Fluid elec (102)
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
701
On Slideshare
701
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
20
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
  • 2. Anatomy and Composition of Fluid Compartments Total Body Water (TBW) adult • 45-70% of body weight • lowest in aged & obese • highest in very lean & young TBW • 60% -- male 70kg • 50-55% female
  • 3. Anatomy and Composition of Fluid Compartments The composition of body fluid: Two compartments • Intracellular Space -- 2/3 -- 40% • Extracellular Space -- 1/3 -- 20%
  • 4. Body fluids Extracellular fluids (ECF) • Interstitial fluid - fills the spaces between most cells of the body • 15% of body weight • Intravascular fluid - plasma • (WBC, RBC and platelets in this fluid) 5% of body weight
  • 5. Body fluids Intracellular fluids (ICF) • Liquids within cell membranes • 40% of body weight
  • 6. Amount and composition of body fluidsActual amount of body water differs according to Age Sex Body composition
  • 7. Physiology of Body Water Balance Newborn 70% 0f WT water 1-year-old 60% of WT water Men: higher water content due to greater muscle mass
  • 8. Physiology of Body Water Balance Obese: less water because fat cells have minimal ICF • Use ideal body weight when estimating TBW for obese Elderly: less water due to less muscle mass
  • 9. Fluid Shifts “Third Spacing Refers to loss of ECF into a space that does not contribute to equilibrium between ICF and ECF Excess fluid in interstitial spaces and connective tissues between cells [edema] or Excess fluid in potential spaces [effusion] • peritoneal cavity • pericardial sac • synovial cavities of joints • alveoli or intra-pleural space
  • 10. Fluid Shifts “Third Spacing” Etiology • Caused by an increase in filtration and/or decrease in reabsorption due to altered capillary forces
  • 11. Fluid Shifts “Third Spacing”Mechanisms causing third spacing & edema • massive inflammation • venous obstruction • increased blood volume • low serum albumin
  • 12. Components in body fluids Electrolyte • an element that when dissolved can carry an electrical current • Cations - (+) ; Anions - (-) • neuromuscular function • acid-base balance
  • 13. Components of body fluids Minerals • ingested compounds • serve as catalysts in nerve response, muscle contraction, and metabolism of nutrients in foods, regulate electrolyte balance
  • 14. Movement of body fluids Diffusion • Area of higher concentration to an area of lower concentration till even distribution Osmosis • Movement of a pure solvent, e.g. water through a semipermeable membrane from a solution that has a lower solute concentration to one that has a higher solute concentration
  • 15. Osmotic pressure Drawing power of water (dependent on the number or molecules in solution) • Isotonic • Hypotonic • Hypertonic
  • 16. Movement of body fluids Filtration • Water and diffusible substances move together in response to fluid pressure Active transport • Requires energy • Able to move larger molecules and go from less to greater concentration
  • 17. Fluid Intake Hypothalamus - thirst control center Oral fluid intake requires an alert state Osmoreceptors - monitor osmolality
  • 18. Fluid Output Loss through the kidneys and GI tract Insensible Sensible
  • 19. Cations Sodium (Na+) • Most abundant in the extracellular fluid • Maintains water balance, transmits nerve impulses, contracts muscles • Values - 135-145 mEq/L
  • 20. Cation Potassium (K+) • Major intracellular cation • Regulates neuromuscular excitability, muscular contraction, and acid-base • Value - 3.5 -5.3 mEq/L
  • 21. Cation Calcium (Ca2+) • Cardiac conduction, blood coagulation, bone growth and formation, & muscular relaxation • Value - 4 - 5 mEq/L
  • 22. Cation Magnesium (Mg2+) • Second most important of intracellular fluids • Enzyme activities, muscular excitability • Value - 1.5 - 2.5 mEq/L
  • 23. Electrolyte Imbalances Hyponatremia • GI losses, sweating, & diuretics • S/S: N/V/D, abd cramps, personality change Hypernatremia • Ingestion of large amounts • S/S: Dry tongue and mucous membranes, restlessness, convulsions, thirst, dry skin
  • 24. Electrolyte imbalances Hypokalemia Causes: K+ wasting diuretics N/V/D polyuria S/S: weak, irregular pulse • hypotension • weakness
  • 25. Electrolyte imbalances Hyperkalemia • Causes: Renal failure • S/S: irregular slow pulse, weakness, irritability
  • 26. Electrolyte Imbalances Hypocalcemia • Causes: Vitamin D deficiency • S/S: Numb and tingling fingers and circumoral region, muscle cramps Hypercalcemia • Causes: osteoporosis, prolonged immobilization • S/S: decreased muscle tone, weakness, lethargy, kidney stones
  • 27. Electrolyte imbalances Hypomagnesemia • Causes: malnutrition and alcoholism polyuria • S/S: muscular tremors, hyperactive deep tendon reflexes Hypermagnesemia • Causes: Renal failure • S/S: hypoactive deep tendon reflexes, shallow and slow respirations
  • 28. Acid - Base Balance Blood pH - 7.35 - 7.45 paCO2 - 35 - 45 Bicarbonate (HCO3) - 22-26 mEq/L
  • 29. Respiratory Acidosis pH < 7.35 paCO2 > 45 mm Hg Causes: Respiratory failure Hypoventilation Resp muscles paralysis Airway obstruction
  • 30. Respiratory Alkalosis pH > 7.45 paCO2 < 35 mm Hg Causes: excessive exhalation of CO2 (hyperventilation)
  • 31. Metabolic Acidosis pH < 7.35 bicarbonate - < 22 mEq/L Causes: Starvation, DKA, Diarrhea, drug use
  • 32. Metabolic Alkalosis pH > 7.45 bicarbonate > 26 mEq/L Causes: excessive vomiting, prolonged gastric suctioning
  • 33. Fluid & Electrolyte Imbalances Burns - body fluid loss Renal D/O - abnormal retention of Na, Cl, K GI Disturbances - Loss of fluid, potassium, and chloride Exercise
  • 34. S/S electrolyte imbalance Head: irritability Fontanels: depressed, bulging Eyes: sunken periorbital edema Mouth: mucous membranes CV: neck veins, edema, blood pressure
  • 35. Imbalances GI: abdomen, V/D Renal: Oliguria or anuria (FVD, FE) Diuresis (FVE) Increased urine spec. gravity (FVD) Skin (Temp) • increased - met acidosis, hypernatremia • decreased - FVD
  • 36. Replacement of fluids andelectrolytes Types of IV fluids Isotonic Hypertonic Hypotonic
  • 37. IV complications Infiltration • IVF enter SQ space Phlebitis • vein inflammation • S/S: pain, redness, warmth Fluid overload • Fluids given too rapidly Bleeding
  • 38. Discontinuing an IV Stop infusion Remove tape 1 - 2 minute pressure
  • 39. Blood transfusions Large bore catheter (18 ga or larger) Give with normal saline Baseline vital signs Double check with two RNs Begin transfusion slowly Observe closely for first 15 min
  • 40. Transfusion Reactions Caused by: • blood incompatibility • allergic sensitivity • S/S: fever, chills, rash, hypotension, shock Treatment: stop transfusion, give NS, save tubing, prepare for emergency drugs