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FLUIDS and ELECTROLYTES

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

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  1. 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.

  2. 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%]

  3. 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

  4. 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)

  5. 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

  6. 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]

  7. 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]

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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)

  15. 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

  16. 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

  17. 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]

  18. 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]

  19. 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

  20. 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

  21. 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

  22. 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+

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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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