FLUIDS and ELECTROLYTES
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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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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.


  • 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%]


    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


    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)


    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


  • 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]


    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]


    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


    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


    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


    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


    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


    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


    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)


    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


    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


    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]


    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]


    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


    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


    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


    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+


    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


    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


    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


    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


    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


    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


    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


    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


    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


    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


    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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