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FLUID AND ELECTROLYTES

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Body fluids are classified according to their location with most ... Fluid compartments are separated by selectively permeable membranes ... (Starling's Law) ... – PowerPoint PPT presentation

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Title: FLUID AND ELECTROLYTES


1
FLUID AND ELECTROLYTES
  • NPN 205

2
FLUIDS
  • 50-60 of the human body is water (decreases with
    age)
  • Body fluids are classified according to their
    location with most of the bodys fluids found
    within the cell
  • Intracellular
  • Extracellular (mainly responsible for transport
    of nutrients and wastes)
  • Fluid compartments are separated by selectively
    permeable membranes that control movement of
    water and solutes
  • The process of homeostasis involves delivery of
    oxygen and nutrients to the cells and removal of
    waste

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Transport of Water and Fluids
  • Osmolality concentration of a solution
    determined by the number of dissolved particles
    per kilogram of water. Osmolality controls water
    movement and distribution in body fluid
    compartments
  • Diffusion the random movement of particles in
    all directions through a solution
  • Active transport movement of solutes across
    membranes requires expenditure of energy
  • Filtration transfer of water and solutes through
    a membrane from a region of high pressure to a
    region of low pressure
  • Osmosis movement of water across a membrane from
    a less concentrated solution to a more
    concentrated solution

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9
Fluid Pressures (Starlings Law)
  • ECF and ICF fluid shifts occur related to changes
    in pressure within the compartments
  • Fluid flows only when there is a difference in
    pressure
  • 3 types of body fluids
  • Isotonic
  • Hypotonic
  • Hypertonic

10
Hydrostatic Pressure and Colloid Osmotic Pressure
  • Tissue fluids and plasma in the capillaries have
    hydrostatic and colloid osmotic pressure
  • Hydrostatic pressure forces fluid and solutes
    through the capillary walls
  • When the hydrostatic pressure inside the
    capillary is greater than the pressure in the
    surrounding interstitial space, fluids and
    solutes inside the capillary they are forced out
    into the interstitial space
  • This also happens in the reverse

11
Albumins Role in F/E Balance
  • Reabsorption prevents too much fluid from leaving
    the capillaries
  • Albumin is a large molecule and will not pass
    through the capillary membrane
  • When fluid filters through the capillary, the
    protein albumin remains behind
  • When the concentration of albumin increases,
    fluid begins to move back into the capillary wall
    by osmosis
  • The pulling force of albumin in the intravascular
    space is called plasma colloid oncotic pressure

12
Plasma Colloid Osmotic Pressure
13
Regulation of Fluid Volume
  • Kidneys
  • Capillary pressure forces fluid through the walls
    and into the tubule
  • At this point H2O or electrolytes are then either
    retained or excreted
  • The urine becomes more dilute or more
    concentrated based on the needs of the body

14
Regulation of Fluid Volume, cont.
  • Antidiuretic hormone (ADH)
  • Produced by the hypothalamus
  • Stored in the pituitary gland
  • Restores blood volume by increasing or decreasing
    excretion of water
  • Increased osmolality or decreased blood volume
    stimulates the release of ADH
  • Then the kidneys reabsorb water
  • Also may be released by stress, pain, surgery,
    and some meds

15
Regulation of Fluid Volume, cont.
  • Renin-angiotensin-aldosterone system
  • Renin secreted in kidney
  • Amount of renin produced depends on blood flow
    and amount of Na in the blood
  • Produces angiotensin II (vasoconstrictor)
  • Angiotensin causes peripheral vasoconstriction
  • Angiotensin II stimulates the production of
    aldosterone

16
Regulation of Fluid Volume, cont.
  • Aldosterone
  • Secreted by the adrenal gland response to
    angiotensin II
  • The adrenal gland may also be stimulated by the
    amount of Na and K in the blood
  • Causes the kidneys to retain Na and H2O
  • Leads to increases in fluid volume and Na levels
  • Decreases the reabsorption of K
  • Maintains B/P and fluid balance

