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FLUIDS and ELECTROLYTES. BODY FLUIDS. Functions of Fluids Body fluids: Facilitate in the transport [nutrients, hormones, proteins, & others…] Aid in removal of cellular metabolic wastes Provide medium for cellular metabolism Regulate body temperature

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slide1

FLUIDS and ELECTROLYTES

BODY FLUIDS

  • Functions of Fluids
      • Body fluids:
        • Facilitate in the transport [nutrients, hormones, proteins, & others…]
        • Aid in removal of cellular metabolic wastes
        • Provide medium for cellular metabolism
        • Regulate body temperature
        • Provide lubrication of musculoskeletal jts.
        • Component in all body cavities [parietal, pleural… fluids]
  • Water is the principal body fluid & essential for life.
slide2

FLUIDS and ELECTROLYTES

FLUIDS and ELECTROLYTES

ICF

ECF

60-kg man

TBW = 0.6 x 60 kg = 3.6 L

ICF = 0.4 x 60 kg

= 24 L

ECF

= 12 L

P

IS

3L

9L

20% TBW

40% TBW

BODY FLUIDS

Distribution of Body Fluids – 50-70% of total body weight;

infant [70-80%], elderly [45-50%]

slide3

FLUIDS and ELECTROLYTES

INTAKE

OUTPUT

ml/day

ml/day

Fluid intake 1,200

Food 1,000

Metabolic water 300

TOTAL 2,500

Insensible loss 700

Sweat 100

Feces 200

Urine 1,500

TOTAL 2,500

BODY FLUIDS

  • Factors that Dictate Body Water Requirement
    • Amount needed to give the proper osmotic concentration
    • Amount needed to replace water lost excretion

Normal Routes of water gain and loss

slide4

FLUIDS and ELECTROLYTES

ICF

ECF

P

ISF

FLUID EXCHANGE BETWEEN BODY FLUID COMPARTMENTS

Osmotic Pressure Gradient

Oncotic P (Colloid osmotic P)

Capillary P (Hydrostatic P)

slide5

FLUIDS and ELECTROLYTES

Control of Osmotic Pressure, Volume & Electrolyte Concentration

  • OBLIGATORY Reabsorption
      • occurs in the proximal tubules
      • 178 L/day of glomerular filtrate (80% reabsorbed)
      • 2 to solute reabsorption
      • independent of the water requirement
  • FACULTATIVE Reabsorption
      • occurs in the distal & collecting tubules
      • independent of the active solute transport
      • dependent of body’s need of water
      • under the control of ADH
slide6

FLUIDS and ELECTROLYTES

FLUIDS and ELECTROLYTES

DISTURBANCES IN FLUID BALANCE

  • EDEMA (Dropsy)
    •  in the interstitial fluid volume of about 2 L or more due to increase transudation of fluid from capillaries 2° to:
      • Increased HP [pregnancy, CHF]
      • Decreased OP [malnutrition, end-stage liver dse, nephrotic syndrome]
slide7

FLUIDS and ELECTROLYTES

DISTURBANCES IN FLUID BALANCE

  • CELL OVERHYDRATION
    • excess of water in the ECC w/ a normal amount of solute or a deficient amount of solute
    • occurs in prolonged and excessive diuresis, forcing hypotonic fluids to produce diuresis in the presence of renal impairment
    • fluid overload from  production of adrenal corticoid hormones [Cushing’s syndrome]
slide8

FLUIDS and ELECTROLYTES

DISTURBANCES IN FLUID BALANCE

  • CELL OVERHYDRATION
    • Symptoms
      • Weight gain & edema
      • Cough, moist rales, dyspnea [fluid congestion in lungs]
      • CVP, bounding pulse,neck vein engorgement [fluid excess in the vascular system]
      • Bulging fontanelles
      •  Hg and Hct
      • Nausea & vomiting
slide9

FLUIDS and ELECTROLYTES

DISTURBANCES IN FLUID BALANCE

  • CELL OVERHYDRATION
    • Management
      • Restrict fluids to lower fluid volume
      • Diuretics or hypertonic saline
      • Continuous assessments to prevent skin breakdown
      • Record daily weight to assess progress of treatment
slide10

