Fluid And Chemical Balance


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Fluid And Chemical Balance

  1. 1. Fluid and Chemical Balance
  2. 2. Body Fluid <ul><li>Is a mixture of water, chemicals called electrolyte and nonelectrolytes and blood cells. </li></ul><ul><li>Water – can live only a short time without water. There is no known substituted for it among living organisms. Water makes up to 45% to 75% of mans body weight. It is necessary for every major physiological function. </li></ul>
  3. 3. <ul><li>It is the medium of all body fluids including gastrointestinal secretions, lymph , blood, urine and perspiration. </li></ul><ul><li>It provides the solvent for products of digestion and metabolism. </li></ul><ul><li>It cushions the cells of the body. </li></ul><ul><li>It is essential for the action of the second component of body fluid,electrolyte substances. </li></ul>
  4. 4. Fluid Compartments <ul><li>Body fluid is located two general compartments: </li></ul><ul><li>Intracellular fluid ( Fluid inside cell) </li></ul><ul><li>Extracellular fluid (fluid outside cell) </li></ul><ul><li>Interstitial fluid – fluid in the tissue space between and around the cells. </li></ul><ul><li>Intravascular fluid – watery plasma or serum, portion of blood) </li></ul>
  5. 5. Percentages of Body Fluid to Age and Gender <ul><li>Fluid infants adult adult elderly </li></ul><ul><li>Compartments men women </li></ul><ul><li>Intravascular 4% 4% 5% 5% </li></ul><ul><li>Interstitial 25% 11% 10% 15% </li></ul><ul><li>Intracellular 48% 45% 35% 25% </li></ul><ul><li>Total 77% 60% 50% 45% </li></ul>
  6. 6. Electrolytes <ul><li>Are chemical substances that develop electrical charges when they are placed in water. </li></ul><ul><li>Are positively charges are called cations. </li></ul><ul><li>The electrolytes with positive charges are sodium, potassium, calcium and magnesium. </li></ul><ul><li>The electrolytes with negative charges are chloride, bicarbonate, carbonic acid,phosphate, protein, lactate and citrate. </li></ul><ul><li>Are measures in the serum of blood specimens and the amount is reported in milliequivalents(mEq). </li></ul>
  7. 7. Major serum electrolytes <ul><li>Electrolyte Chemical Cation Normal Predominant </li></ul><ul><li>symbol anion level compartment </li></ul><ul><li>Sodium Na + 135-148 ECF </li></ul><ul><li>Potasium K + 3.5-5.0 ICF </li></ul><ul><li>Chloride CL - 90-110 ECF </li></ul><ul><li>Phosphate PO4 - 1.7-2.6 ICF </li></ul><ul><li>Calcium Ca + 2.1 -2.6 ICF </li></ul><ul><li>Magnessium Mg + 1.3 -2.1 ICF </li></ul><ul><li>Bicarbonate Hcos - 22-26 ICF </li></ul>
  8. 8. Nonelectrolytes <ul><li>Are chemical compounds that remain bound together when dissolved in a solution and do not conduct electricity. </li></ul><ul><li>The chemical end –products of carbohydrate ,protein and fat metabolism namely: glucose, amino acids and fatty acids – provide continuous supply of nonelectrolytes. </li></ul>
  9. 9. Blood <ul><li>Consists of 3 liters of plasma or fluid. 2 liters of blood cells for a total of 5 liters circulating blood volume. </li></ul><ul><li>Blood cells includes erythrocytes or red blood cells ( RBC) and Platelets known as thrombocytes. </li></ul><ul><li>For every 500 red blood cells there are approximately 30 platelets and 1 white blood cells. </li></ul><ul><li>Any disorder that allert the volume of body fluid whether it is fluid retention or loss affects the plasma volume of blood. </li></ul>
  10. 10. Physiologic transport mechanism <ul><li>Osmosis – helps to regulate the distribution of water by controlling the movement of fluid from one location to another. </li></ul><ul><li>Under the influence of osmosis ,water moves through a semipermeable membrane like those surrounding body cells .capillary walls and the body organs and cavities from an area where the fluid is more dilute to another are where the fluid is more concentrated. </li></ul>
  11. 11. <ul><li>The presence and quantity of colloids on either side of the semipermeable membrane osmosis. </li></ul><ul><li>Colloids are undissolved proteins substances such as albumin and blood cells within the body fluids that do not readily pass through the membranes. </li></ul><ul><li>Their presence produces a colloidal pressure (Force for attracting water) that influences fluid volume in any given fluid location. </li></ul>
  12. 12. Filtration <ul><li>Movement of water and substances from a compartment where the pressure s higher to one where the pressure is lower. </li></ul><ul><li>It is another mechanism that influences fluid distribution </li></ul><ul><li>The force of filtration is referred to as hydrostatic pressure( pressure exerted against a membrane) </li></ul>
