14
Lesson Plans for
Fluids and Electrolytes
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 14.1:
2. Describe the composition of the extracellular and intracellular body fluid compartments.
4. Identify the causes, signs and symptoms, and treatment of fluid imbalances.
6. Identify the causes, signs and symptoms, and treatment of electrolyte imbalances.
8. Discuss the medical treatment and nursing management of persons with fluid and electrolyte
imbalances.
10. List the four types of acid-base imbalances.
12. Explain the medical treatment and nursing management of acid-base imbalances.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to fluid and electrolytes.
• The student will have the opportunity to become acquainted with the extracellular and intracellular body
fluid compartments; the mechanisms of fluid transport and fluid balance; the causes, signs and
symptoms, and treatment of fluid and electrolyte imbalances; data to be collected in assessing fluid and
electrolyte status; and the causes and management of acid-base imbalances.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Homeostasis and Regulation
• Concept: Fluid and Electrolyte Balance
• Exemplar: Deficient Fluid Volume, p. 201
• Table 14-5: Deficient Fluid Volume, p. 202
• Exemplar: Excess Fluid Volume, p. 201
• Table 14-6: Excess Fluid Volume, p. 203
• Exemplar: Hyponatremia (Sodium Deficit), p. 202
• Exemplar: Hypernatremia (Sodium Excess, p. 204
• Box 14-5: Top Ten Categories of High-Sodium Foods, p. 205
2 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
• Concept: Acid-Base Balance
• Exemplar: Respiratory Acidosis, p. 207
___________________________________________________________ Chapter 14 Fluids and Electrolytes 3
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) The body’s ability to maintain constant conditions in the fluid compartments is __________.
a) regulation
b) homeostasis
c) acid-base balance
d) osmolarity
2) Fluids inside of cells are called __________.
a) water
b) extracellular
c) interstitial
d) intracellular
3) Which type of cell holds the least amount of water?
a) Fat cells
b) Muscle cells
c) Brain cells
d) Blood cells
4) An example of a cation is __________.
a) chloride
b) phosphate
c) calcium
d) bicarbonate
5) The primary electrolyte in extracellular fluid is __________.
a) potassium
b) sodium
c) chloride
d) calcium
6) The transfer of water and solutes through a membrane from an area of high pressure to an area of
low pressure is __________.
a) diffusion
b) active transport
c) osmosis
d) filtration
7) A hormone that affects the concentration of urine and the volume of urine excreted is __________.
a) aldosterone
b) renin
c) antidiuretic hormone (ADH)
d) atrial natriuretic factor
8) Fluid needs in the elderly person __________.
a) increase
b) decrease
c) stay the same
d) fluctuate
9) The drug, polystyrene sulfonate (Kayexalate), is used to treat which electrolyte imbalance?
a) Hyponatremia
b) Hypocalcemia
c) Hypokalemia
d) Hyperkalemia
10) The acid-base disturbance that occurs when the body retains too many hydrogen ions or loses too
many bicarbonate ions is called __________.
a) metabolic acidosis
b) respiratory alkalosis
c) metabolic alkalosis
d) respiratory acidosis
4 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the two types of body fluids?
Question: What is homeostasis? Why is homeostasis necessary for the body to function properly?
___________________________________________________________ Chapter 14 Fluids and Electrolytes 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Textbook Objectives Covered
1. Describe the extracellular and intracellular fluid compartments.
3. Discuss the mechanisms of fluid transport and fluid balance.
5. Describe the major functions of the major electrolytes—sodium, potassium, calcium,
magnesium, and chloride.
