Transcript FLUIDS AND ELECTROLYTES - Southeast Community College

2 Compartments for Body Fluids
0 Intracellular – 40% of total body weight
0 Extracellular – 20% of total body weight
0 Intravascular (in blood vessels)
0 Interstitial (between blood vessels and cells)
Body Fluids
What is in body fluids?
0 Water
0 Electrolytes (ions capable of carrying an electric
current
0 Cations – positive charged ions
0 Anions – negative charged ions
Electrolytes are measured in mEq/L
How do body fluids move?
0 Diffusion – solute moves from an area of high
concentration to an area of low concentration
0 Osmosis – fluid (water) moves across a
semipermeable membrane from an area of lower
concentration of solute to an area of higher
concentration of solute
0 Active Transport – movement of ions against osmotic
pressure; requires energy
DIFFUSION
OSMOSIS
ACTIVE TRANSPORT
Question??
0 In what fluid compartment is the majority of our body
fluid located?
Types of Solutions
0 Hypertonic – solution of higher osmotic pressure pulls
fluid from cells
0 Isotonic – solution of same osmotic pressure expands
body’s fluid volume without a fluid shift
0 Hypotonic – solution of lower osmotic pressure;
solution moves into cells
Isotonic Solution
Hypotonic Solution
Hypertonic Solution
Questions??
0 Which type of solution if given to a patient would
cause fluid to move from inside body cells
(intracellular)?
0 Where would the fluid move to?
Hormonal Regulation of Body Fluids
0 ADH (antidiuretic hormone) – stored in posterior
pituitary gland and released in response to changes in
blood osmolality – stimulates kidney to reabsorb
water
0 Aldosterone – released by adrenal cortex and acts on
distal portion of renal tubule to increase reabsorption
of Na (also causes loss of potassium)
Fluid Output Regulation
Kidneys – produces
1200-1500 mL of
urine/day; the
kidneys are the
primary regulators
of fluid output
Other fluid output regulators
Gastrointestinal Tract
Question?
0 Which of the following causes sodium reabsorption by
the kidneys?
0 Antidiuretic hormone
0 Renin
0 Insulin
0 Aldosterone
Terms
0 Osmolarity – used to describe concentration of
solutions
0 Sensible fluid loss – fluid loss that is seen
0 Insensible fluid loss – fluid loss that is not perceived
Electrolyte Regulation
Goal is to maintain
electrical neutrality
Sodium
0 Most abundant in extracellular fluid
0 Major contributor to water balance
0 Nerve impulse transmission
0 Acid-base balance
0 Cellular chemical reactions
0 Normal level 135-145 mEq/L
0 Level influenced by dietary intake and aldosterone
Sodium
Potassium
0 Most abundant in intracellular fluid
0 Necessary for glycogen deposits in the liver and
skeletal muscle
0 Conduction of nerve impulses
0 Normal cardiac rhythms
0 Skeletal and smooth muscle contraction
0 Normal level 3.5-5.0 mEq/L
0 Body does not conserve potassium well
Potassium
Foods with potassium
Calcium
0 Stored in bone (99%), 1% in ECF
0 Bone and teeth formation
0 Blood clotting
0 Cell membrane integrity
0 Cardiac conduction
0 Transmission of nerve impulses
0 Muscle contraction
Foods with Calcium
Magnesium
0 Enzyme activities
0 Neurochemical
activities
0 Cardiac and skeletal
muscle excitability
0 Most found
intracellular (along
with potassium)
Anions – negative charge
0 Chloride – major anion in ECF; dietary intake and
kidneys regulate chloride level
0 Bicarbonate – major chemical base buffer in the body;
kidneys regulate bicarbonate
0 Phosphate
0
0
0
0
Assist with acid-base balance
Helps to develop & maintain bones and teeth
Neuromuscular action
CHO metabolism
Acid/Base Balance
Goal is to maintain balance
pH 7.35-7.45
Arterial pH is an indirect measurement of hydrogen
ions – the greater the concentration of hydrogen ions
the more acidic the solution and the lower the pH
The pH Scale
Acid-base regulators in the
body
0 1. Buffer systems in the body (chemical regulators) –
first to respond to an acid/base imbalance
0 2. Lungs – regulate CO2 by increasing/decreasing rate
& depth of respirations
0 3. Kidneys – regulate excretion/retention of hydrogen
ions and bicarbonate – last to respond but a more
lasting effect
Sodium Imbalances
Hyponatremia
Causes: increased sweating, GI losses (diarrhea), use
of diuretics
Data: confusion, abdominal cramping, nausea &
vomiting, tachycardia
Risk for Hyponatremia
Sodium Imbalances
Hypernatremia
Causes: increased ingestion of concentrated salt
solutions, diabetes insipidus, water deprivation
Data: thirst, dry flushed skin, dry sticky tongue and
mucous membranes, fever, convulsions
Hypernatremia
Potassium Imbalances
Hypokalemia
Causes: most common is diuretic use, also diarrhea,
vomiting, extreme sweating
Data: weakness, fatigue, decreased muscle tone, weak
irregular pulse
Loss of Potassium
Potassium Imbalances
Hyperkalemia (big cardiac problem)
Causes: primarily renal failure, also burns and trauma
of cells (cause release of K+)
Data: dysrhythmias, paresthesias, weakness,
abdominal cramps, diarrhea
Hyperkalemia
Calcium Imbalances
Hypocalcemia
Causes: decreased Ca++ intake, Vitamin D deficiency,
hypoalbuminemia (because 50% of Ca++ is bound to
protein)
Data: numbness and tingling of fingers, tetany, muscle
