Fluid and Electrolyte Imbalances (Nursing)

00:00 Hi, I'm Joanna Jackson and we're going to review Fluid and Electrolyte Imbalances.

00:05 Many students find fluid and electrolyte imbalances some of the most difficult content you have to learn.

00:11 Here are some tips to help you conquer this material. Review lab values, immediately before the test begins.

00:17 Write them down on a blank piece of paper or dry erase board that you're given as soon as the test starts.

00:24 Make up funny or quirky acronyms about medications or processes that will help you remember them.

00:30 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.

00:52 First, we will talk about hypovolemia. As the name implies, hypovolemia means volume depletion.

00:59 This volume depletion initially refers to loss of fluid from the extracellular and eventually the intracellular space. The clinical presentation depends on the degree of hypovolemia. I.e. how much fluid is lost. Initial signs and symptoms include poor skin turgor, dry mucous membranes, tachycardia, and decreased capillary refill. If the cause of hypovolemia remains untreated it can lead to confusion, agitation, hypotension and finally death. As you can see on the slide, the most common causes of hypovolemia include gastrointestinal losses, excessive sweating, hemorrhage and loss of fluids in the third space. Hypervolemia is the exact opposite of hypovolemia. And refers to excess presence of volume leading to expansion of the extracellular space. It is caused by increased total body sodium that results in increased extracellular water. Be careful though. Although the total body sodium is increased and this is the principle mechanism of hypervolemia, this does not mean that there is going to be hypernatremia. Hypernatremia refers to the concentration of sodium. Not the amount of sodium in the body. The majority of patients with hypervolemia actually have hyponatremia because the water content is greater than the sodium content. The most common causes of hypervolemia are congestive heart failure, liver cirrhosis, chronic kidney disease and nephrotic syndrome. The symptoms depend on the underlying condition. Patients with fluid overload are most likely hypertensive and have edema.

02:40 Now, lets compare and contrast. Hypervolemia means too much and hypovolemia mean too little body water.

02:50 Normal laboratory findings. It is really crucial and important for your 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 reference them 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.

03:26 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. Hyponatremia refers to low sodium in a fluid excess. Hyponatremia mainly manifests itself with signs and symptoms from the central nervous system such as confusion, seizures, lethargy, and finally death. This can be caused by GI losses, diuretics, kidney disease, sweating, or heart failure. Hypernatremia refers to increase sodium intake or sodium retention. Hypernatremia most commonly occurs in elderly patients due to diminished sense of thirst or access to fluids. Since these patients do not drink water, the water concentration decreases and the sodium concentration increases. Pathologic states that can lead to hypernatremia include hyperglycemic states where increased glucose concentration leads to osmotic diuresis and water loss. Diabetes insipidus due to underproduction or diminished action of ADH lead to excessive loss of water from the kidneys leading to hypernatremia.

04:42 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.

05:03 This imbalance occurs in the intracellular fluid. You have hypokalemia and hyperkalemia.

05:11 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.

05:25 Hyperkalemia refers to high potassium. The signs and symptoms include weakness, fatigue, and arrythmias that can potentially be life threatening. Hyperkalemia can be caused by drugs such as ACE inhibitors and beta blockers, chronic kidney disease, acidosis, and Addison's disease.

05:45 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.

06:13 Always assess before taking any action. If two answers feel correct, always choose the best answer.

06:20 And opposites attract, if two answers are complete opposites, one is usually the correct answer.