  13. 13. Passive Diffusion <ul><li>Is the physiologic process in which dissolved substances such as electrolytes and gases move from an area of higher concentration to an area of lower concentration through a semipermeable membrane. </li></ul><ul><li>It occurs without an expenditure of energy , hence it was passive. </li></ul><ul><li>Facilitates electrochemical neutrality( identical balance of cations awith anions) </li></ul>
  14. 14. Facilitated Diffusion <ul><li>Is the process in which certain dissolved substances require assistance of a carrier molecule to pass from one side of a semipermeable membrane to another. </li></ul><ul><li>It regulates chemical balance </li></ul><ul><li>Glucose is an example of a substance distributed by facilitated diffusion </li></ul><ul><li>Insulin is the carrier substance for glucose. </li></ul>
  15. 15. Active Transport <ul><li>A process of chemical distribution that requires an energy source invloves a substance called adenosine triphoshate(ATP). </li></ul><ul><li>Provides energy to drive dissolved chemical against the concentrations gradient. </li></ul><ul><li>It allows chemical distribution from an area low concentrations to one that is higher-opposite of passive diffusion. </li></ul>
  16. 16. Fluid Volume Assessment <ul><li>Intake and Output is one tool to asess fluid status by keeping a record of a clients fluid intake and fluid loss over a 24 hour period. </li></ul>
  17. 17. Daily Fluid Intake And Losses <ul><li>Sources Of Fluid Mechanism of Fluid Loss </li></ul><ul><li>Oral liquids – 1,200-1,500 Urine 1,200-1,700 </li></ul><ul><li>ml/day ml/day </li></ul><ul><li>Food - 700-1,000ml feces 100-250ml/day </li></ul><ul><li>Metabolism - 200-400 ml/day perspiration 100-150 ml/day </li></ul><ul><li>insensible losses </li></ul><ul><li>skin 350-400 ml/day </li></ul><ul><li>lungs 350-400 ml/day </li></ul><ul><li>Total 2,100-2,900ml/day 2,100-2,900ml/day </li></ul><ul><li>Average intake 2,500 ml/day average loss 2,500 ml/day </li></ul>
  18. 18. Fluid Intake <ul><li>Is the sum of all fluid that a client consumes or is instilled into the client’s body. </li></ul><ul><li>All liquids a client drinks </li></ul><ul><li>The liquid equivalent of melted ice chips, which is half of frozen volume </li></ul><ul><li>Foods that are liquid by the time they are swallowed such as gelatin, ice cream and thin cooked cereal </li></ul><ul><li>Fluid infusions such as iv solutions </li></ul>
  19. 19. Fluid Output <ul><li>Urine </li></ul><ul><li>emesis </li></ul><ul><li>blood loss </li></ul><ul><li>Diarrhea </li></ul><ul><li>Wound or tube drainage </li></ul><ul><li>Aspirated irigations </li></ul>
  20. 20. Common Fluid Imbalances <ul><li>Is a general term describing any several conditions in which the body’s water is not in the proper volume or location within the body. It can be a life threatening situation. </li></ul><ul><li>Common fluid imbalances include: </li></ul><ul><li>HYPOVOLEMIA </li></ul><ul><li>HYPERVOLEMIA </li></ul><ul><li>THIRD SPACING </li></ul>
  21. 21. HYPOVOLEMIA <ul><li>Is a low volume in the extracellular fluid compartment. </li></ul><ul><li>If untreated, hypovolemia results in hydration a fluid deficit in both extracellular and intracellular compartments. </li></ul><ul><li>Mild dehydration is present when there is 3% TO 5% of loss body weight </li></ul><ul><li>Moderate dehydration is associated with 6% TO 10% loss of body weight. </li></ul><ul><li>Severe dehydration a life threatening emergency occurs with a loss of more than 9% TO 15% of body weight. </li></ul><ul><li>In addition to weight loss, dehydration is evidenced by decreased skin turgor . </li></ul>
  22. 22. Causes of fluid volume deficits <ul><li>Inadequate fluid intake </li></ul><ul><li>Fluid loss in excess of fluid intake </li></ul><ul><li>Translocation of large volumes of intravascular fluid to the interstitial compartment or to areas with only potential spaces such as peritoneal cavity, pericardium and pleural spaces. </li></ul>
  23. 23. Fluid balance restored by treating the cause of hypovolemia <ul><li>Increasing oral fluid </li></ul><ul><li>Administering iv fluid replacements </li></ul><ul><li>Controlling fluid losses </li></ul><ul><li>Combination of all the above measures </li></ul>
