1 / 42

Fluid And Electrolytes

Fluid And Electrolytes. Nur 102 SpringSemester. Fluid and Electrolytes. * The proportion of fluid is large * 60% of the adult’s wt is water. Functions of water: 1)- Medium for metabolic reactions within cells.

gelias
Download Presentation

Fluid And Electrolytes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Fluid And Electrolytes Nur 102 SpringSemester

  2. Fluid and Electrolytes * The proportion of fluid is large * 60% of the adult’s wt is water. Functions of water: 1)- Medium for metabolic reactions within cells. 2)- Transport for nutrients, waste products & other substances. 3)- Lubrication. 4)- Shock absorber. 5)- regulating & maintaining body temp.

  3. * Factors affect total body water: 1)- Age: The proportion of body water decreases with aging. * Infants have the highest proportion ( 70-80%) of wt. 2)- Body fat tissues: fat tissues are free of water. * Lean tissues contain significant amount of water. * Water makes up lean body wt >obese persons. 3)- Sex : women have more body fat than men , so they have less water. *Distribution of body fluids: 1)- ICF: fluid within the cells. * Composes 2/3 of total body fluid in adults. * Functions of ICF: - Vital for normal cell function: it contains solutes ( O2, electrolytes, & glucose). - It provides a medium for metabolic processes.

  4. 2)- ECF: outside cells & composes 1/3 of total body fluid . * ECF composed of : A)- Intravascular fluid: or plasma found within vascular system, 20% of ECF. B)- Interstitial fluid : surrounds cells ( lymph). compose 3\4 0f ECF, transport waste from cells, 75% of ECF C)- Trancellular fluid: includes : CSF, pleural, peritoneal , & synovial fluids, intraocular and biliary. * Functions of ECF: Transport system carries nutrients to & waste products from the cells. * e.g. Plasma carries O2 from lungs & glucose from GIT →capillaries of vascular system →into interstitial spaces →into cells ( via cellular membrane). The opposite route for waste products CO2 from cells → lungs & metabolic acid wastes →kidneys

  5. * Composition of Body Fluids : Many salts dissociate in water : break up into charged ions: - Cations: +ve charged ions( e.g. Na + , K+, Ca +2. MG+2). -Anions : - ve charged ions (e.g. Cl-, HCO3 , SO4, HPO4).

  6. * Movement of body fluids: * Selective permeability of the cellular membrane ( small particles(O2, ions, CO2 ) can easily cross the membrane while large molecules can not ( proteins & glucose) pass. 1)- Osmosis: movement of H2O across cell membrane from the less concentrated solution to the more concentrated solution. Solute: substance dissolved in liquid Solvent: dissolve a solute e.g in body water is the solvent while electrolyte,O2, CO2 is solute

  7. * Osmolality: concentration of solutes in the body fluids ( mOsm/Kg) or tonicity ( isotonic, hypotonic, hypertonic).. - Na is the main determinant of osmolality in ECF while K, glucose & urea are basic for ICF. * Osmotic pressure: power of solution to draw water across semipermiable membrane. * Colloid osmotic pressure : ( Oncotic): osmotic pressure created by proteins pulling water from interstitial space into the vascular.( important in maintaining vascular volume). Types of solution: Isotonic Hypotonic Hypertonic

  8. 2)- Diffusion: movement of molecules from solution of higher concentration to solution of lower concentration * The rate of diffusion is affected by ( size , concentration, & temperature of the solution ).. 3)- Filtration: Fluid & solutes move together a cross a membrane from one compartment (higher pressure) to another (lower pressure) ( e.g. movement of fluid & nutrients from the capillaries of the arteries to the interstitial fluids around the cells).

