Fluids and Electrolytes Demystified www.com Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work.
Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.com Fluids and Electrolytes Demystified Joyce Y. Johnson, PhD, RN, CCRN Dean and Professor, Department of Nursing College of Sciences and Health Professions Albany State University Albany, Georgia With contributions by: Edward Lyons, PhD Professor of Biology, Department of Natural Sciences Albany State University Albany, Georgia Bennita W.
Vaughans, RN, MSN Nurse Recruiter Central Alabama Veterans Health Care System Montgomery, Alabama New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto www.com Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.
0-07-159565-1 The material in this eBook also appears in the print version of this title: 0-07-149624-6. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more information, please contact George Hoare, Special Sales, at george_hoare@mcgraw-hill. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work.
Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work.
Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.com To my mother, who has been my most powerful role model. To my husband Larry, my daughter Virginia, and my son Larry, who love me unconditionally. To my friends and family, who sustain me.
To my students, who provide my motivation to teach and to write.com ABOUT THE AUTHORS Joyce Y. Johnson, PhD, RN, CCRN, serves as dean of the College of Sciences and Health Professions at Albany State University, with primary oversight for the under- graduate and graduate programs in the Department of Nursing and three additional departments. Johnson has been a nurse for over 30 years and a nurse educator for 25 years. She received her bachelor’s of science in nursing from Vanderbilt University, her master’s in nursing from Emory University, and her PhD from the University of Mississippi.
Johnson is author of many nursing textbooks and book chapters, articles, and monographs. Her research areas are in curriculum trends in nursing programs and facilitating nursing student success, in addition to various clinical topics. Edward Lyons, PhD, is a professor of biology in the Department of Natural Sci- ences at Albany State University in Albany, Georgia. Lyons has been a science educator for over 35 years and has taught biology and anatomy and physiology to many nursing students during his tenure.
Lyons received his bachelor’s and master’s degrees from Howard University and his PhD in cell biology from Atlanta University. Vaughans, RN, MSN, is a nurse recruiter at the Central Alabama Veterans Health Care System. She has been a nurse educator for over 20 years and has provided care to adults in many health care settings. Copyright © 2008 by The McGraw-Hill Companies, Inc.
Click here for terms of use.com CONTENTS AT A GLANCE PART ONE FOUNDATIONAL CONCEPTS AND ASSESSMENTS CHAPTER 1 Key Elements Underlying Fluid and Electrolyte Balance 3 CHAPTER 2 Key Elements Underlying Acid–Base Balance 19 CHAPTER 3 General Nursing Assessments and Diagnostic Tests Related to Fluid, Electrolyte, and Acid–Base Balance 29 PART TWO FLUID, ELECTROLYTE, AND ACID–BASE IMBALANCES CHAPTER 4 Fluid Volume Imbalances: Hypovolemia and Hypervolemia 61 CHAPTER 5 Sodium Imbalances: Hyponatremia and Hypernatremia 79 CHAPTER 6 Potassium Imbalances: Hypokalemia and Hyperkalemia 97 CHAPTER 7 Calcium Imbalances: Hypocalcemia and Hypercalcemia 111 CHAPTER 8 Magnesium Imbalances: Hypomagnesemia and Hypermagnesemia 123 www.com viii Fluids and Electrolytes Demystified CHAPTER 9 Phosphorus Imbalances: Hypophosphatemia and Hyperphosphatemia 135 CHAPTER 10 Acid–Base Imbalances 147 PART THREE APPLICATIONS FOR FLUID AND ELECTROLYTE CONCEPTS CHAPTER 11 Multisystem Conditions Related to Fluid, Electrolyte, and Acid–Base Imbalances 159 CHAPTER 12 Conditions Resulting in Fluid, Electrolyte, and Acid–Base Imbalances 185 Answers to Final Check-ups 207 References 211 Index 213 www.com For more information about this title, click here CONTENTS Acknowledgments xv Introduction xvii PART ONE FOUNDATIONAL CONCEPTS AND ASSESSMENTS CHAPTER 1 Key Elements Underlying Fluid and Electrolyte Balance 3 Learning Objectives 3 Overview 4 The Cell 5 Fluid 7 Electrolytes 11 Conclusion 16 Final Check-up 17 CHAPTER 2 Key Elements Underlying Acid–Base Balance 19 Learning Objectives 19 Overview 20 What Is pH? 20 Acids 21 Bases 22 Acid and Base Balance 23 www.com x Fluids and Electrolytes Demystified Regulation 23 Conclusion 25 Final Check-up 26 CHAPTER 3 General Nursing Assessments and Diagnostic Tests Related to