7. List data to be collected in assessing fluid and electrolyte status.
9. Explain why older persons are at increased risk for fluid and electrolyte imbalances.
11. Identify the major causes of each acid-base imbalance.
12. Explain the medical treatment and nursing management of acid-base imbalances.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Speaker: gerontology nurse practitioner or clinical nurse specialist
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying fluids and electrolytes, including:
• Fluid imbalances
• Electrolyte imbalances
• Acid-base imbalances
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• acid (p. 206)
• acid-base balance (p. 206)
• active transport (p. 194)
• base (p. 206)
• deficit fluid volume (p. 201)
• diffusion (p. 194)
• osmolality (p. 194)
• osmolarity (p. 195)
• osmosis (p. 194)
• selectively permeable
membrane (p. 194)
6 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 192-193)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 210)
ANSWER – Study Guide
• Part IA: 1-4 (p. 73)
2
READ – Textbook (pp. 193-194)
REVIEW
• Table 14-1: Total Body Fluids (p. 193)
• Table 14-2: Electrolyte Composition of Extracellular and Intracellular Fluids (p. 193)
3
READ – Textbook (pp. 194-197)
REVIEW
• Figure 14-1: Regulation of Body Fluid (p. 197)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 210)
ANSWER – Study Guide
• Part IC: 1, 2 (p. 74)
4
READ – Textbook (pp. 201-202)
REVIEW
• Table 14-3: 24-Hour Intake and Output of Body Fluids (p. 196)
• Table 14-5: Fluid Volume Deficit (p. 202)
• Table 14-6: Fluid Volume Excess (p. 203)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 7 (p. 210)
ANSWER – Study Guide
• Part IE: 1, 2 (p. 74)
• Part IIG: 4-8, 39, 42, 43 (pp. 75–76)
• Part IIIH: 2-8, 10, 11 (pp. 78–79)
___________________________________________________________ Chapter 14 Fluids and Electrolytes 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
5
READ – Textbook (pp. 202-206)
REVIEW
• Table 14-4: Normal Values Related to Fluid and Electrolyte Balance (p. 200)
ANSWER – Text
• Review Questions for the NCLEX Examination: 8 (p. 210)
ANSWER – Study Guide
• Part IB: 1 (p. 74)
• Part IIG: 36, 37 (p. 76)
6
READ – Textbook (pp. 202-206)
7
READ – Textbook (pp. 197-201)
REVIEW
• Box 14-1: Vital Sign Changes with Fluid and Electrolyte Imbalances (p. 198)
• Box 14-5: Top Ten Categories of High-Sodium Foods (p. 204)
• Box 14-6: Potassium Content of Common Foods (p. 205)
8
READ – Textbook (pp. 197-206)
ANSWER – Study Guide
• Part IIIH: 17-20 (pp. 79-80)
9
READ – Textbook (pp. 196-197)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5 (p. 210)
10
READ – Textbook (pp. 206-209)
REVIEW
• Table 14-7: Arterial Blood Gas Values with Uncompensated Respiratory and Metabolic
Acidosis and Alkalosis (p. 207)
ANSWER – Text
• Review Questions for the NCLEX Examination: 9, 10 (p. 211)
8 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
11
READ – Textbook (pp. 206-209)
ANSWER – Study Guide
• Part IIG: 35 (p. 76)
12
READ – Textbook (pp. 208-209)
REVIEW
• Box 14-7: Assessment of Acid-Base Balance (p. 207)
ANSWER – Study Guide
• Part IIIH: 13, 16 (p. 79)
Lecture Outline 20 minutes
Slide 1
Chapter 14
Fluids and Electrolytes
1
Slide 2
Homeostasis
• Maintaining relatively constant conditions as in fluid compartments
• To maintain internal balance, body must be able to regulate fluids
• All organs and structures of the body involved in homeostasis
TALKING POINTS:
• What percent of the human body is composed of water?
Slide 3
Homeostasis (cont.)
• Intracellular fluid
• Fluid within a cell
• Most of the body’s fluids found within the cell
• Extracellular fluid
• Fluid outside the cell
TALKING POINTS:
• Which fluid is mainly responsible for the transport of nutrients and wastes throughout the
body?
___________________________________________________________ Chapter 14 Fluids and Electrolytes 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 4
Composition of Body Fluids
• Water
• Solutes
2
Slide 5
• Obese people have a lower percentage of body water because of the increased
number of fat cells
Water
• Largest portion of body weight
• Percentage affected by age, sex, body fat
2
&
3
Slide 6
Solutes
• Electrolyte
• Substance that develops an electrical charge when dissolved in water
• Examples: sodium, potassium, calcium, chloride, bicarbonate, and magnesium
TALKING POINTS:
5
Slide 7
Solutes (cont.)
