na+K+-ATPase pump helps to maintain osmotic equilibrium and membrane
potential (the difference in electric potential between the interior and the exterior of a
biological cell) in cells.
3. Endocrine
Antidiuretic hormone (ADH) controls the amount of water by increasing permeability
of the distal renal tubules in response to increase or low blood volume, thus increasing
the reabsorption of water.
4. Cardiovascular
The cardiovascular system regulates the volume of fluid, blood pressure sensor, and
atrial natriuretic factor (ANF – the atrial natriuretic hormone is a cardiac hormone which
gene and receptors are widely present in the body. Its main function is to lower blood
pressure and to control electrolyte homeostasis).
 Changes in blood volume directly affect atrial blood pressure and urinary output.
 Arterial baroreceptors and low-pressure sensors in aorta and carotid react to
changes in blood volume.
 ANF (hormone secreted by the cardiac atria). Controls fluid volume by signaling
the kidney to decrease sodium reabsorption and by stretching the walls of the
blood vessels in times of fluid overload.
5. Gastrointestinal
In the GI absorbs fluid and electrolyte through digestion. The hormones and enzymes
during digestion with active and passive transport helps in fluid and electrolyte
regulation.
6. Pulmonary
Regulates fluid by controlling respirations: hypoventilating or hyperventilating.
Nursing Process
Nursing Assessment:
 Vital signs
 Dietary pattern- type of food/fluids, number of meals a day
 Food preferences & intake of protein, carbohydrates, & fats
 Vitamin / food supplements
 Loss of appetite
 Nausea/ vomiting
 Heart burn or indigestion
 Weight, body built
 Skin turgor, condition of mucous membrane & teeth
 Medications
 Elimination pattern
 Presence of edema, crackles, or wheezes
 Jugular vein distension or flatness
 Bowel sounds m& abdominal girth
 Pattern of elimination: urine concentration and characteristics stools & frequency of
elimination.
Nursing Diagnosis:
 Fluid Volume, Excess related to compromised regulatory mechanism

 Fluid Volume, Deficit related to active fluid loss
 Altered Mucous Membrane related to dehydration
 Imbalanced Nutrition: less than/ more than body requirements related to inability to
ingest, digest, or absorb nutrients.
Planning:
 Stabilize fluid volume at a functional level
 Shows laboratory values within normal limits

 Demonstrates behaviors to monitor excess or deficits
 Displays intact, moist mucous membrane
 Maintain appropriate weight
Implementation: Interventions will depend on the specific fluid status or electrolyte imbalance.
 Monitor strict intake and output
 Fluid replacement or restrictions
 Daily weighing
 Dietary modification
 Skin care
 Oral care
 Monitor CNS status
 Monitor laboratory results
Evaluation:
 Stabilize fluid volume at a functional level

 Shows laboratory values within normal limits
 Demonstrates behaviors to monitor excess or deficits
 Displays intact, moist mucous membrane
 Maintain appropriate weight
Discharge Plan and Home Care Management
1. Encourage to follow dietary recommendations
2. Enforce the need for oral fluid intake or restrictions
3. Compliance regular check-ups
4. Compliance to home medications
Guidelines in Documentation
 Client’s behavior including factors affecting ability to manage body fluids and degree
of deficit.
 Intake & Output, vital signs, fluid status, current and weight changes.
 Results of laboratory studies and diagnostic test.
 Nursing Plan of care.
 Client’s responses to therapy, nursing care, and teachings performed.
 Achievement towards desired goals/outcomes.
 Changes to care plan.
References:
Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L. (2014). Medical-surgical
nursing: an assessment and management of clinical problems. 9th edition. Elsevier.
eBook.
Saxton, D., Nugent, P., Pelican, P., (2010). Mosby’s Comprehensive Review of Nursing
for NCLEX-RN Examination, Nineth ed. Philadelphia: Wolters Kluwer. Fluid balance,
(1), 32-34.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., Cheever, K.H.(2010). Brunner & Suddarth’s
textbook of medical-surgical nursing. 12th edition. Wolters Kluwer Health / Lippincott
Williams & Wilkins. eBook.
Willis, L. (2015). Fluids and Electrolytes Made Incredibly Easy. Fourth Edition. Wolters
Kluwer Health/Lippincott Williams & Wilkins, available at: Skyscape Medpresso Inc.

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What are the major components of body fluids and their functions?

What are electrolytes and examples of major electrolytes in the body?

There are many ways of looking at man but nowhere in a better way than seeing than

TOTAL BODY FLUIDS

o Bicarbonate: HCO3ˉ 22 - 28 mEq/L

Movement of Fluids and Electrolytes

1. Diffusion is the movement of particles from an area of a greater concentration to an

 Fluid Volume, Excess related to compromised regulatory mechanism

 Shows laboratory values within normal limits

 Stabilize fluid volume at a functional level

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