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Fluid, Electrolyte, and Acid-Base Balance


Fluid, Electrolyte, and Acid-Base Balance Learning Outcomes Discuss the function, distribution, movement, and regulation of fluids and electrolytes in the body. – PowerPoint PPT presentation

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Title: Fluid, Electrolyte, and Acid-Base Balance

Fluid, Electrolyte, and Acid-Base Balance
Learning Outcomes
  • Discuss the function, distribution, movement, and
    regulation of fluids and electrolytes in the
  • Describe the regulation of acidbase balance in
    the body, including the roles of the lungs, the
    kidneys and buffers.
  • Identify factors affecting normal body fluid,
    electrolyte, and acidbase balance.
  • Discuss the risk factors for and the causes and
    effects of fluid, electrolyte, and acidbase
  • Collect assessment data related to the clients
    fluid, electrolyte, and acidbase balances.

Learning Outcomes
  • Identify examples of nursing diagnoses, outcomes,
    and interventions for clients with altered
    fluid, electrolyte, or acidbase balance.
  • Teach clients measures to maintain fluid and
    electrolyte balance.
  • Implement measures to correct imbalances of
    fluids and electrolytes or acids and bases such
    as enteral or parenteral replacements and blood
  • Evaluate the effect of nursing and collaborative
    interventions on the clients fluid, electrolyte,
    or acidbase balance.

  • A delicate (fragile) balance of fluids,
    electrolytes, and acids and bases is maintained
    in the body. This balance depends on multiple
    physiologic processes that regulate fluid intake
    and output and the movement of water and
    substances dissolved in it between body

  • Water is vital to health and normal cellular
    function. It serves as a medium for metabolic
    reactions within the cells a transporter for
    nutrients, waste products, and other substances
    a lubricant an insulator a shock absorber and
    one means of regulating and maintaining body

  • The bodys fluid is divided into two major
    compartments intracellular and extracellular.
    Intracellular fluid (ICF) is found within the
    cells, and extracellular fluid (ECF) is found
    outside the cells.

  • The two main compartments of the ECF are
    intravascular fluid (plasma) and interstitial
    fluid (surrounds the cells). Other compartments
    of ECF include lymph and transcellular fluids
    such as cerebrospinal, pericardial, pancreatic,
    pleural, intraocular, biliary, peritoneal, and
    synovial fluids. Intracellular fluid is vital to
    normal cell functioning.

  • It contains solutes such as oxygen, electrolytes,
    and glucose, and it provides a medium in which
    metabolic processes of the cell take place.
    Extracellular fluid is the transport system that
    carries nutrients to and waste products from the

  • Fluids and electrolytes move among the body
    compartments by osmosis, diffusion, filtration,
    and active transport. The volume and composition
    of body fluids is regulated through several
    homeostatic mechanisms the kidneys, the
    endocrine system, the cardiovascular system, the
    lungs, and the gastrointestinal system.

  • The antidiuretic hormone (ADH), also called
    arginine vasopressin (AVP), the
    renin-angiotensin-aldosterone system.

Movement of Body Fluids
  • Osmosis
  • Diffusion
  • Filtration
  • Active transport

Osmosis Water molecules move from the less
concentrated area to the more concentrated area
in an attempt to equalize the concentration of
solutions on two sides of a membrane.
Diffusion The movement of molecules through a
semipermeable membrane from an area of higher
concentration to an area of lower concentration.
Schematic of filtration pressure changes
within a capillary bed. On the arterial side,
arterial blood pressure exceeds colloid osmotic
pressure, so that water and dissolved substances
move out of the capillary into the interstitial
space. On the venous side, venous blood pressure
is less than colloid osmotic pressure, so that
the water and dissolved substances move into the
Regulating Body Fluids
  • Fluid intake
  • Thirst
  • Fluid output
  • Urine
  • Insensible loss
  • Feces
  • Maintaining homeostasis
  • Kidneys
  • ADH
  • Renin-angiotensin-aldosterone system

  • ECF and ICF contain ions (charged particles).
    Anions are negative ions and cations are positive
    ions called electrolytes. The number of cations
    and anions in should be equal.

  • The principal electrolytes in the ECF are sodium,
    chloride, and bicarbonate. Other electrolytes
    such as potassium, calcium, and magnesium but in
    much smaller quantities.