• Sodium (Na)
• Most abundant electrolyte; primary electrolyte in extracellular fluid
• Major role in regulating body fluid volumes, muscular activity, nerve impulse
conduction, and acid-base balance
Slide 8
Solutes (cont.)
• Potassium (K)
• Found mainly in the intracellular fluid; the major intracellular cation
• Important in maintaining fluid osmolarity and volume within the cell
maintain plasma acid-base balance
Slide 9
Solutes (cont.)
• Chloride (Cl)
• An extracellular anion that is usually bound with other ions, especially sodium or
potassium
• Functions are to regulate osmotic pressure between fluid compartments and assist in
regulating acid-base balance
10 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 10
Solutes (cont.)
• Calcium (Ca)
• Usually combined with phosphorus to form the mineral salts of the bones and teeth
TALKING POINTS:
• How does calcium regulation take place in the body?
Slide 11
Solutes (cont.)
• Magnesium (Mg2+)
• A cation found in bone (50% to 60%), intracellular fluid (39% to 49%), and extracellular
fluid (1%)
TALKING POINTS:
• How much of the magnesium ingested through the diet is absorbed?
• Magnesium is excreted through the kidneys, and the rate of excretion is regulated by
sodium and calcium excretion, extracellular fluid volume, and parathyroid hormone.
Slide 12
Solutes (cont.)
• Nonelectrolytes
• Other substances dissolved in the body fluids
• Urea, protein, glucose, creatinine, and bilirubin
• These solutes do not carry an electrical charge
4
Slide 13
Transport of Water and Electrolytes
• Membranes
• Selectively permeable membranes
• Separate fluid compartments and control movement of water and certain solutes
TALKING POINTS:
• What is an example of selective permeability?
• Small molecules and water move freely across membranes, whereas larger molecules
such as protein move less readily.
Slide 14
Transport Processes
• Diffusion
• The random movement of particles in all directions is necessary for a substance to
move from an area of higher natural tendency concentration to an area of lower
concentration
• Facilitated diffusion
• A carrier protein transports the molecules through membranes toward an area of
lower concentration
___________________________________________________________ Chapter 14 Fluids and Electrolytes 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Transport Processes (cont.)
• Active transport
transported across cell membranes
TALKING POINTS:
• How does a sodium pump function?
Slide 16
Transport Processes (cont.)
• Filtration
• Transfer of water and solutes through a membrane from an area of high pressure to
an area of low pressure
Transport Processes (cont.)
Osmolality
• Concentration of solution determined by number of dissolved particles per kg water
• Controls water movement and distribution by regulating the concentration of fluid in each
TALKING POINTS:
• A higher osmolality means there is a higher concentration of a solute in the water
because the solution contains less water.
• What is the normal osmolality of body fluid?
• Osmolarity refers to the concentration of particles per liter of solution.
Slide 19
Kidneys
• Main regulators of fluid balance
• Control extracellular fluid by adjusting the concentration of specific electrolytes,
osmolality of body fluids, the volume of extracellular fluid, blood volume, and pH
12 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 20
Kidneys (cont.)
• Filtration
• Blood plasma entering the kidney via the renal artery is delivered to the glomerulus
• About 20% of plasma filtered into glomerular capsule
• Most remaining plasma leaves kidney through the renal vein
• Filtrate then moves through the tubules, where it is transformed into urine by tubular
reabsorption and secretion
• Adjusts volume and composition of the filtrate; prevents excessive fluid loss through
kidneys
Kidneys (cont.)
• Tubular reabsorption
• A process by which most of the glomerular filtrate is returned to the circulation
Slide 22
Kidneys (cont.)
• Tubular secretion
• The last phase in the work of the kidneys
• The filtrate is transformed into urine
Slide 23
Hormones
• Renin
• Hormone secreted when blood volume or blood pressure falls
• Causes the release of aldosterone with subsequent sodium and water retention
• Aldosterone
Slide 24
Hormones (cont.)
• Antidiuretic hormone (ADH)
• Causes capillaries to reabsorb more water, so urine is more concentrated and less
volume is excreted
• Atrial natriuretic factor (ANF)
TALKING POINTS:
• Where is ADH produced?
• An increase in plasma osmolality stimulates the release of ADH into the bloodstream to
replenish needed fluid in the body.