  24. 24. HYPERVOLEMIA <ul><li>Means a higher than normal volume of water in the intravascular fluid compartment and is another example of fluid imbalance. </li></ul><ul><li>Edema develops when excess fluid is distributed to the interstitial space. </li></ul><ul><li>When fluid accumulates in dependent areas of the body (Those influenced by gravity ) the tissues pits ( forms indentations) when compressed. </li></ul>
  25. 25. <ul><li>Edema does not usually occur unless there is a three liter excess in the body fluid. </li></ul><ul><li>Hypovolemia can lead to a circulatory overload (severely compromised heart function) if it remains unresolved. </li></ul>
  26. 26. Foods high in Salt <ul><li>Processed meat </li></ul><ul><li>Smoked fish </li></ul><ul><li>Frozen egg substituted </li></ul><ul><li>Peanut butter </li></ul><ul><li>Dairy products, hard cheese </li></ul><ul><li>Powdered cocoa, hot chocolate mix </li></ul><ul><li>Canned vegetables </li></ul><ul><li>Pickles </li></ul><ul><li>Tomato and tomato juice </li></ul><ul><li>Can soup bouillon </li></ul><ul><li>boxed casserole mixes </li></ul><ul><li>Baking mixes </li></ul><ul><li>Salted snack foods </li></ul><ul><li>Seasoning as catsup, gravy mix, soy sauce, monosodium glutamate, pickle relish , tartar sauce. </li></ul>
  27. 27. Third Spacing <ul><li>The movement of intravascular fluid to nonvascular fluid compartment, where it becomes trapped and useless. </li></ul><ul><li>It is manifested by tissue swelling or fluid that accumulates in a body such as the peritoneum </li></ul>
  28. 28. <ul><li>Third spacing is associated commonly with disorder in which albumin levels are low. </li></ul><ul><li>HYPOALBUMINEMIA - deficit in albumin in the blood – caused by liver disease, chronic disease and disorders in which the capillary and cellular permeability is altered such as burns and severe allergic reactions. </li></ul><ul><li>The priority is to restore the circulatory volume by providing iv fluids ,sometimes in large volumes at rapid rates (FULL BLASTS) </li></ul>
  29. 29. <ul><li>Blood transfusions or the administration of albumin by Iv infusions also, is used to restore colloidal osmotic pressure and full trapped fluid back into the intravascular space . </li></ul><ul><li>When this conditions occurs, client who were previously hypovolemic can suddenly become hypervolemic. </li></ul><ul><li>The nurse closely monitors client’s who receives albumin replacement for signs of circulatory overload. </li></ul>
  30. 30. <ul><li>Fluid Deficit Fluid Excess </li></ul><ul><li>Starvation kidney failure </li></ul><ul><li>Impaired swallowing heart failure </li></ul><ul><li>Vomiting rapid administration </li></ul><ul><li>Gastric suction administration of albumin </li></ul><ul><li>Laxative abuse corticosteroid drug therapy </li></ul><ul><li>Potent diuretics excessive intake of sodium </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Major burns </li></ul><ul><li>Draining wounds </li></ul><ul><li>Fever and sweating </li></ul><ul><li>Exercise and sweating </li></ul><ul><li>Environment heat and humidity </li></ul>
  31. 31. Intravenous fluid administration <ul><li>Policies and practices concerning how much responsibility the practical/vocational nurse assume with iv fluid therapy. </li></ul><ul><li>Intravenous (IV ) fluids are solutions infused into a client’s vein to : </li></ul><ul><ul><li>Maintain and restore fluid balanc when oral replacement is inadequate or impossible. </li></ul></ul><ul><ul><li>Maintain and replace electrolytes. </li></ul></ul><ul><ul><li>Administer water-soluble vitamins. </li></ul></ul><ul><ul><li>Provide a source of calories </li></ul></ul><ul><ul><li>Route for administration of drugs </li></ul></ul><ul><ul><li>Replace bloods and blood products. </li></ul></ul>
  32. 32. <ul><li>TYPES OF SOLUTIONS </li></ul><ul><li>Crystalloid Solutions- are made of water and other uniformly dissolved crystals such as salt and sugar. They are classified as: </li></ul><ul><ul><li>Isotonic </li></ul></ul><ul><ul><li>Hypotonic </li></ul></ul><ul><ul><li>hypertonic </li></ul></ul>
  33. 33. <ul><li>2. Colloid Solutions – are made of water and molecules of suspended substances such as: </li></ul><ul><li>a. blood </li></ul><ul><li>b. blood products ( albumin ) </li></ul><ul><li>They are both administered intravenously. </li></ul>
  34. 34. Isotonic solutions <ul><li>Contain the same concentration of dissolved substances as normally found in plasma. </li></ul><ul><li>It is administered to maintain balance in clients who may not be able to eat or drink for a short period of time. </li></ul><ul><li>Because of equal concentration, an isotonic solution does not cause any appreciable redistribution of body fluid. </li></ul>