Hi, I'm Joanna Jackson and we're going to
review Fluid and Electrolyte Imbalances.
Many students find fluid and electrolyte
imbalances some of the most difficult
content you have to learn.
Here are some tips to help you conquer this material.
Review lab values, immediately before the
test begins. Write them down on a blank
piece of paper or the dry erase board that
you're given as soon as the test starts.
Make up funny or quirky acronyms about
medications or processes that will help
you remember them. For example, the nursing
process can be remembered as
ADPIE. Assess, diagnose, plan, implement and evaluate.
Here are some key terms.
Listen for these terms throughout this lesson,
write the definition, and practice
using these words in sentences, and visualize
using them as a nurse.
Hypovolemia. This is a fluid imbalance.
Hypovolemia is a fluid volume deficit,
meaning not enough fluid. It is a serum
concentration of less than
135 mEq/L. It occurs when there's an excess
of extracellular water
relative to sodium. Some signs and symptoms
are fatigue, confusion, a headache,
abdominal cramps and nausea.
If left untreated, it can lead to seizures,
coma, or even death.
This is most easily remembered as being caused
by gastrointestinal losses,
sweating, hemorrhages, diuretics, or third spacing.
The exact opposite of
hypovolemia is hypervolemia. This occurs when
there's a deficit of extracellular
water relative to sodium. The serum concentration
for hypervolemia is greater
than 160 mEq/L. Some signs and
symptoms of hypervolemia
include tachycardia, hypertension, tachypnea,
dyspnea, crackles in the lungs, edema
and weight gain. Causes include excessive
sodium intake, burns, abnormal renal
function, and heart failure.
Now let's compare and contrast. Hypervolemia
means too much. Hypovolemia means too
little. Both are related to the serum concentration
of sodium within the
body, and both are related to the total
body water volume. Normal laboratory findings.
It is really crucial and important for you review
and learn normal volumes of
each fluid and electrolyte imbalance. Again, if
you write these as soon as the
test begins, it will help you in referencing when
you get a question about them.
There are many different types of electrolyte imbalances.
The most common occur, in
relation to sodium, potassium, calcium, magnesium,
phosphorous and chloride. All of
these have hypo and hyper states.
Let's review the most common. Sodium is one common
electrolyte that can be imbalanced in the body.
This is referred to as hyponatremia or hypernatremia.
Hyponatremia refers to low
sodium in a fluid excess. Signs and symptoms include
fatigue, headache, mental
status changes and tachycardia. This can be caused
by GI losses, diuretics, kidney
disease, sweating or heart failure.
Hypernatremia refers to increase sodium intake
or sodium retention. This can be
as a result from kidney failure,
Cushing's syndrome, burns or diarrhea. High
sodium equals low fluid. Signs and symptoms
include thirst, flushed skin, tachycardia, and abdominal
cramping. Hyponatremia is
not strictly due to fluid excess. It can mean
increased, decreased, or normal
extracellular fluid. I know that can be
confusing, so try and remember this by
simply knowing that it is a gain of water
or a loss of sodium rich fluids.
Potassium is another major electrolyte. This
imbalance occurs in the intracellular
fluid. You have hypokalemia and hyperkalemia.
Hypokalemia refers to low potassium.
Signs and symptoms include bradycardia, nausea,
vomiting or diarrhea. This can be
caused by GI losses, the use of diuretics,
kidney disease or even sweating.
Hyperkalemia refers to high potassium. The
signs and symptoms of this include
restlessness, irritability, and weakness. This
can be caused by increased sodium
intake or sodium retention, including
kidney failure, burns and diarrhea. What
to expect on the exam? Expect questions
that give you lab values and symptoms, and ask
you which imbalance you're suspecting.
Expect questions that ask you which condition
or disease is associated with
a particular imbalance. If you learn the signs,
symptoms and causes, it becomes
very easy to pick the correct treatment.
Tips for success: Always assess, diagnose,
plan and then implement. Always assess before
taking any action. If two answers
always choose the best answer. And
if two answers are complete opposites, one is
usually the correct answer.