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Fluid and electrolytes balance. Terry White, MBA, BSN. Body fluid and electrolyte: About 46 to 6o % of the average adult weight is water. Water may serve as:. Medium of metabolic reaction with cells. Transporter for nutrients, waste products, and other substance. A lubricant.

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Fluid and electrolytes balance
Fluid and electrolytes balance

Terry White, MBA, BSN


Fluid and electrolytes balance

Body fluid and electrolyte:

  • About 46 to 6o % of the average adult weight is water.


Water may serve as
Water may serve as:

  • Medium of metabolic reaction with cells.

  • Transporter for nutrients, waste products, and other substance.

  • A lubricant.

  • Shock absorber.

  • Regulate and maintain body temperature.


Fluid and electrolytes balance


Distribution of body fluids
Distribution of body fluids: age and sex effect of total body water.

  • The body fluid divided in two major compartments:

    A) Intracellular fluid (ICF):

  • Is found in the cells of the body. its constitute 2/3 of the total body fluid in the adult.


Fluid and electrolytes balance

b) Extracelluar fluid (ECF): age and sex effect of total body water.

  • is found out side of cell and account 1/3 of the total body fluid.

  • it’s subdivided into three compartments:

    1) Intravascular fluid or plasma: is found within vascular system.

    2) Interstitial fluid: is found surrounding the cell and includes lymph.

    3) Transcellular: includes cerebrospinal fluid, pleural, peritoneal and synovial fluid.


Fluid and electrolytes balance

plasma interstitial intracellular age and sex effect of total body water.

Cations

Na 140 146 12

K 4 4 150

Ca 5 3 10

Mg 2 1 7

Anions

Cl 103 104 3

HCO 24 27 10

SO4 1 1 -

HPO4 2 2 116

Protein 16 5 40

Composition of Fluids


Fluid and electrolytes balance

  • Function of ICF & ECF: age and sex effect of total body water.

  • ICF: is vital to normal cell function, its contain solutes such as oxygen, electrolytes and glucose. It provides a medium to metabolic process.

  • ECF: it is the transport system that carries nutrients and waste product from the cell.


Movement of body fluid and electrolyte
Movement of body fluid and electrolyte: age and sex effect of total body water.

1. Osmosis:

  • Is the movement of water across cell membranes, from the less concentrated solution to more concentrated solution. In other word water move toward higher concentration.


Fluid and electrolytes balance

  • Solutes are substance dissolved in liquid. age and sex effect of total body water.

  • Crystalloid: salts that dissolved readily in to true solution.

  • Colloids: substance such as large protein molecules that do not dissolved in true solution.

  • Sodium is the major determinant of serum osmolality.


  • Fluid and electrolytes balance

    2. Diffusion: age and sex effect of total body water.

    • Is the continual intermingling of molecules in liquid, gases by random movement of the molecules.


    Fluid and electrolytes balance

    3. Filtration age and sex effect of total body water.:

    • Is the process where by fluid and solutes moved together across a membrane from one compartment to another.


    Fluid and electrolytes balance

    4. Active transport age and sex effect of total body water.:

    • substance can move across cell membranes from a less concentrated solution to amore concentrated one by active transport.


    Fluid and electrolytes balance

    Regulating body fluid: age and sex effect of total body water.

    • The average adult drinks about 1500ml per day, but need to 2500ml per day, this added volume is acquired by the food.

    • The thirst center is located in the brain, this center trigger by osmotic pressure and angiotensin II .


    Hormonal regulation
    Hormonal regulation age and sex effect of total body water.


    Regulation of ecf
    Regulation of ECF age and sex effect of total body water.


    Fluid out put
    Fluid out put: age and sex effect of total body water.

    • Urine: normal urine out put 1500ml per 24hrs or at least 30ml per hours.

    • Insensible loss: through the skin as perspiration and through the lung a water vapor in the expired air.

    • Loss through the intestine (feces)


    Fluid and electrolytes balance

    • Obligatory losses: age and sex effect of total body water. approximately 500ml of fluid must be exerted through the kidney to eliminate metabolic waste product and feces, respiration and perspiration to maintain body temperature.

    • The average daily fluid out put for an adult 2500ml/ day.


    Client at risk for fluid and electrolyte imbalance
    Client at risk for fluid and electrolyte imbalance: age and sex effect of total body water.

    • Post operative client.

    • Client with sever trauma or burn.

    • Client with chronic disease as congestive heart failure.

    • Client who are NPO.

    • Client with intravenous infusion.

    • Client with special drainage.

    • Client who receiving diuretic


    Factor effecting fluid and electrolyte balance
    Factor effecting fluid and electrolyte balance: age and sex effect of total body water.

    • Age: infant have greater water need and greater loss due to greater metabolic rate.

