FLUIDS AND FLUIDS AND

ELECTROLYTESELECTROLYTES

Southeast Community College

2 Compartments for Body Fluids

0 Intracellular – 40% of total body weight

0Extracellular – 20% of total body weight0 Intravascular (in blood vessels)

0 Interstitial (between blood vessels and cells)

Body Fluids

What is in body fluids?

0Water

0Electrolytes (ions capable of carrying an electric current0 Cations – positive charged ions0 Anions – negative charged ions

Electrolytes are measured in mEq/L

How do body fluids move?

0Diffusion – solute moves from an area of high concentration to an area of low concentration

0Osmosis – fluid (water) moves across a semipermeable membrane from an area of lower concentration of solute to an area of higher concentration of solute

0Active 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

0Hypertonic – 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

0Hypotonic – solution of lower osmotic pressure; solution moves into cells

Isotonic Solution

Hypotonic Solution

Hypertonic Solution

Questions??

0Which type of solution if given to a patient would cause fluid to move from inside body cells (intracellular)?

0Where would the fluid move to?

Hormonal Regulation of Body Fluids

0ADH (antidiuretic hormone) – stored in posterior pituitary gland and released in response to changes in blood osmolality – stimulates kidney to reabsorb water

0Aldosterone – 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?

0Which of the following causes sodium reabsorption by the kidneys?0 Antidiuretic hormone0 Renin0 Insulin0 Aldosterone

Terms

0Osmolarity – used to describe concentration of solutions

0Sensible 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

0Most abundant in extracellular fluid0Major contributor to water balance0Nerve impulse transmission0Acid-base balance0Cellular chemical reactions0Normal level 135-145 mEq/L0Level influenced by dietary intake and aldosterone

Sodium

Potassium

0Most abundant in intracellular fluid0Necessary for glycogen deposits in the liver and

skeletal muscle0Conduction of nerve impulses0Normal cardiac rhythms0Skeletal and smooth muscle contraction0Normal level 3.5-5.0 mEq/L0Body does not conserve potassium well

Potassium

Foods with potassium

Calcium

0Stored in bone (99%), 1% in ECF0Bone and teeth formation0Blood clotting0Cell membrane integrity0Cardiac conduction0Transmission of nerve impulses0Muscle contraction

Foods with Calcium

Magnesium

0Enzyme activities0Neurochemical

activities0Cardiac and skeletal

muscle excitability0Most found

intracellular (along with potassium)

Anions – negative charge

0Chloride – major anion in ECF; dietary intake and kidneys regulate chloride level

0Bicarbonate – major chemical base buffer in the body; kidneys regulate bicarbonate

0Phosphate0 Assist with acid-base balance0 Helps to develop & maintain bones and teeth0 Neuromuscular action0 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

01. Buffer systems in the body (chemical regulators) – first to respond to an acid/base imbalance

02. Lungs – regulate CO2 by increasing/decreasing rate & depth of respirations

03. 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 DeficitCauses: losses from GI tract (diarrhea, vomiting), loss of plasma or whole blood (burns, hemorrhage), fever, increased perspiration, decreased oral intake of fluids, diuretic useData: 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

0pH – measures H+ ion concentration in body fluids; 7.35-7.45

0paCO2 – partial pressure of carbon dioxide in arterial blood; 35-45 mm Hg

0Bicarbonate (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

0Age – infants, young children and elderly0Chronic diseases0History of GI problems (vomiting, diarrhea)0Any recent surgery or burns0Vigorous exercise/temperature extremes?0Dietary intake0Medication use, smoking, alcohol

Assessment – Physical Exam

0 Weight0 Skin and mucous membranes0 Body temperature0 Orientation0 Distended neck veins0 Edema (sacrum, legs)0 Dysrhythmias, pulse rate, blood pressure0 Lung sounds, rate of respirations0 Vomiting? Diarrhea? Bowel sounds?0 Urine output (amount, color, specific gravity)0 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

0Deficient fluid volume0Excess fluid volume0Risk for imbalanced fluid volume0 Impaired gas exchange0 Ineffective tissue perfusion0Decreased cardiac output0 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

0Daily weight – single most important indicator of fluid status

0 Intake & output – examine for trends0Enteral fluid replacement – oral replacement or

nasogastric, gastrostomy or jejunostomy tube feedings

0Fluid restriction (if fluid volume excess)0Parenteral 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

0Clean technique0Place client in high Fowler’s position0Lubricate with water soluble lubricant0During insertion, if possible, have client take sips of

water 0Always verify placement post insertion and before

any feeding or irrigations (pH of stomach contents at 4)

0Use normal saline for irrigations

Nursing Interventions

0Monitor intake and output (How would you calculate if performing nasogastric irrigations?)

0Apply water soluble lubricant to nares to prevent irritation

0Good oral hygiene0When 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