FLUIDS and ELECTROLYTES

DISTURBANCES IN FLUID BALANCE

  • CELL DEHYDRATION (DHN)
    • loss of body fluids, particularly from the extracellular fluid compartment
    • water loss > water intake
    • Causes
      • Fever
      • Insufficient water intake
      • Diarrhea, vomiting
      • Excess urine output [Diabetes insipidus, diuretics]
      • Excessive perspiration, burns
      • Hemorrhage, shock, metabolic acidosis
slide11

FLUIDS and ELECTROLYTES

DISTURBANCES IN FLUID BALANCE

  • CELL DEHYDRATION (DHN)
    • Symptoms
      • Thirst, dry mucus membranes, sunken eyeballs
      • “Doughy“ abdomen, dry skin w/ poor turgor
      •  temp, weight loss
      •  HR,  RR,  BP
      • Restlessness,irritability, disorientation, convulsion, coma [22-30% body H20 loss]
    • Management
      • Fluid replacement therapy & continued fluid maintenance
slide12

FLUIDS and ELECTROLYTES

Volume ECF ICF Water Conditions

Disorder Vol. Vol. Shift

Expansion

Isotonic Inc N No net change Isotonic fluid

ingestion

Hypertonic Inc Dec ICF  ECF Sea water

ingestion

Hypotonic Inc Inc ECF  ICF Hypotonic IVF

Contraction

Isotonic Dec N No net change Diarrhea

Hypertonic Dec Dec ICF  ECF Diabetes insipidus

Hypotonic Dec Inc ECF  ICFAddison’s dse

Volume Disorders 2° Alteration in Sodium Balance

slide13

FLUIDS and ELECTROLYTES

  • ELECTROLYTES
    • salts or minerals in extracellular or intracellular body fluids
      • Sodium – major cation of ECF
      • Potassium – major cation of ICF
      • Chloride - major anion of ICF
      • Protein – in ICF > ISF
slide14

FLUIDS and ELECTROLYTES

ELECTROLYTE Composition

Electrolyte Conc Plasma (mEq/L) ISF ICF

Sodium, Na+ 142 141 10

Potassium, K+ 5 4.1 150

Calcium, Ca++ 5 4.1 -

Magnesium, Mg++ 3 3 40

(155)

Chloride, Cl- 103 115 15

Bicarbonate, HCO3- 27 29 10

Biphosphate, HPO4- 2 2 100

Sulfate, SO4-2 1 1 20

Protein 16 1 60

Organic foods 6 3.4 -

(155)

slide15

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Functions of Electrolytes
      • Contribute most of the osmotically active particles in body fluids
      • Provide buffer systems for pH regulation
      • Provide the proper ionic environment for normal neuromuscular irritability & tissue function
slide16

FLUIDS and ELECTROLYTES

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hyponatremia [Na+ < 135 mEq/L; Normal = 135-145 mEq/L]
      • Causes
        •  Na+ intake
        •  Na+ excretion [diaphoresis, GI suctioning]
        • Adrenal insufficiency
      • Assessment
        • N & V, abdominal cramps, weight loss
        • Cold, clammy skin,  skin turgor
        • Apprehension, HA, convulsions, focal neurologic deficit, coma [cerebral edema]
        • Fatigue, postural hypotension
        • Rapid thready pulse
slide17

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hyponatremia [Na+ < 135 mEq/L; Normal = 135-145 mEq/L]
      • Management
        • Provide foods high in sodium
        • Administer NSS IV
        • Assess blood pressure frequently

[measure lying down, sitting & standing]

slide18

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]
      • Causes
        • Excessive, rapid IV adm’n of NSS
        • Inadequate water intake
        • Kidney disease
      • Assessment
        • Dry, sticky mucus membranes
        • Flushed skin
        • Rough dry tongue, firm skin turgor
        • Intense thirst
        • Edema, oliguria to anuria
        • Restlessness, irritability [cerebral DHN]
slide19

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]
      • Nursing Intervention
        • Weigh daily
        • Assess degree of edema frequently
        • Measure I & O
        • Assess skin frequently & institute nursing measures to prevent breakdown
        • Encourage sodium-restricted diet
slide20

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]
      • Causes
        • Renal insufficiency
        • Adrenocortical insufficiency
        • Cellulose damage [burns]
        • Infection
        • Acidotic states
        • Rapid infusion of IV sol’n w/ potassium-conserving diuretics
slide21

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]
      • Assessment
        • Thready, slow pulse
        • Shallow breathing
        • N & V, diarrhea, intestinal colic
        • Irritability
        • Muscle weakness, flaccid paralysis
        • Numbness, tingling
        • Difficulty w/ phonation, respiration
slide22