    • Environment: excess heat stimulates the sympathetic nervous system and cause person to sweat.


    Fluid and electrolytes balance


    Fluid and electrolytes balance

    Disturbances in fluid and electrolyte: protein by breaking down the fat and glycogen.

    • Hypovolemia: decrease blood volume

    • Hypovolemic shock when intravascular fluid is depleted.

    • Hypervolimia: increase blood volume.


    Fluid and electrolytes balance

    Edema: protein by breaking down the fat and glycogen. is collection of fluids in the tissue.

    Type of edema:

    • Dependent edma: found in the lowest part body.

    • Pitting edma: edema that leaves a depression or pit after finger pressure is applied on the swollen area.


    Pitting odema
    Pitting odema protein by breaking down the fat and glycogen.


    Fluid and electrolytes balance

    • Sodium (Na): protein by breaking down the fat and glycogen.

    • Is the most abundant cation in the extracelluar fluid and major contributor to serum osmolality.

    • Function of sodium:

    • controlling and regulating water balance.

    • Maintaining blood volume

    • Transmitted nerve impulses.


    Fluid and electrolytes balance

    • Normal level is 135 – 145 mg/dl. protein by breaking down the fat and glycogen.

    • Hyponatremia: sodium deficit in the blood.

    • Hypernatremia: sodium excess in the blood.

    • Sodium is found in many foods, such as processed cheese, table salt.


    Fluid and electrolytes balance

    Potassium: protein by breaking down the fat and glycogen.

    • Is the major cation in intracellular fluid.

    • Function of potassium:

    • Maintain ICF osmolality.

    • Transmitting nerve impulses.

    • Regulate cardiac impulses.

    • Skeletal and smooth muscle function.

    • Regulate acid base balance


    Fluid and electrolytes balance


    Fluid and electrolytes balance

    • Hypocalcemia fish, milk.: calcium deficit in the blood.

    • Hypercalcemia: calcium excess in the blood.


    Loss of water and electrolyte
    Loss of water and electrolyte: fish, milk.

    • Vomiting.

    • Diarrhea.

    • Excessive sweating.

    • Ployuria.

    • Fever.

    • Nasogastric suction.

    • Abnormal drainage.

    • Anorexia.

    • Nausea

    • Impaired swallowing.


    Finding associated with fluid and electrolyte imbalance
    Finding associated with fluid and electrolyte imbalance: fish, milk.

    • Skin: dry pale, cool skin, reduce skin Turgor.

    • Oral cavity: dry mucous membrane, absence of salivation.

    • Weak rapid pulse.

    • Decreased blood pressure.

    • Decreased central venous pressure


    Fluid and electrolytes balance


    Fluid volume excess
    Fluid volume excess: fish, milk.

    • Excess intake of sodium – containing intravenous fluid.

    • Excess of ingestion of sodium in diet.

    • Heart failure.

    • Renal failure.

    • Liver cirrhosis.


    Clinical manifestation
    Clinical manifestation: fish, milk.

    • Weight gain.

    • Fluid intake greater than out put.

    • Moist mucous membrane.

    • Tachycardia.

    • Increased blood pressure.

    • Distended neck vein.

    • Dyspnea and crackles.

    • Mental confusion.



    Nursing care plan
    Nursing care plan fish, milk.

    • Assessment:

      • Nursing history:

    • Date include fluid and food intake, output.

    • Recent fluid losses.

    • Sign of fluid deficit.

    • Common sign of electrolyte disturbance.

    • Medication.


    Fluid and electrolytes balance

    Clinical measurement: fish, milk.

    • Daily weights, vital sign, fluid intake and output (I&O), serum electrolyte, complete blood count (CBC). Serum osmolality, urine specific gravity.


    Nursing diagnosis
    Nursing diagnosis: fish, milk.

    • Fluid volume deficit related to dehydration.

    • Fluid volume excess related to heart failure.

    • Altered oral mucous membrane related to fluid volume defects.

    • Impaired skin integrity related to dehydration

    • Decreased cardiac output related to hypovolemia.

    • Altered tissue perfusion related to decreased cardiac output.


    Implementation
    Implementation: fish, milk.

    • Assess clinical manifestation of hypo or Hypervolimia.

    • Provide fluid and electrolyte orally.

    • Foods.

    • Intravenous therapy can prescribed for those reason

    • Provide salts if needed.

    • Provide glucose for metabolism.

    • Provide water soluble vitamins


    Fluid and electrolytes balance

    • Monitor intake & output. fish, milk.

    • Monitor lapratory finding.

    • Provide frequent oral care.

    • Monitor weight.

    • Assess for edma.

    • Place patient in fowler position.

    • Assess breathing sound, inspiration and expiration (crackles).

    • Provide safety for client


    Fluid and electrolytes balance

    The End fish, milk.