FLUIDS and ELECTROLYTES BODY FLUIDS Functions of Fluids Body fluids: Facilitate in the transport...
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Transcript of FLUIDS and ELECTROLYTES BODY FLUIDS Functions of Fluids Body fluids: Facilitate in the transport...
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 ELECTROLYTESFLUIDS and ELECTROLYTES
BODY FLUIDS
ICF ECF
40% TBW 20% TBW
P IS
Distribution of Body Fluids – 50-70% of total body weight;
infant [70-80%], elderly [45-50%]
60-kg manTBW = 0.6 x 60 kg = 3.6 L
ICF = 0.4 x 60 kg = 24 L
ECF = 12 L
3L 9L
FLUIDS and ELECTROLYTES
BODY FLUIDS
Factors that Dictate Body Water Requirement
1) Amount needed to give the proper osmotic concentration
2) Amount needed to replace water lost excretion
Normal Routes of water gain and loss
INTAKE OUTPUTml/day ml/day
Fluid intake 1,200Food 1,000Metabolic water 300
TOTAL 2,500
Insensible loss 700Sweat 100Feces 200Urine 1,500
TOTAL 2,500
FLUIDS and ELECTROLYTES
FLUID EXCHANGE BETWEEN BODY FLUID COMPARTMENTS
Osmotic Pressure Gradient
Oncotic P (Colloid osmotic P)
Capillary P (Hydrostatic P)
ICF ECF
P ISF
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 ELECTROLYTESFLUIDS 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 Disorders 2° Alteration in Sodium Balance
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 ICF Addison’s dse
Volume ECF ICF Water Conditions Disorder Vol. Vol. Shift
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 150Calcium, Ca++ 5 4.1 -Magnesium, Mg++ 3 3 40
(155)Chloride, Cl- 103 115 15Bicarbonate, HCO3- 27 29 10Biphosphate, HPO4- 2 2 100Sulfate, SO4-2 1 1 20Protein 16 1 60Organic 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 ELECTROLYTESFLUIDS and 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
ELECTROLYTES
FLUIDS and 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]
ELECTROLYTES
FLUIDS and 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]
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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+
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
FLUIDS and 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
ELECTROLYTES
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