  • Plasma and interstitial fluids (major components
    of ECF) contain essentially the same electrolytes
    and solutes with the exception of proteins, which
    are plentiful in the plasma.

  • The primary electrolytes in the ICF are
    potassium, magnesium, phosphate, and sulfate. As
    in ECF, other electrolytes are present within the
    cells, but in smaller concentrations.

Distribution of Body Fluids
Regulating Electrolytes
  • Sodium
  • Potassium
  • Calcium
  • Magnesium
  • Chloride
  • Phosphate
  • Bicarbonate

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Regulation Acid-Base Balance
  • An important part of regulating the chemical
    balance or homeostasis of body fluids is
    regulating their acidity or alkalinity, which is
    measured as pH. The pH reflects the hydrogen
    concentration of the solution.

  • The higher the hydrogen ion concentration, the
    lower the pH (more acidic) and vice versa. Body
    fluids are maintained within a narrow range that
    is slightly alkaline (arterial blood is between
    7.35 and 7.45).

  • Several body systems, including buffers, the
    respiratory system, and the renal system, are
    actively involved in maintaining the narrow pH
    range necessary for optimal function. The lungs
    and kidneys help maintain a normal pH by either
    excreting or retaining acids and bases.

  • Buffers (substance that keeps a constant balance
    between acid and alkali) prevent excessive
    changes in the pH by removing or releasing
    hydrogen ions. The major buffer system in ECF is
    the bicarbonate (HCO3) and carbonic acid (H2CO3)

  • The amounts of bicarbonate and carbonic acid in
    the body vary. However, as long as a ratio of 20
    parts of bicarbonate to 1 part of carbonic acid
    is maintained, pH remains within normal limits.
    In addition, plasma proteins, hemoglobin, and
    phosphates function as buffers.

Regulation of Acid-BaseBalance
  • Low pH acidic
  • High pH alkalinic
  • Body fluids maintained between pH of 7.35 and
    7.45 by
  • Buffers
  • Respiratory system
  • Renal system

  • Prevent excessive changes in pH
  • Major buffer in ECF is HCO3 and H2CO3
  • Other buffers include
  • Plasma proteins
  • Hemoglobin
  • Phosphates

  • The lungs help regulate acidbase balance by
    eliminating or retaining carbon dioxide, a
    potential acid. Combined with water, carbon
    dioxide forms carbonic acid. This chemical
    reaction is reversible.

  • Working together with the bicarbonatecarbonic
    acid buffer system, the lungs regulate acidbase
    balance and pH by altering the rate and depth of

  • Carbon dioxide is a powerful stimulator of the
    respiratory center. When blood levels of carbonic
    acid and carbon dioxide rise, the respiratory
    center is stimulated and the rate and depth of
    respiration increase. Carbon dioxide is exhaled
    and carbonic acid levels fall.

  • By contrast when bicarbonate levels are
    excessive, the rate and depth of respirations are
    reduced, causing carbon dioxide to be retained,
    carbonic acid to rise, and excess bicarbonate to
    be neutralized.

  • The respiratory system response to changes in pH
    is rapid, occurring within minutes.

  • The kidneys are the ultimate long-term regulator
    of acidbase balance. They are slower to respond
    to changes, requiring hours to days to correct
    imbalances, but their response is more permanent
    and selective than that of the other systems.

  • Kidneys maintain acidbase balance by selectively
    excreting or conserving bicarbonate and hydrogen
    ions. When excess hydrogen ion is present and the
    pH falls (acidosis), the kidneys reabsorb and
    regenerate bicarbonate and excrete hydrogen ions

  • In the case of alkalosis and a high pH, excess
    bicarbonate is excreted and a hydrogen ion is

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Factors Affecting Body Fluid, Electrolyte, and
Acid-Base Balance
  • Age
  • Gender
  • Body size
  • Environmental temperature
  • Lifestyle

  • Ageinfants and growing children have much
    greater fluid turnover than adults because of
    their higher metabolic rates, increase fluid
    loss, immature kidneys (infants), rapid
    respiratory rate (infants), and greater body
    surface area (infants).