  9. Diffusion

  10. * Filtration pressure : pressure that results in the movement of fluid & substances out of the compartment. * Hydrostatic pressure: pressure exerted by a fluid within a closed system on the walls of the container ( e.g. force exerted by the blood against arteries). 4)- Active transport: energy is needed : substance combines with a carrier on the outside surface of the cell membrane & they move to the inside surface of the membrane. Fluid moves from area of less concentration to the area of high concentration (as Na- k pump)

  11. Active Transport

  12. * Regulation of body fluids: normally fluid intake & loss are balanced. 1)- Fluid intake: the average adult drinks ( 1500 ml/day ) but needs 2500 ml ( additional 1000ml). - Thirst mechanism is the primary regulator of intake. - Thirst center in the brain triggered by (osmotic pressure, vascular volume, & Angiotesein II( released as a result of ↓blood flow to kidneys). Runner example : ↑concentration of solutes & ↑osmotic pressure stimulates thirst & desire to drink water.

  13. Additional 1000ml of fluid taken from food 90% from fresh vegetables 85% from fresh fruit 60% from lean meat 200 ml of water as a byproduct of food metabolism

  14. 2)- Fluid output: 4 routs: A) Urine : ( major route of output). volume formed by the kidneys & exerted from the bladder * Average urine output: adult 1400-1500/24 hrs(30-50ml /hr). *↑intake →↑UO. * if loss by other routs increased ( urine decreased to maintain fluid volume).

  15. B)- Insensible fluid loss: not noticeable & cannot be measured. - Lungs: 350-400 ml . - Skin: 350-400 ml. - Sweat: 100ml : fever & exercise increase loss via skin. C)- Feces: 100- 200 loss . Obligatory fluid loss : must be lost to maintain body function : feces , respiration & skin - 500 ml of fluid must be exerted by kidneys.

  16. Homeostasis: regulation System involve in homeostasis are kidney, lung, cardiovascular, endocrine and GIT 1)- Kidneys: regulate fluid & electrolytes excretion , reabsorbing , & acid –base balance( regulating excreting & reabsorbing of H+ ion & HCO3+) . 2)- ADH: hypothalamus : regulate water excretion from the kidneys . - ↑osmolality → ↑ ADH production : increase permeability of collecting ducts to water →allows more water to be reabsorbed into blood.

  17. As more water is reabsorbed →↓UO→ ↓serum osmolality because water dilutes body fluids . • ↓osmolality → ↓ADH→ ↑ UO.

  18. 3)- Renin-Angiotensein – Aldesterone System: - if blood flow to kidneys ↓ → release of rennin. →converting of angiotesinonogen into angiotesein I →Angiotesein II by ACE →angiotesein II acts on nephrons & ↑Na & water retention& stimulate the release of Aldesterone from adrenal cortex → retention of Na & water in distal nephrons and excretion of K. -This system helps to restore blood volume. 4)- ANF: (Atrial Natriuretic Factor):released from cells in the atria of heart in response to excess blood volume & stretching of the atrial walls.. -Acts as diuretics to loose water & Na. - Inhibit thirst lead to decrease fluid intake

  19. * Regulating Electrolytes : General functions: 1)- Maintain fluid balance . 2)- contribute to Acid-base regulation. 3)- Facilitating enzyme reactions. 4)- transmitting Neuromuscular reactions. Na: Most abundant cation in ECF & major contribute to S. osmolality Control and regulate water balance to maintain ECF volume NR 135 – 145 mEq\l if < 135 ( hyponatremia), if > 145 (hypernatremia) K: Major cation in ICF Maintain ECF and ICF balance Vital electrolyte to skeletal, cardiac and smooth muscle activity

  20. Also maintain acid – base balance NR 3.5 – 5 mEq\l, if <3.5 (hypokalemia) if >5 (hyperkalemia) Ca: Majority is in skeletal system Vital in regulating muscle contraction and relaxation, neuromuscular & cardiac function Regulated by PTH, calcitonin & calcitirol NR 8.5 – 10.5 mg\dl, if <8.5 (hypocalcemia) if > 10.5 (hypercalcemia)

  21. * Regulation of Acid-Base Balance: -Normal arterial pH (7.35-7.45). 1)- Buffers: preventing excessive changes in pH by removing or releasing H+ . A)- Major buffer : HCO3 & H2CO3. -PH ↓→acidosis. -PH ↑ →Alkalosis. B)- Proteins, Hb, & phosphate. 2)- Respiratory regulation : by eliminating or retaining CO2 ( potential acid ).: CO2+H2O↔ H2CO3 - Lungs can regulate level of CO2 by altering rate & depth of respiration. - Regulate CO2 & HCO3. 3) Renal regulation : slower to respond to changes (hrs-days _) to compensate imbalance - Regulate H+ & HCO3 reabsorption & excretion in response to alkalosis & acidosis. - Normal HCO3 (22-26 mEq/L)..