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]
      • Nursing Interventions
        • Administer kayexalate as ordered
        • Administer/monitor IV infusion of glucose & insulin
        • Control infection
        • Provide adequate calories & carbohydrates
        • Discontinue IV or oral sources of K+
slide23

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]
      • Causes
        • Renal insufficiency
        • Adrenocortical insufficiency
        • Cellulose damage [burns]
        • Infection
        • Acidotic states
        • Rapid infusion of IV sol’n w/ potassium-conserving diuretics
slide24

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]
      • Assessment
        • Thready, rapid, weak pulse
        • Faint heart sounds
        •  BP
        • Skeletal muscle weakness
        •  or absent reflexes
        • Shallow respirations
        • Malaise, apathy, lethargy
        • Loss of orientation
        • Anorexia, vomiting, weight loss
        • Gaseous intestinal distention
slide25

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]
      • Nursing Interventions
        • Administer K+ supplements to replace losses
        • Be cautious in administering drugs that are not potassium-sparing
        • Monitor acid-base balance
        • Monitor pulse, BP and ECG
slide26

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]
      • Causes
        • Hyperparathyroidism
        • Immobility
        • Increased vitamin D intake
        • Osteoporosis & osteomalacia [early stages]
      • Assessment
        • N & V, anorexia, constipation
        • Headache, confusion
        • Lethargy, stupor
        • Decreased muscle tone
        • Deep bone/flank pain
slide27

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]
      • Nursing Interventions
        • Encourage mobilization
        • Limit vitamin D intake
        • Limit calcium intake
        • Normal saline
        • Administer diuretics
        • Calcitonin
slide28

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]
      • Causes
        • Acute pancreatitis
        • Diarrhea
        • Hypoparathyroidism
        • Lack of vitamin D I the diet
        • Long-term steroid therapy
      • Assessment
        • Painful tonic muscle & facial spasms
        • Fatigue, dyspnea
        • Laryngospasm, convulsions
        • (+) Trousseau’s and Chvostek’s signs
slide29

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]
      • Nursing Interventions
        • Administer oral Ca lactate or IV CaCl2 or gluconate
        • Providing safety by padding side rails
        • Administer dietary sources of calcium
        • Vitamin D
        • Provide quiet environment
slide30

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hyermagnesemia [Mg > 3.0 mEq/L; Normal = 1.5-3.0 mEq/L]
      • Causes
        • Renal insufficiency, dehydration
        • Excessive use of Mg-containing antacids or laxatives
      • Assessment
        • Lethargy, somnolence, confusion
        • N & V
        • Muscle weakness, depressed reflexes
        •  pulse and respirations
      • Nursing Intervention
        • Withhold Mg-cont’g drugs/foods; Ca adm’n
        •  fluid intake, unless CI
slide31

FLUIDS and ELECTROLYTES

ELECTROLYTES

  • Hypomagnesemia [Mg < 1.50 mEq/L; Normal = 1.5-3.0 mEq/L]
      • Causes
        • Low intake of Mg in the diet
        • Prolonged diarrhea
        • Massive diuresis
        • Hypoparathyroidism
      • Assessment
        • Paresthesias, muscle spasm
        • Confusion, hallucination, convulsions
        • Ataxia, tremors, hyperactive deep reflexes
        • Flushing of the face, diaphoresis
      • Nursing Intervention
        • Provide good dietary sources of Mg
slide32

FLUIDS and ELECTROLYTES

IV FLUID REPLACEMENT THERAPY

  • Indications
      • Replacement of abnormal fluid & electrolyte losses [surgery, trauma, burns, GI bleeding]
      • Maintenance of daily fluid & electrolyte needs
      • Correction of fluid disorders
      • Correction of electrolyte disorders
slide33

FLUIDS and ELECTROLYTES

IV FLUID REPLACEMENT THERAPY

  • Types of Solutions
      • Isotonic
        • 0.9% sodium chloride (NSS)
        • Lactated Ringer’s sol’n
      • Hypotonic
        • 5% dextrose and water (D5W)
        • 0.45% sodium chloride
        • 0.33% sodium chloride
      • Hypertonic
        • 3% NaCl
        • Protein sol’ns
      • Colloids
        • Salt pour albumin Plasmanate, Dextran
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