cramps, pathological fractures
Tetany
Calcium Imbalances
Hypercalcemia
Causes: malignant disease, osteoporosis, prolonged
immobilization
Data: N & V, constipation, weakness, can lead to
cardiac arrest, low back pain (from kidney stones)
Hypercalcemia
Magnesium Imbalances
Hypomagnesemia
Causes: malnutrition, alcoholism, diarrhea, vomiting,
nasogastric drainage
Data: muscle tremors, confusion
Hypomagnesemia
Magnesium Imbalances
Hypermagnesemia
Causes: renal failure, excessive intake
Data: hypotension, decreased rate and depth of
respirations
Hypermagnesemia
Fluid Imbalances
Fluid Volume Deficit
Causes: losses from GI tract (diarrhea, vomiting), loss
of plasma or whole blood (burns, hemorrhage), fever,
increased perspiration, decreased oral intake of fluids,
diuretic use
Data: hypotension, tachycardia, poor skin turgor,
thirst, dry mucous membranes, confusion, oliguria,
weak pulse, lethargy
Fluid Volume Deficit
Fluid Imbalances
Fluid Volume Excess
Causes: congestive heart failure, renal failure, liver
disease (cirrhosis), excessive Na intake
Data: edema (especially dependent), rapid weight
gain, hypertension, neck vein distention, crackles in
lungs
Edema
Jugular Venous Distention
Arterial Blood Gases
0 pH – measures H+ ion concentration in body fluids;
7.35-7.45
0 paCO2 – partial pressure of carbon dioxide in arterial
blood; 35-45 mm Hg
0 Bicarbonate (HCO3) – major renal component; 22-26
mEq/L
0 (think of CO2 as an acid and HCO3 as a base)
Arterial Blood Gases
Acid Base Imbalances
Respiratory Acidosis
Causes: hypoventilation (atelectasis, pneumonia,
cystic fibrosis, airway obstruction, chest wall injury),
drug overdose, paralysis of respiratory muscles
Data: confusion, dizziness, warm/flushed skin,
muscular twitching, ventricular dysrhythmias
A cause of Respiratory
Acidosis
Acid Base Imbalances
Respiratory Alkalosis
Causes: hyperventilation (initial phase of asthma,
anxiety, central nervous system infections, salicylate
overdose)
Data: dizziness, confusion, tachypnea, numbness &
tingling of extremities
Respiratory Alkalosis
Acid Base Imbalances
Metabolic Acidosis – high acid content in the blood; loss
of sodium bicarbonate
Causes: starvation, diabetic ketoacidosis, renal
failure, heavy exercise, drug use
Data: headache, lethargy, confusion, tachypnea (lungs
are trying to compensate), dysrhythmias
Metabolic Acidosis
Acid Base Imbalances
Metabolic Alkalosis
Causes: excessive vomiting (most common),
prolonged NG suctioning, drug use
Data: dizziness, dysrhythmias, numbness and tingling
of fingers and toes, muscle cramps
Assessment
0 Age – infants, young children and elderly
0 Chronic diseases
0 History of GI problems (vomiting, diarrhea)
0 Any recent surgery or burns
0 Vigorous exercise/temperature extremes?
0 Dietary intake
0 Medication use, smoking, alcohol
Assessment – Physical Exam
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Weight
Skin and mucous membranes
Body temperature
Orientation
Distended neck veins
Edema (sacrum, legs)
Dysrhythmias, pulse rate, blood pressure
Lung sounds, rate of respirations
Vomiting? Diarrhea? Bowel sounds?
Urine output (amount, color, specific gravity)
Numbness, tingling, muscle cramps?
Assessment – Lab Studies
Electrolyte levels, hematocrit, creatinine & BUN,
urine specific gravity, ABG’s
Hematocrit is an indication of hydration status
of the patient; it will elevate when fluid is lost
and decrease when fluid is retained
Blood creatinine levels measure kidney function
Potential Nursing Diagnoses
0 Deficient fluid volume
0 Excess fluid volume
0 Risk for imbalanced fluid volume
0 Impaired gas exchange
0 Ineffective tissue perfusion
0 Decreased cardiac output
0 Ineffective breathing pattern
Patient Outcomes
Your patient as a fluid volume deficit. What would you
write as an outcome?
What if your patient had a fluid volume excess?
Nursing Interventions
0 Daily weight – single most important indicator of fluid
status
0 Intake & output – examine for trends
0 Enteral fluid replacement – oral replacement or
nasogastric, gastrostomy or jejunostomy tube
feedings
0 Fluid restriction (if fluid volume excess)
0 Parenteral replacement
Daily Weights
Nasogastric Tubes
Purposes of nasogastric tubes:
Gastric decompression
Gastric feeding
Administer medications
Types of Nasogastric Tubes
Types of nasogastric tubes
Levin – single lumen
Salem sump – larger lumen to remove gastric secretions
and a smaller (usually blue) lumen to vent to air (do
not clamp or irrigate the air vent)
Insertion of a nasogastric
tube
Insertion of a nasogastric
tube
0 Clean technique
0 Place client in high Fowler’s position
0 Lubricate with water soluble lubricant
0 During insertion, if possible, have client take sips of
water
0 Always verify placement post insertion and before any
feeding or irrigations (pH of stomach contents at 4)
0 Use normal saline for irrigations
Nursing Interventions
0 Monitor intake and output (How would you calculate
if performing nasogastric irrigations?)
0 Apply water soluble lubricant to nares to prevent
irritation
0 Good oral hygiene
0 When removing nasogastric tube instruct client to
take a deep breath and hold it while removing the
tube smoothly and quickly
Keeping it all in balance