  • In elderly people normal aging process and the
    likelihood of the presence of chronic diseases
    may affect fluid balance. Thirst is blunted (not
    sharp) nephrons are less able to conserve water
    in response to ADH.

  • Gender and body sizefat cells contain little
    water and lean tissue has an increased water
    content. People with a greater percentage of body
    fat have less body fluid. Women have
    proportionally greater body fat than men and have
    less body water than men.

  • Environmental temperatureindividuals with
    illness and participation in strenuous exercise
    are at risk for fluid and electrolyte imbalances
    when the environmental temperature in high the
    loss of water and salt in sweat.

  • Lifestylediet (intake of fluid and
    electrolytes), exercise (calcium balance), and
    stress (increases cellular metabolism, blood
    glucose concentration, and cathecholamine levels)
    affect fluid and electrolyte and acidbase
    balance. Heavy alcohol consumption decreases
    calcium, magnesium, and phosphate levels and
    increases the risk of acidosis from breakdown of

Risk Factors for Fluid, Electrolyte, and
Acid-Base Imbalances
  • Chronic diseases
  • Acute conditions
  • Medications
  • Treatments
  • Extremes of age
  • Inability to access food and fluids

  • Chronic diseases (e.g., lung disease, heart
    failure, Cushings or Addisons diseases,
    diabetes mellitus, and cancer), acute conditions
    (e.g., acute gastroenteritis, burns, crushing
    injuries, surgery, or fever), medications (e.g.,
    diuretics, corticosteroids, and NSAIDs),
    treatments (e.g., chemotherapy, intravenous
    therapy or total peripheral nutrition,
    nasogastric suction, enteral feedings, mechanical
    ventilation) and other factors (such as the very
    young and the very old, inability to access food
    and fluids independently) .

  • Fluid imbalances are of two basic types isotonic
    and osmolar. Isotonic imbalances occur when water
    and electrolytes are lost or gained in equal
    proportions so that the osmolality of body fluids
    remains constant. Osmolar imbalances involve the
    loss of only water so that the osmolality of the
    serum is altered.

Fluid Imbalances
  • Isotonic loss of water and electrolytes (fluid
    volume deficit)
  • Isotonic gain of water and electrolytes (fluid
    volume excess)
  • Hyperosmolar loss of only water (dehydration)
  • Hypo-osmolar gain of only water (overhydration)

  • Fluid imbalances are of two basic types isotonic
    and osmolar.
  • Isotonic imbalances occur when water and
    electrolytes are lost or gained in equal
    proportions so that the osmolality of body fluids
    remains constant.

  • Osmolar imbalances involve the loss of only water
    so that the osmolality of the serum is altered.
    Thus there are four categories of fluid
    imbalances an isotonic loss of water and
    electrolytes (fluid volume deficit), an isotonic
    gain of water and electrolytes (fluid volume
    excess), a hyperosmolar loss of only water
    (dehydration), and a hypo-osmolar gain of only
    water (overhydration).

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  • The risk for dehydration increases with older age
    due to decreased thirst sensation. Also at risk
    for dehydration are clients who are
    hyperventilating or have prolonged fever or are
    in diabetic ketoacidosis and those receiving
    enteral feedings with insufficient water.

  • Common manifestations of dehydration include
    weight loss, decreased skin turgor and capillary
    refill, dry mucous membranes, weak, rapid pulse,
    decreased blood pressure and orthostatic
    hypotension, increased specific gravity of the
    urine, hematocrit and blood urea nitrogen.

  • Overhydration may occur if only water is replaced
    or from the syndrome of inappropriate
    antidiuretic hormone (SIADH), which can result
    from some malignant tumors, AIDS, head injury, or
    administration of certain drugs such as
    barbiturates or anesthetics.

  • Common manifestations of overhydration include
    weight gain, full bounding pulse, tachycardia,
    elevated blood pressure, distended neck and
    peripheral veins, adventitious lung sounds,
    shortness of breath, and confusion.

  • Collecting Assessment Data
  • Nursing history
  • Physical assessment
  • Clinical measurement
  • Review of laboratory test results
  • Evaluation of edema

  • The nursing history includes current and past
    medical history, medications, and functional,
    developmental, and socioeconomic factors. Common
    risk factors for fluid and electrolyte imbalances

  • The nurse also needs to elicit data about the
    clients food and fluid intake, fluid output, and
    the presence of signs or symptoms suggestive of
    altered fluid and electrolyte balance. The
    Assessment Interview provides examples of
    questions to elicit information regarding fluid,
    electrolyte, and acidbase balance.