  22. * Factors affecting body fluid , electrolytes & acid-base balance: 1) Age:Infants: -High fluid loss ( high MR). - Immature kidneys : less able to conserve water. - High insensible loss by rapid respiration. * In elderly - High risk for dehydration due to : - impaired thirst response. - Nephrons become less able to conserve water in response to ADH ( normal or elevated) - ↑ANF : loss of ability to conserve water. - Presence of combining diseases : heart diseases, impaired renal function, & multiple drug regimen. 2)- Gender & body size. 3)- Environmental temperature: sweating.( loss of H2O, & salts).

  23. 4)- Lifestyle: A)- Diet: anorexia nervosa or bulimia ( induced vomiting, use diuretics & laxatives) ( eating disorder) leads to malnutrition & fluid depletion . B)- Regular weight bearing exercises : +ve effect on Ca balance & prevent osteoporosis. C)- Stress: ↑: - Cellular metabolism - Blood glucose levels. - Catecholamine. ADH : increase blood volume. D)- Other factors: - alcohol: cause electrolyte depletion, & acidosis due to break down of fat tissues. - Illness: decrease blood flow to kidneys due to impaired cardiac functions, DM , COPD ( acid base balance). - Trauma: & burns: loss of fluid & electrolytes from damaged cells - Medications: diuretics or corticosteroids

  24. Fluid Imbalances • 2 basic type: isotonic & osmolar • Isotonic imbalance: water & electrolyte are lost or gained in equal proportion, osmolarity remain constant • Osmolar imbalance: when water is lost or gained alone, osmolarity altered • 4 categories: • Isotonic loss (FVD, or hypovolemia) • Isotonic gain (FVE, or hypervolemia) • Hyperosmolar loss ( dehydration) • Hypo- osmolar gain ( over hydration, or water intoxication)

  25. FVD • Occur when body loss both water and electrolyte from ECF in same proportion . • Causes: • Abnormal loss through skin, GIT, & kidney (excessive sweating, V&D, polyuria, fever NGT suction) • Decrease intake of fluid (anorexia, N, inability to take fluid, impaired swallowing) • Bleeding • Shift of fluid into third space.

  26. FVE • Occur when body gain water and electrolyte in same proportion to ECF. • Causes: • Excess intake of NaCl • Excess intake of Na containing IVF • Impaired fluid balance regulation related to disease process as in ( HF, RF, liver cirrhosis)

  27. Edema occur in FVE, it is an increase fluid accumulation in interstitial fluid Pitting edema: small depression or indentation left after applying pressure to swollen area, mainly over bony prominence, disappear within 5sec

  28. Dehydration • Hyperosmolar imbalance • Occur when water alone is lost from the body • Occur in: • Older adult • In hyperventilation, or prolonged fever • In DKA • Enteral feeding without sufficient water intake

  29. Overhydration • Hypo-osmolar imbalance (water intoxication) • Gain of water in excess of electrolyte

  30. Assessment 1)- Ng Hx: - A)- Identify pts who are at risk of fluid ,electrolyte, & acid-base imbalance (e.g. COPD, cardiac diseases, renal disease, gastroenteritis...(See Box: risk , factors ). B)- Obtain data about food & fluid intake . C)- Data about Fluid output. D)- presence of S&S suggestive of altered fluid & electrolytes 2)- P/E: includes: ( SEE Table: Focused P/E Assessment for fluid & Electrolytes). A)- Skin( e.g. color, temp, turgor). B)- Oral cavity & mucous membranes: (color, moisture). C)- Eyes: Firmness. D)- Cardiovascular : H.R , B.P, pulses, …. E)- Respiratory system: lung sounds , R.R. F)- Neurological : LOC, reflexes, motor functions.