17
Regulation of Fluid Volume, cont
  • Atrial natriuretic peptide or factor (ANP) (ANF)
  • Cardiac hormone
  • Released in response to increased pressure in the
    atria (increased blood volume)
  • Opposes the renin-angiotensin-aldosterone system
  • Stimulates excretion of Na and H2O
  • Suppresses renin level
  • Decreases the release of aldosterone
  • Decreases ADH release
  • Reduces vascular resistance by causing
    vasodilation

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Fluid shifting
  • 1st space shifting- normal distribution of fluid
    in both the ECF compartment and ICF compartment.
  • 2nd space shifting- excess accumulation of
    interstitial fluid (edema)
  • 3rd space shifting- fluid accumulation in areas
    that are normally have no or little amounts of
    fluids (ascites)

20
REGULATION OF FLUID VOLUME
21
Diagnostic Tests for F/E
  • Urine studies
  • Urine pH Urine specific gravity
  • Urine osmolarity
  • Urine creatinine clearance
  • Urine sodium
  • Urine potassium

22
Blood Studies
  • Serum Hematocrit 40-54/men, 38-47 for women
  • Serum Creatinine 0.6 1.5 mg/dl
  • BUN 8-20 mg/dL
  • Serum osmolality
  • Serum Albumin 3.5-5.5 g/dL
  • Serum Electrolytes

23
ASSESSMENT FOR F/E BALANCE
  • History of potential factors which place patient
    at risk
  • Vital signs
  • I/O
  • Body weight
  • Skin
  • Mucus membranes
  • Vascular system

24
FLUID VOLUME DEFICITE
  • Hypovolemia isotonic extracellular fluid
    deficit
  • Deficiency of both water electrolytes
  • Caused by decreased intake, vomiting, diarrhea,
    fluid shift
  • Dehydration hypertonic extracellular fluid
    deficit
  • Deficiency of water
  • Caused by water loss related to high blood
    glucose, inadequate ADH production, high fever,
    excess sweating

25
Assessment of Fluid Deficit
  • Hypotension
  • Weak rapid pulse
  • Temperature decreased if hypovolemic, and
    increased in dehydration
  • Weight loss
  • Skin turgor poor in dehydration and possible
    edema in hypovolemic
  • Concentrated urine and blood

26
Treatment of Deficit
  • Correct cause
  • IV fluids
  • I and O
  • Skin care
  • Assist with ADLs

27
FLUID VOLUME EXCESS
  • Extracellular isotonic fluid excess
  • Excess of both water and electrolytes
  • Caused by retention of water and electrolytes
    related to kidney disease overload with isotonic
    IV fluids
  • Intracellular water excess
  • Excess of body water without excess electrolytes
  • Caused by over-hydration in the presence of renal
    failure administration of D5W

28
FLUID VOLUME EXCESS/Assessment
  • Isotonic
  • Hypertension
  • Bounding pulse
  • Crackles, dyspnea
  • Weight gain
  • Edema in extremities
  • JVD
  • Irritable, confused
  • Hypotonic
  • Systolic B/P
  • Decreased pulse
  • Increased respirations
  • Weight gain
  • Cerebral edema
  • Irritable, confused

29
FLUID VOLUME EXCESS/ Treatment
  • Isotonic
  • Correct cause
  • Restrict H2O and Na
  • Diuretics
  • Digitalis
  • Possible dialysis
  • Hypotonic
  • Correct cause
  • Restrict H2O intake
  • IV fluids with E-lytes

30
FLUID VOLUME EXCESS/Nursing Care
  • Isotonic
  • Monitor for excess excretion of H2O R/T diuretics
  • Maintain fluid restriction
  • Consult dietary for salt restrictions
  • Watch for skin problems
  • HOB 30 degrees
  • Hypotonic
  • IVs and meds as ordered
  • I/O
  • Oral care and ice chips
  • Safety precautions
  • Seizure precautions

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