  • lists the focused physical assessment of fluid,
    electrolyte, or acidbase imbalances, including
    assessment of the skin, mucous membranes, eyes,
    fontanels (infants), cardiovascular system,
    respiratory system, neurologic and muscular

  • Clinical measurement includes daily weights,
    vital signs, and fluid intake and output.

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Evaluation of Edema
NANDA Nursing Diagnoses
  • Deficient Fluid Volume
  • Excess Fluid Volume
  • Risk for Imbalanced Fluid Volume
  • Risk for Deficient Fluid volume
  • Impaired Gas Exchange

NANDA Nursing Diagnoses
  • Fluid and Acid-base Imbalances as Etiology
  • Impaired Oral Mucous Membrane
  • Impaired Skin Integrity
  • Decreased Cardiac Output
  • Ineffective Tissue Perfusion
  • Activity Intolerance
  • Risk for Injury
  • Acute Confusion

Desired Outcomes
  • Maintain or restore normal fluid balance
  • Maintain or restore normal balance of
  • Maintain or restore pulmonary ventilation and
  • Prevent associated risks
  • Tissue breakdown, decreased cardiac output,
    confusion, other neurologic signs

Nursing Interventions
  • Monitoring
  • Fluid intake and output
  • Cardiovascular and respiratory status
  • Results of laboratory tests
  • Assessing
  • Clients weight
  • Location and extent of edema, if present
  • Skin turgor and skin status
  • Specific gravity of urine
  • Level of consciousness, and mental status

Nursing Interventions
  • Fluid intake modifications
  • Dietary changes
  • Parenteral fluid, electrolyte, and blood
  • Other appropriate measures such as
  • Administering prescribed medications and oxygen
  • Providing skin care and oral hygiene
  • Positioning the client appropriately
  • Scheduling rest periods

Promoting Fluid andElectrolyte Balance
  • Consume 6-8 glasses water daily
  • Avoid foods with excess salt, sugar, caffeine
  • Eat well-balanced diet
  • Limit alcohol intake
  • Increase fluid intake before, during, after
    strenuous exercise
  • Replace lost electrolytes

Promoting Fluid andElectrolyte Balance
  • Maintain normal body weight
  • Learn about, monitor, manage side effects of
  • Recognize risk factors
  • Seek professional health care for notable signs
    of fluid imbalances

Teaching Client to Maintain Fluid and
Electrolyte Balance
  • Promoting fluid and electrolyte balance
  • Monitoring fluid intake and output
  • Maintaining food and fluid intake
  • Safety
  • Medications
  • Measures specific to clients problems
  • Referrals
  • Community agencies and other sources of help
  • Facilitating fluid intake

Practice GuidelinesFacilitating Fluid Intake
  • Explain reason for required intake and amount
  • Establish 24 hour plan for ingesting fluids
  • Set short term goals
  • Identify fluids client likes and use those
  • Help clients select foods that become liquid at
    room temperature
  • Supply cups, glasses, straws
  • Serve fluids at proper temperature
  • Encourage participation in recording intake
  • Be alert to cultural implications

Practice GuidelinesRestricting Fluid Intake
  • Explain reason and amount of restriction
  • Help client establish ingestion schedule
  • Identify preferences and obtain
  • Set short term goals place fluids in small
  • Offer ice chips and mouth care
  • Teach avoidance of ingesting chewy, salty, sweet
    foods or fluids
  • Encourage participation in recording intake

Correcting Imbalances
  • Oral replacement
  • If client is not vomiting
  • If client has not experienced excessive fluid
  • Has intact GI tract and gag and swallow reflexes

Correcting Imbalances
  • Restricted fluids may be necessary for fluid
  • Vary from nothing by mouth to precise amount
  • Dietary changes

Oral Supplements
  • Potassium
  • Calcium
  • Multivitamins
  • Sports drink

  • Collect data as identified in the plan of care
  • If desired outcomes are not achieved, explore the
    reasons before modifying the care plan

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