Fluid, Electrolyte, and Acid–Base Balance 29 Learning Objectives 29 Overview 30 Laboratory Test Units of Measure 31 Laboratory Tests Indicating Fluid Imbalance 32 Nursing Assessments for Fluid Imbalance 33 Laboratory Tests Indicating Acid–Base Imbalance 34 Acid–Base Balance Assessment 38 Laboratory Tests Indicating Electrolyte Imbalance 42 Nursing Assessments for Electrolyte Imbalance 43 Potassium 43 Sodium 46 Chloride 48 Calcium 49 Magnesium 51 Phosphate 52 Blood Urea Nitrogen and Creatinine 54 Conclusion 54 Case Situation 55 Final Check-up 57 References 58 Web Sites 58 PART TWO FLUID, ELECTROLYTE, AND ACID–BASE IMBALANCES CHAPTER 4 Fluid Volume Imbalances: Hypovolemia and Hypervolemia 61 Learning Objectives 61 Overview 62 www.com Contents xi Normal Intake and Output 63 Fluid Regulation 64 Fluid Circulation 64 Hypovolemia 66 Hypervolemia 72 Conclusion 75 Final Check-up 76 References 77 Web Site 77 CHAPTER 5 Sodium Imbalances: Hyponatremia and Hypernatremia 79 Learning Objectives 79 Overview 80 Sodium Regulation 81 Hypernatremia 84 Hyponatremia 87 Conclusion 92 Case Application 92 Final Check-up 94 References 95 Web Site 95 CHAPTER 6 Potassium Imbalances: Hypokalemia and Hyperkalemia 97 Learning Objectives 97 Overview 98 Hyperkalemia 100 Hypokalemia 103 Case Application 105 Conclusion 106 Final Check-up 107 References 109 Web Site 109 www.com xii Fluids and Electrolytes Demystified CHAPTER 7 Calcium Imbalances: Hypocalcemia and Hypercalcemia 111 Learning Objectives 111 Overview 112 Hypocalcemia 113 Hypercalcemia 118 Conclusion 120 Final Check-up 120 Reference 122 Web Sites 122 CHAPTER 8 Magnesium Imbalances: Hypomagnesemia and Hypermagnesemia 123 Learning Objectives 123 Overview 124 Hypermagnesemia 125 Hypomagnesemia 128 Conclusion 130 Case Application 132 Final Check-up 133 References 134 Web Site 134 CHAPTER 9 Phosphorus Imbalances: Hypophosphatemia and Hyperphosphatemia 135 Learning Objectives 135 Overview 136 Hypophosphatemia 139 Hyperphosphatemia 142 Final Check-up 144 Web Sites 145 CHAPTER 10 Acid–Base Imbalances 147 Learning Objectives 147 Overview 148 Acidosis 148 www.com Contents xiii Alkalosis 151 Impact of Acid–Base Imbalances/Complications 153 Conclusion 153 Final Check-up 154 References 155 Web Site 155 PART THREE APPLICATIONS FOR FLUID AND ELECTROLYTE CONCEPTS CHAPTER 11 Multisystem Conditions Related to Fluid, Electrolyte, and Acid–Base Imbalances 159 Learning Objectives 159 Overview 160 Age Extremes 162 Case Application 167 Renal Conditions 169 Case Application 173 Conditions with High Impact on Fluid Balance: Burn Injury and Pregnancy 175 Case Application 180 Conclusion 183 Final Check-up 184 CHAPTER 12 Conditions Resulting in Fluid, Electrolyte, and Acid–Base Imbalances 185 Learning Objectives 185 Heart Failure 186 Endocrine Conditions: Diabetes Insipidus, Syndrome of Inappropriate ADH (SIADH), and Diabetes (Diabetic Ketoacidosis [DKA] and Hyperosmolar Hyperglycemic Syndrome [HHS]) 191 Conclusion 202 Case Application 203 Final Check-up 205 www.com xiv Fluids and Electrolytes Demystified References 206 Web Site 206 Answers to Final Check-ups 207 References 211 Index 213 www.com ACKNOWLEDGMENTS Thank you to Quincy McDonald for providing this opportunity and for giving continuous positive energy to this project. Thank you to Robert Pancotti for guidance through the preparation of the manuscript and for patience. Thank you to Lynnette Johnson for assistance in manuscript preparation. Thank you to Bennita Vaughans for her contributions to the manuscript.
Thank you to Dr. Edward Lyons for lending his expertise to the project. Copyright © 2008 by The McGraw-Hill Companies, Inc. Click here for terms of use.com This page intentionally left blank www.com INTRODUCTION Fluids and Electrolytes Demystified is a detailed overview of the critical concepts involved in fluid, electrolyte, and acid–base balance and imbalance, collectively one of the hardest topics to master in undergraduate nursing.
Fluid and electrolyte balance and acid–base balance have challenged students for ages. Some of the difficulty in understanding this content may lie in the attempt to remember each individual detail or symptom associated with an imbalance combined with the difficulty of mastering the physiology involved in each process. The list of symptoms of imbalance can be extensive; there is often duplication and overlap between electrolyte and acid–base imbalances. In Fluids and Electrolytes Demystified, the normal functions are discussed to provide baseline data.
The concepts of imbalance are presented individually, but the links between concepts are addressed.