  31. 3)- Clinical measurements: A)- Daily wt: significant changes wt over a short period ( days to 1-2 weeks) indicates acute fluid changes. - Each Kg loss = 1L fluid. - Wt reflects total body fluid rather than any compartment. * Moderate to severe fluid volume deficit or excess : wt loss or gain of 5-8% of total body weight. * Measurement of wt should be reliable.

  32. B) V/S: - ↑Temp: in dehydration, or increased fluid loss. - Tachycardia is an early sign of hypovolemia. ↓Pulse volume in FVD & ↑FVE. - Irregular pulse in electrolytes imbalances. - Changes in R.R & depth affect acid-base balance. - BP: indicates blood volume change (e.g.↓ in hypovolemia & ↑in FVE. - Orthostatic hypotension. C)- Fluid intake & output: 24 hrs measurement of I& O. * Measurement of fluid intake: 1)- Oral fluids: all types of fluids drunk by the pt ( water with medication…). 2)- Ice chips: one half their volume. 3)- Foods that tend to be liquid in the room temp( jello). 4)- Tube feeding : including water for rinsing. 5) - Parenteral fluids : IVF. 6)- IV medication: some are diluted in large amounts of solutions (50-100ml). 7)- Catheter or tube irrigates .

  33. * Measurement of output: 1)- Urine output : following each voiding use container to measure. 2)- Vomitus & liquid feces. 3)- Tube drainage: : gastric drainage. 4)- Wound drainage & draining fistula: * I&O are recorded & totaled at the end of the shift (8-12 hrs).

  34. D)- Laboratory tests: 1)- Serum electrolytes : Na, K, urea. 2)- CBC: e.g. HTC ↑ in sever dehydration, and ↓ in sever Overhydration. 3)-Serum Osmolality: measure of solute concentration of the blood.( normal is 280-300 mOsm/Kg),↑ with FVD and ↓ with FVE. - Determined by Na, glucose & urea ( BUN) 4)- Urine Osmolality : solute concentration of urine( urea, Createnine, & uric acid). - Normal ( 500-800 mOsm/Kg), ↑ with FVD and ↓ with FVE. 5)- Urine pH : by analysis or dipstick on urine specimen, indicate the kidney regulation of acid- base imbalances . 6)- Urine specific gravity: indicator of urine concentration ( 1.005-1.030), increase solute concentration in urine ↑ USG.

  35. 7)- ABGs: includes: - pH 7.35- 7.45 - Pao2. 80-100 - Paco2. 35-45 -HCO3. 22-26 - O2 saturation 95-98 Base excess. +2 or -2

  36. DX - Fluid Volume Deficit. - Fluid Volume Excess. - Risk for Fluid Volume Imbalance . - Risk for Fluid Volume Deficit. - Impaired Gas Exchange. - Altered Oral Mucous Membrane R\T FVD. -Impaired Skin Integrity RT dehydration /edema. • Decreased Cardiac Output RT cardiac dysrhythmias secondary to electrolytes imbalance ( K). • ineffective Tissue Perfusion.Rt decrease CO secondary to FVD. - Activity Intolerance RT hypervolemia. - Risk for injury R\t Ca shift out of bones into ECF.

  37. Planning 1)- Maintain or restore normal fluid balance. 2)- Maintain or restore normal balance of electrolytes in IC or EC compartment. -3)- Maintain or restore pulmonary ventilation & oxygenation. 4)- Prevent associated risks ( tissue breakdown, decreased CO, neurological signs).

  38. Implementation 1)- Promoting wellness: people must know that it is important to drink adequate fluids & consume a balanced diet. 2)- Enteral fluid & electrolyte replacement: A)- Fluid intake modifications : - Increase fluids: in pts with risk or actual FVD. - Restrict fluids: Pts who have fluid retention which results from many diseases( HF, RF, SIADH).

  39. B)- Dietary changes: - e.g. pts who receive K depleting diuretics : must receive K ( supplements or by food ( banana, orange , leafy greens). C)- Oral electrolyte supplements. 3)- Parenteral fluid & electrolyte replacement: IVF ( isotonic, hypertonic, hypotonic). - Regulating rate of fluid flow: - Total infusion volume Χ drop factor divided on Total time of infusion in minutes. 4)- Blood Transfusion of blood

More Related