38824367 fluids-and-electrolytes


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38824367 fluids-and-electrolytes

  2. 2.  60% of the weight of a typical adult consists of fluid Factors that influence the amount of body fluid are age, gender, and body fat Body fluids is located in two fluid compartments: intracellular space and the extracellular space
  3. 3.  The ECF compartment is further divided into the intravascular, interstitial, and transcellular spaces Loss of ECF into a space that does not contribute to equilibrium between the ICF and ECF is referred to as a third-space fluid shift or third spacing
  4. 4.  Early evidence of a third-space fluid shift is a decrease in urine output despite adequate fluid intake Other signs and symptoms of third spacing that indicate an IVF volume deficit include increased heart rate, decreased BP, edema, increased body weight, decreased CVP, and imbalances in fluid intake and output
  5. 5.  Electrolytes in body fluids are active chemicals Major cations are: sodium, potassium, calcium, magnesi um, and hydrogen ions The major anions are: chloride, bicarbonate, phosphate, sulf ate, and proteinate ions
  6. 6. Regulation of Body Fluid Compartments
  7. 7. Osmosis and Osmolality Osmosis occurs when fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration
  8. 8. Diffusion Is the natural tendency of a substance to move from an area of higher concentration to one of lower concentration
  9. 9. Filtration Movement of water and solutes occur from an area of high hydrostatic pressure to an area of low hydrostatic pressure
  10. 10. Sodium – Potassium Pump Located in the cell membrane and actively moves sodium from the cell into the ECF
  11. 11. Maintaining Fluidand Electrolyte Balance
  12. 12.  Homeostasis is a term that indicates the relative stability of the internal environment Concentration and composition of body fluid must be nearly constant If a substance must be deficient it must be replaced normally
  13. 13.  The kidneys play a major role in controlling all types of balance in fluid and electrolytes The adrenal glands, through the secretion of aldosterone, also aids in controlling extracellular fluid volume by regulating the amount of sodium reabsorbed by the kidneys
  14. 14.  Antidiuretic hormone from the pituitary gland regulates the osmotic pressure of extracellular fluid by regulating the amount of water reabsorbed by the kidney
  15. 15. FLUID VOLUME DEFICIT Dehydration occurs when the fluid intake of the body is not sufficient to meet the fluid needs of the body The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit
  16. 16. Types of Fluid Volume Deficits1. Isotonic Dehydration – water and dissolved electrolytes are lost in equal proportion2. Hypertonic Dehydration – water loss exceeds electrolyte loss, shrinks cells3. Hypotonic Dehydration – electrolyte loss exceeds water
  17. 17. Causes of FVD Isotonic dehydration Inadequate intake of fluids and solutes Fluid shifts between compartment Hypertonic dehydration Excessive perspiration Hyperventilation Diarrhea ESRD Diabetes insipidus
  18. 18.  Hypotonic dehydration Excessive fluid replacement Renal failure Chronic malnutrition Chronic illness
  19. 19. Assessment findings Increased pulse rate Decreased BP and orthostatic (postural) hypotension Diminished peripheral pulses Fever Decreased urinary output Dry skin Poor skin turgor Dry mouth
  20. 20.  Constipation Increased rate and depth of respirations Thirst Decreased body weight Increased hematocrit
  21. 21. Interventions Monitor cardiovascular, respiratory, neuromusc ular, renal, integumentary, and gastrointestinal status Prevent further fluid losses and increase fluid compartment volumes to normal ranges Monitor intake and output
  22. 22.  Provide oral rehydration therapy and IV fluid replacement Administer medications as prescribed such as antidiarrheal, antimicrobial, antiemetic, and antipyretic medications Administer oxygen as prescribed Monitor electrolyte values
  23. 23. FLUID VOLUME EXCESS Fluid intake or fluid retention exceeds the fluid needs of the body Also called overhydration or fluid overload The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload
  24. 24. Types of Fluid Volume Excess1. Isotonic Overhydration – known as hypervolemia, results from excessive fluid in the extracellular fluid compartment, causes circulatory overload and interstitial edema2. Hypertonic Overhydration – caused by excessive sodium intake3. Hypotonic Overhydration – water intoxication; electrolyte imbalance due to dilution
  25. 25. Causes Isotonic overhydration Inadequately controlled IV therapy Renal failure Long term corticosteroid therapy Hypertonic overhydration Excessive sodium ingestion Rapid infusion of hypertonic saline
  26. 26.  Hypotonic overhydration Congestive heart failure SIADH Inadequately controlled IV therapy
  27. 27. Assessment findings Bounding, increased pulse rate Elevated BP Distended neck and hand veins Elevated CVP Dyspnea Moist crackles on auscultation Pitting edema in dependent areas Skin pale and cool to touch
  28. 28.  Increased motility of the GI tract Polyuria Projectile vomiting Decreased hematocrit
  29. 29. Interventions Monitor cardiovascular, respiratory, neuromusc ular, renal, integumentary, and gastrointestinal status Prevent further fluid overload, and restore normal fluid balance Administer diuretics as prescribed
  30. 30.  Control fluid and sodium intake Monitor intake, output, and weight Monitor electrolyte values
  31. 31. DIURETIC
  32. 32. D – diet; increase sodium for all except aldactoneI – intake and output, daily weightU – undesirable effects: F&E imbalanceR – review HR, BP, and electrolytesE – elderly careful, evening dose not recommended
  33. 33. T – take with or after meals and in AMI – increase risk of orthostatic hypotension’ move slowlyC – cancel alcohol, cigarettes
  34. 34. Loop Diuretics Inhibits sodium, chloride, and water reabsorption in the proximal portion of the ascending loop of Henle Edema associated with CHF, ascites, hypertension (furosemide) Bumetanide (Bumex, Furosemide (Lasix), Torsemide (Demadex)
  35. 35. Thiazides Increases urine output by inhibiting reabsorption of sodium, chloride, and water in the distal portion of the ascending loop of Henle Edema associated with CHF, ascites, hypertension Chlorothiazide (Diuril), Hydrochlorothiazide (Hydrodiuril)
  36. 36. Potassium Sparing Diuretics Promotes excretion of sodium and water, but retains potassium in the distal renal tubule Used with loop or thiazide diuretics in treating CHF and hypertension, edema Spironolactone (Aldactone)
  37. 37. Osmotic Diuretics Increases osmotic pressure of glomerular filtrate, thus preventing reabsorption of water Oliguria, edema, increased ICP, increased IOP Mannitol (Osmitrol)
  38. 38. Assignment Form 4 groups, do a drug study of the chosen class of diuretic, and make your own mnemonic for that chosen class Be creative in presenting your work, use of powerpoint is not allowed Presentation will be next week, indicate your reference