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Fluid and-electrolyte report
 

Fluid and-electrolyte report

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    Fluid and-electrolyte report Fluid and-electrolyte report Presentation Transcript

    • Fluid and electrolytes balance Christelle Anne Sison III-BSN
    • Body fluid and electrolyte: • About 46 to 6o % of the average adult weight is water.
    • Water may serve as: • Medium of metabolic reaction with cells. • Transporter for nutrients, waste products, and other substance. • A lubricant. • Shock absorber. • Regulate and maintain body temperature.
    • • The proportion of water decreases with aging because fat, age and sex effect of total body water. • (Infant 70 – 80%).
    • Distribution of body fluids: • The body fluid divided in two major compartments: A) Intracellular fluid (ICF): • Is found in the cells of the body. its constitute 2/3 of the total body fluid in the adult.
    • b) Extracelluar fluid (ECF): • is found out side of cell and account 1/3 of the total body fluid. • it’s subdivided into three compartments: 1) Intravascular fluid or plasma: is found within vascular system. 2) Interstitial fluid: is found surrounding the cell and includes lymph. 3) Transcellular: includes cerebrospinal fluid, pleural, peritoneal and synovial fluid.
    • Composition of Fluids • plasma interstitial intracellular •Cations •Na 140 146 12 •K 4 4 150 •Ca 5 3 10 •Mg 2 1 7 •Anions •Cl 103 104 3 •HCO 24 27 10 •SO4 1 1 - •HPO4 2 2 116 •Protein 16 5 40
    • • Function of ICF & ECF: • ICF: is vital to normal cell function, its contain solutes such as oxygen, electrolytes and glucose. It provides a medium to metabolic process. • ECF: it is the transport system that carries nutrients and waste product from the cell.
    • Movement of body fluid and electrolyte: 1. Osmosis: • Is the movement of water across cell membranes, from the less concentrated solution to more concentrated solution. In other word water move toward higher concentration.
    • – Solutes are substance dissolved in liquid. – Crystalloid: salts that dissolved readily in to true solution. – Colloids: substance such as large protein molecules that do not dissolved in true solution. • Sodium is the major determinant of serum osmolality.
    • 2. Diffusion: • Is the continual intermingling of molecules in liquid, gases by random movement of the molecules.
    • 3. Filtration: • Is the process where by fluid and solutes moved together across a membrane from one compartment to another.
    • 4. Active transport: • substance can move across cell membranes from a less concentrated solution to amore concentrated one by active transport.
    • Regulating body fluid: • The average adult drinks about 1500ml per day, but need to 2500ml per day, this added volume is acquired by the food. • The thirst center is located in the brain, this center trigger by osmotic pressure and angiotensin II .
    • Hormonal regulation
    • Regulation of ECF
    • Fluid out put: • Urine: normal urine out put 1500ml per 24hrs or at least 30ml per hours. • Insensible loss: through the skin as perspiration and through the lung a water vapor in the expired air. • Loss through the intestine (feces)
    • • Obligatory losses: approximately 500ml of fluid must be exerted through the kidney to eliminate metabolic waste product and feces, respiration and perspiration to maintain body temperature. • The average daily fluid out put for an adult 2500ml/ day.
    • Client at risk for fluid and electrolyte imbalance: • Post operative client. • Client with sever trauma or burn. • Client with chronic disease as congestive heart failure. • Client who are NPO. • Client with intravenous infusion. • Client with special drainage. • Client who receiving diuretic
    • Factor effecting fluid and electrolyte balance: • Age: infant have greater water need and greater loss due to greater metabolic rate. • Environment: excess heat stimulates the sympathetic nervous system and cause person to sweat.
    • • Diet: in nutritional deficiency, the body preserved the protein by breaking down the fat and glycogen. • Stress: water retention and increase the production antiduritic hormone. • Illness: burn, renal disorder
    • Disturbances in fluid and electrolyte: • Hypovolemia: decrease blood volume • Hypovolemic shock when intravascular fluid is depleted. • Hypervolimia: increase blood volume.
    • Edema: is collection of fluids in the tissue. Type of edema: • Dependent edma: found in the lowest part body. • Pitting edma: edema that leaves a depression or pit after finger pressure is applied on the swollen area.
    • Pitting odema
    • • Sodium (Na): • Is the most abundant cation in the extracelluar fluid and major contributor to serum osmolality. • Function of sodium: • controlling and regulating water balance. • Maintaining blood volume • Transmitted nerve impulses.
    • • Normal level is 135 – 145 mg/dl. • Hyponatremia: sodium deficit in the blood. • Hypernatremia: sodium excess in the blood. • Sodium is found in many foods, such as processed cheese, table salt.
    • Potassium: • Is the major cation in intracellular fluid. • Function of potassium: • Maintain ICF osmolality. • Transmitting nerve impulses. • Regulate cardiac impulses. • Skeletal and smooth muscle function. • Regulate acid base balance
    • – Potassium is found in many fruits and vegetables, meat, fish, milk. – Normal level of potassium is 3.5 – 5.3meq/l. – Hypokalemia: potassium deficit in the blood. – Hyperkalemia: potassium excess in the blood.
    • • Hypocalcemia: calcium deficit in the blood. • Hypercalcemia: calcium excess in the blood.
    • Loss of water and electrolyte: • Vomiting. • Diarrhea. • Excessive sweating. • Ployuria. • Fever. • Nasogastric suction. • Abnormal drainage. • Anorexia. • Nausea • Impaired swallowing.
    • Finding associated with fluid and electrolyte imbalance: • Skin: dry pale, cool skin, reduce skin Turgor. • Oral cavity: dry mucous membrane, absence of salivation. • Weak rapid pulse. • Decreased blood pressure. • Decreased central venous pressure
    • • Decreased urine out put. • Increased hematocrit. • Thirst. • Flat neck vein.
    • Fluid volume excess: • Excess intake of sodium – containing intravenous fluid. • Excess of ingestion of sodium in diet. • Heart failure. • Renal failure. • Liver cirrhosis.
    • Clinical manifestation: • Weight gain. • Fluid intake greater than out put. • Moist mucous membrane. • Tachycardia. • Increased blood pressure. • Distended neck vein. • Dyspnea and crackles. • Mental confusion.
    • Acid – Base Balance
    • Nursing care plan • Assessment: – Nursing history: • Date include fluid and food intake, output. • Recent fluid losses. • Sign of fluid deficit. • Common sign of electrolyte disturbance. • Medication.
    • Clinical measurement: – Daily weights, vital sign, fluid intake and output (I&O), serum electrolyte, complete blood count (CBC). Serum osmolality, urine specific gravity.
    • Nursing diagnosis: • Fluid volume deficit related to dehydration. • Fluid volume excess related to heart failure. • Altered oral mucous membrane related to fluid volume defects. • Impaired skin integrity related to dehydration • Decreased cardiac output related to hypovolemia. • Altered tissue perfusion related to decreased cardiac output.
    • Implementation: • Assess clinical manifestation of hypo or Hypervolimia. • Provide fluid and electrolyte orally. • Foods. • Intravenous therapy can prescribed for those reason • Provide salts if needed. • Provide glucose for metabolism. • Provide water soluble vitamins
    • • Monitor intake & output. • Monitor lapratory finding. • Provide frequent oral care. • Monitor weight. • Assess for edma. • Place patient in fowler position. • Assess breathing sound, inspiration and expiration (crackles). • Provide safety for client