___________________________________________________________ Chapter 14 Fluids and Electrolytes 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 25
Thirst
• Regulates fluid intake
• Increased plasma osmolality stimulates osmoreceptors in the hypothalamus to trigger the
sensation of thirst
• More sodium and less water in the body make a person thirsty
• Additional fluids consumed; kidneys conserve water until osmolality returns to normal
Fluid Gains and Losses
• In healthy adult, 24-hour fluid intake and output approximately equal
Fluid Gains and Losses (cont.)
• Losses through the skin occur by sweating
TALKING POINTS:
• Where is the bulk of fluid secreted into the GI tract reabsorbed?
6
&
7
Slide 28
Assessment of Fluid and Electrolyte Balance
• Health history
• Determines if patient has conditions that contribute to fluid or electrolyte imbalances
• Vomiting, diarrhea, kidney diseases, diabetes, salicylate poisoning, burns,
Slide 29
Assessment of Fluid and Electrolyte Balance (cont.)
• Vital signs
• Pulse, respiration, temperature, and blood pressure can indicate changes in fluid and
electrolyte balance.
TALKING POINTS:
• Fever poses a risk of water and electrolyte loss associated with sweating and an
increased metabolic rate.
• How should blood pressure be measured in the older adult?
14 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 30
Assessment of Fluid and Electrolyte Balance (cont.)
• Intake and output
• Accurate records are essential to determine whether the patient’s intake is equal to
output
Slide 31
Assessment of Fluid and Electrolyte Balance (cont.)
• Skin
• Characteristics
• Moisture, turgor, and temperature reflect fluid balance.
Dry, flushed skin—dehydration. Pale, cool, clammy skin—severe fluid volume
deficit that occurs with shock. Moist, edematous tissue seen with excess fluid
volume
• Facial characteristics
Slide 32
Assessment of Fluid and Electrolyte Balance (cont.)
• Skin turgor
• Measured by pinching the skin over the sternum, the inner aspects of the thighs, or
the forehead
• In patients who are dehydrated, skin flattens more slowly after the pinch is released
• Edema
TALKING POINTS:
• What does the term tenting mean?
• Pitting edema is evaluated on a four-point scale, ranging from +1 edema (barely
detectable pit) to +4 edema (deep and persistent pit that is approximately 1 inch [2.54
cm] deep).
Slide 33
Assessment of Fluid and Electrolyte Balance (cont.)
• Mucous membranes
• Tongue turgor
• In a well person, tongue has one longitudinal furrow. Fluid volume deficit causes
additional longitudinal furrows, and the tongue is smaller. Sodium excess causes
the tongue to appear red and swollen.
• Moisture of the oral cavity
___________________________________________________________ Chapter 14 Fluids and Electrolytes 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 34
Diagnostic Tests and Procedures
• Urine studies
• Urine pH
• Determines if kidneys are responding appropriately to metabolic acid-base
imbalances
• Urine specific gravity
TALKING POINTS:
• What is the normal pH of urine? Specific gravity? Osmolarity?
• Diet is a factor in that a person who consumes large amounts of citrus fruits and
Diagnostic Tests and Procedures (cont.)
• Urine creatinine clearance tests
• Detect glomerular damage in the kidney
TALKING POINTS:
• What instructions should the patient be given during a urine creatinine clearance test?
16 Chapter 14 Fluids and Electrolytes ___________________________________________________________
LESSON 14.1
Slide 36
• Indicator of renal function
Diagnostic Tests and Procedures (cont.)
• Blood studies
• Serum hematocrit
• Percentage of blood volume composed of red blood cells
• Serum creatinine
TALKING POINTS:
• What is the normal range for hematocrit? Serum creatinine? Blood urea nitrogen?
• The serum creatinine level is a better indicator of renal function than the blood urea
nitrogen.
Slide 37
Diagnostic Tests and Procedures (cont.)
• Serum albumin
• A plasma protein that helps maintain blood volume by creating colloid osmotic
pressure
• Serum electrolytes
TALKING POINTS:
4
Slide 38
Fluid Imbalances
• Deficient fluid volume
• Less water than normal in the body
• Isotonic extracellular fluid deficit
• Hypovolemia
• Hypertonic extracellular fluid deficit
• Dehydration
TALKING POINTS: