• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Fluid And Electrolytes1

Fluid And Electrolytes1






Total Views
Views on SlideShare
Embed Views



3 Embeds 16

http://angelina.blackboard.com 10
http://www.slideshare.net 5
http://wildfire.gigya.com 1



Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

    Fluid And Electrolytes1 Fluid And Electrolytes1 Presentation Transcript

    • Fluid, Electrolyte and Acid-Base Balance
    • Total Fluid Volumes by Age and Sex
    • Normal Water Balance
            • Intake:
              • Fluid ingestion 60%
              • Foods 30%
              • Metabolism 10%
            • Output:
              • Urine 60%
              • Sweat 8%
              • Feces 4%
              • "Insensible" loss 28%
              • (skin, lungs)
    • Fluid Compartments Extracellular Interstitial Intracellular Intravascular Intracellular
    • Fluid is in both compartments 50-60% of body weight ¾ of ECF ¼ of ECF
    • Intravascular Fluid or Plasma (1/4 of ECF)
      • Volume
        • Necessary for BP Maintenance
      • Maintenance of Proportional Distribution
        • Protein content of blood (Serum proteins- globulin and albumin
        • Integrity of blood vessels linings
        • Hydrostatic pressure inside blood vessels
      • Osmolarity
        • Concentration of dissolved substances expressed in mOsm/L (Normal 280-300)
    • Movement of Body Fluids
      • Filtration
        • Hydrostatic pressure
      • Osmosis
        • Concentration- solvent moves to make concentrations even although volume is not.
      • Diffusion
        • Redistributing - high to low to make even
      • Active Transport
        • Energy requirement for selective admission
    • Filtration
    • Osmosis
        • Movement of fluid through semipermeable membrane
        • Concentration controls- solvent moves to make concentrations even although volume is not
    • Filtration Pressures in a Capillary
    • Problem Examples: Edema Congestive heart failure
    • Diffusion - movement of solutes against a concentration gradient; tries to to balance cations + with anions -
    • Active Transport
      • Requires energy from metabolism to move larger or uneven substances across cell membranes
        • Glucose needs insulin to enter cell
        • Na/K pump
    • Active Transportation of Glucose
    • Na-K Pump: For every molecule of ATP, 3 molecules of Na move to outside of cell and 3 molecules of K move inside the cell
    • Factors Affecting Fluid & Electrolyte Movement
        • Osmotic Pressure and Tonicity
        • Hydrostatic Pressure
        • Filtration Pressure
    • Osmolality and Tonicity
      • Osmolality (Kg) and osmolarity (L) are determined by the solutes (mainly Na) in the ECF
        • Abnormalities tell us that there are problems with water regulation in the ECF.
      • Tonicity is the force that the ECF solutes (mainly Na) have to pull water into the ECF.
        • (Na, glucose, mannitol, sorbitol are effective osmoles.)
    • Osmosis and Tonicity Na is the main determinant of plasma tonicity . Thirst and ADH release Swelling of cells
    • Problem Examples: Edema Congestive heart failure
    • Tonicity HYPO 0.45% saline (1/2 normal) Moves fluid into cells
    • Tonicity ISO Same osmolarity as plasma 0.9 % saline (Normal saline) – no fluid shift
    • Tonicity HYPER 3% saline Pulls fluid from cells
    • Tonicity
    • Electrolytes + - - - - - + + + +
    • ECF Electrolytes
        • Sodium - Na 135-145mEq/L
        • Potassium - K 3.5-5.0 mEq.L
        • Calcium - Ca 4.5-5.5 mEq/L
        • Magnesium - Mg 1.5 - 2.5 mEq/L
        • Chloride - Cl 90-110 mEq/L
        • Bicarbonate – HCO 3
            • Arterial 22-26 mEq/L
            • Venous 24-30 mEq/L
    • Sodium and ECFV
      • The total amount of Sodium in ECF is the major determinant of the size of the ECF Volume
        • Na increases = ECFV increases until ECF ‘volume overload’ results (edematous states)
          • CHF, Cirrhosis of the liver, nephrotic syndrome
          • Pleural effusions, pulmonary edema, ascites
        • Na decreases = ECFV decreases eventually leading to ‘volume depletion’ manifested by poor skin turgor, tachycardia, orthostatic hypotension
    • Sodium Regulation
      • Kidney receptors sense changes in renal perfusion causing renin-angiotensin system to retain sodium in kidney.
      • Volume receptors in great veins sense filling and release atrial natriuretic factor that promotes Na excretion.
      • Pressure receptors in aorta and carotid sinus activate sympathetic NS to retain Na .
      • Water ALWAYS follows Na
      • Therefore when ECFV increases, these mechanisms are activated to increase Na excretion; and conversely, if ECFV decreases, the same means promotes Na retention.
    • Water Regulation ( Hypo- and Hyper-Natremia are always a problem with water, not Sodium)
      • Osmolality increase in ECF -> Thirst
      • Renal responsiveness to tonicity
      • Adequate delivery of water and solutes to glomerulus of kidney ( Problem: Early reabsorption of water due to volume depletion or edematous states )
      • Water conservation mechanisms in kidney (Can be overridden by diuretics either in loop or in distal tubule.
      • ADH in response to tonicity changes, i.e., Na, or in response to volume changes (Problems: SIADH and DI)
    • Diuretics
      • Both Thiazides and Loop diuretics block Na reabsorption and cause decrease in ECF, too.
      • Loop cause greater loss of Na but equal water, but thiazides lose less water than Na and can cause hyponatremia .
    • Manifestations of Fluid, and Electrolyte Imbalances
      • Imbalances of Intake and Output and Body Weight
      • Changes in Mental Status
      • Changes in Vital Signs
      • Abnormal Tissue Hydration
      • Abnormal Muscle Tone
    • Signs and Symptoms of Dehydration *Poor skin turgor (tenting of the skin of the back of the hand is common in normal geriatric patients b/c of age-related skin changes A recent history of poor oral intake and/or a documented weight loss are probably better warning signs of dehydration in geriatric residents.
      • Difficulty swallowing
      • Clumsiness
      • Shriveled skin
      • Sunken eyes
      • Visual disturbances
      • Painful urination
      • Numb skin
      • Muscle spasm
      • Delirium
      • Headache
      • Fatigue
      • Loss of appetite
      • Flushed skin
      • Heat intolerance
      • Light-headedness
      • Dry mouth or eyes
      • Burning sensation in stomach
      • Dark urine with strong odor
      Advanced Dehydration Early Dehydration
    • Nursing Interventions
      • Health Promotion
        • Teaching depending upon setting
      • Altered Function
        • Oral fluid increase
        • Oral fluid restriction
        • Electrolyte replacement
          • Diet or supplement
          • IV therapy
    • Renal failure, chemoTx, enemas containing Malnourished, alcohol withdrawal, phosphate- binding antacids Muscle, RBC’s, CNs, w/ Calcium in bones and teeth 1.7-4.6 Phos Phosphate Maalox and Milk of Magnesia in patients with renal failure Diarrhea, vomiting, NG Suction, hyper aldosteronism Muscle, RBC’s and CNS, metabolism 1.5-2.5 Mg Magnesium Mult. Myeloma, thiazide diuretics, malignancies, Chronic renal failure, Vit D deficiency, pancreatiti,s, loop diuretics, diarrhea hyporparathyroidism Transmission of nerve impulses, cardiac contractions, bone, blood clotting 4.5-5.5 Ca Calcium Acidosis Renal disease K containing drugs K salt substitute GI Losses – diarrhea, vomiting, duretics, diaphoresis Major ICF cation; cellular and metabolic functions including cardiac rhythms 3.5-5.0 K Potassium High fever, heatstroke due to insensible water loss, diabetes insipidus GI Losses Diuretics, burns, wound drainage Maintains concentration of ECF 135-145 Na Sodium Hyper Causes Hypo Causes Function Normal Value Symbol Name Serum Electrolytes
    • Objective Data
      • Neck Vein Distention
      • Central Venous Pressure
      • Pulmonary Artery Pressure
      • Bowel Assessment
      • Laboratory and Diagnostic Tests
        • Urine Tests
        • Blood Tests
    • Central Venous Pressure or Jugular Venous Distention
    • Assessment
      • Subjective Data
        • Normal Pattern Identification
        • Risk Identification
        • Dysfunction Identification
      • Objective Data—Physical Assessment
        • Intake and Output
        • Body Weight
        • Integumentary Assessment
    • plasma expander Isotonic (308 mOsm/L) 10% Dextran 40 in 0.9%NS closely resemble the electrolyte composition of normal blood serum and plasma; will need additional K; does not provide calories or  free water; used to treat losses from lower GI tract and burns.   Isotonic (273 mOsm/L) Lactated Ringer’s Solution provides free water (hypotonic) to the extracellular and intracellular spaces, as the dextrose is quickly metabolized; promotes renal elimination of solutes; treats hypernatremia; does not provide electrolytes; one liter is 170 calories Isotonic (252 mOsm/L) D5W - 5% Dextrose in water to treat fluid volume deficit; for daily maintenance of body fluids and nutrition; basically the same as NS, except provides 170 calories per liter Hypertonic (559 mOsm/L) D5NS - 5% Dextrose & 0.9NaCl to promote renal function and excretion; basically the same as .45NS except provides 170 calories per liter Hypertonic (406 mOsm/L) D5 1/2 NS - 5% Dextrose & 0.45NaCl assists with renal function; provides free water, Na and Cl.; replaces normal hypotonic daily fluid losses- assists with daily body fluid needs, but not with electrolyte replacement or provision of calories. Hypotonic (154 mOsm/L) 1/2 NS - 0.45%NaCl replaces NaCl deficit and restores/expands extracellular fluid volume; the only solution that may be administered with blood products --does not provide free water that causes hemolysis of red blood cells Isotonic (308mOsm/L) NS - 0.9% NaCl Usage and Limitations Osmolality Solution
    • Third Spacing: Loss of fluid into a space that cannot contribute to ICF/ECF equilibrium S&S: Urine output decreases Increased heart rate Decreased BP Decreased CVP Increased body weight Edema I & O imbalance Causes: Burns Ascites Peritonitis Bowel obstruction Massive bleeding into joint or body cavity
    • Factors Affecting Fluid, Electrolyte, and Acid-Base Balance
      • Fluid and Food Intake
      • Fluid and Electrolyte Output
      • Stress
      • Chronic Illnesses
      • Surgery
      • Pregnancy
    • Acid Base Balance Two systems work to maintain correct pH. Respiratory System by adjusting respirations. Metabolic system by adjusting serum HCO3
    • Acid Base Balance
    • Acidosis pH < 7.4 Increased paCO2 Decreased HCO3
    • Acid…………………Base
      • High CO2
      • Low HCO3
      • Low CO2
      • High HCO3
      pCO2 = 35-45 HCO3 = 22-28
    • Respiratory Acidosis
      • Hypoventilation for any reason
      • COPD
      • Paralysis of respiratory muscles
      • Cardiac Arrest – Code
    • Metabolic Acidosis
      • Starvation
      • DKA
      • Renal Failure
      • Lactic Acidosis from heavy exercise
      • Drugs – EtOH, ASA
      • Diarrhea
    • Alkalosis pH > 7.4 Decreased CO2 Increased HC03
    • Respiratory Alkalosis
        • Hyperventilation from any cause
        • Pneumonia
        • Too high ventilator settings
    • Metabolic Alkalosis
      • Excessive vomiting
      • Gastric suctioning
      • Hypokalemia OR Hypercalcemia
      • Excess aldosterone
      • Drugs – Steroids, diuretics, NaHCO3
    • Easy Read of Blood Gases
      • Check pH
      • <7.4 = Acidosis; > 7.4 = alkalosis
      • Which of the following parameters matches the pH?
        • CO2 or HCO3?
          • High C02 is acid; low CO2 is alkaline- respiratory
          • High HCO3 is alkaline; low HCO3 is acid - metabolic
      Matching parameter + pH direction is diagnosis! If both parameters match, then it is a combined _____; if opposite parameter is abnormal, compensation is occurring.