The document provides information about fluid and electrolyte balance, including average daily water intake and output in adults. It discusses the fluid compartments in the body and the functions of water and fluids. It also describes electrolytes, types of solutions, and nursing management for clients with burns or problems related to the genitourinary system such as renal failure.

1. Irene M. Magbanua, RN Review Specialist FLUID AND ELECTROLYTE BALANCE

2. Average daily water intake and output of normal adult water in food- 1000 Urine- 1500 water ingested- 1200 Feces-150 water from oxidation- 300 Lungs -350 2500 Skin-500 2550 W a t e r Water constitutes over 50% of an individual’s weight Infant- 70-80% Adult 50-60% Geriatric 45-55% Water requirement= 2500cc/day; minimum of 1500 cc/day

7. Types of Solution 1. Hypertonic- exerts greater concentration of particles outside than inside the cell; cells shrink e.g. D51/2NS, D5 NS, D5 LR, 3%NS, 5%NS 2. Hypotonic- exerts lesser concentration of particles outside than inside the cells; cells swell e.g. 1/2 NS, 1/4 NS, 1/3 NS, 2.5% Dextrose, D5W 3. Isotonic- same concentration of particles inside and outside the cell; no change on size and shape of cells eg. Normal Saline, Lactated Ringer’s

8. Care of Clients with Burns Irene M. Magbanua, RN Professiomal Review Specialist

14. Classifications of Burns: 1. Major- partial thickness> 25% or full thickness > 10% 2. Moderate- partial thickness 15-25% or full thickness <10% 3. Minor- partial thickness <15% or full thickness < 2%

15. Categories of burn depth: 1. Partial thickness a. Superficial Partial Thickness (First degree) depth: epidermis cause: sunburn, splashes of hot liquid sensation: painful characteristic: erythema, blanching on pressure, no vesicles

16. B. Deep Partial Thickness (second degree) depth: epidermis and dermis cause: flash, scalding or flame burn sensation: very painful characteristic: fluid filled vesicles, red, shiny, wet after vesicle rupture

17. 2. Full thickness (third and fourth degree) depth: all skin layers and nerve endings, may involve muscles, tendons and bones cause: flame, chemicals, scalding, electric current sensation: little or no pain characteristic: wound dry, white, leathery, or hard tissue *eschar- leathery or hard tissue due to loss of blood supply

18. Nursing Management in Different Stages of Burns : 1. Emergent phase- remove person from source of burn Goals: relief of pain, minimize contamination, transport a. Thermal- stop, drop and roll; flame off b. Smoke inhalation- ensure patent airway c. Chemical- remove clothing that contains chemical; lavage with copious amounts of water d. Electrical- shut off source of electricity; note entry or exit wound

24. Care of Client with Problems Related to the Genitourinary System Irene M. Magbanua, RN Professional Review Specialist

42. 4. Renal Failure- state of total or nearly total loss of kidney function Acute Renal Failure- sudden inability of the kidneys to regulate fluid and electrolyte balance and remove toxic products from the body; reversible Causes: a. Pre-renal- factors interfering with perfusion and resulting in decreased blood flow and glomerular filtrate, ischemia and oliguria b. Intra-renal- conditions that cause damage to nephrons c. Postrenal- mechanical obstruction from tubules to urethra

43. Phases: 1. Onset- period precipitating event to development of oliguria 2. Oliguria ( to anuria)- urinary output less 400ml 3. Diuretic- gradual return of GFR and BUN level 4. Convalescent- renal function stabilizes with gradual improvement in 3-12 months

44. Signs and Symptoms: a. oliguria to anuria b. edema c. anorexia d. nausea or vomiting e. leukocytosis f. anemia g. bleeding tendencies h. drowsy i. Muscle twitching and coma (uremic encephalopathy)

45. Nursing Management a. Fluid and nutrition- limited fluids to 500ml to replace obligatory loss from lungs or skin b. Low protein diet c. Rest d. Precautions: side rails up e. Mouth or skin care f. Pharmacotherapeutics- diuretics g. Dialysis

46. Chronic Renal Failure- progressive irreversible destruction of kidneys that continues until nephrons are replaced with scar tissues Predisposing Factors: recurrent infections, exacerbations of nephritis, urinary tract obstructions, diabetes, hypertension Signs and Symptoms: a. Electrolyte imbalance b. Cardiovascular- hypertension,left ventricular hypertrophy, CHF c. Hematologic- anemia, decreased erythropoeitin, increased hematocrit and bleeding tendencies

47. d. Gastro-intestinal- anorexia, nausea, vomiting e. Respiratory- fluid overload, pulmonary edema: “uremic lung” f. Orthopedic- increased Ca elimination, decreased serum Ca, osteodystrophy or osteomalacia g. Dermatological- excoriation or dry skin, uremic frost h. Neurologic- peripheral neuropathy, burning feet; CNS nystagmus, twitching, seizure i. Reproductive-menstrual irregularities impotence, testicular atrophy and decreased sperm count j. Psychological- behavioral and personality changes k. Impaired immunologic system- increased susceptibility to infection

48. Stages of CRF: 1. Renal impairment 2. Renal insufficiency 3. Renal failure 4. End stage of Renal disease

49. Nursing Management: 1. Conservative- assess uremia, mental function and supportive; avoid undue fatigue 2. Advanced renal failure- oliguric or uremic phase a. peritoneal dialysis b. hemodialysis c. kidney transplant 3. Dietary- early- no restriction - advanced- low protein Giordano or Giovanette diet- low protein with amino acids

50. Dialysis- removal by artificial means of metabolic wastes, excess electrolytes and excess fluids Principles: -Diffusion, Osmosis, Ultrafiltration Purposes: 1. To remove excessive amounts of drugs or toxins in poisoning 2. To check serious electrolyte or acid base imbalance 3. To maintain kidney function when renal shutdown occurs 4. To temporarily replace kidney function in patients with acute renal failure and permanently replace in chronic renal failure

51. Peritoneal Dialysis- introduction of specially prepared dialysate solution into the abdominal cavity where the peritoneum acts as a semi permeable membrane between the dialysate and blood in the abdominal vessels Nursing Interventions: a. Weight pt, VS every 15 mins then every hour b. Patient voids c. Warm dialysate solution to body temperature d. Assist in trocar insertion e. Inflow time, Dwell time and Drain time f. Observe character of dialysate flow

54. Nursing Interventions: 1. Auscultate for bruit and palpate thrill- check patency 2. Check bleeding 3. Observe arm precaution 4. Avoid restrictive clothing or dressings over site Complications: 1. Hypovolemic Shock 2. Dialysis disequilibrium syndrome

55. Renal transplant pre-requisites 1. Evaluation of patient’s medical immunologic, psychological and social status 2. Should be identical- ABO and HLA compatible Contraindications: 1. Acute infection 2. Malignancy 3. COPD 4. Liver disorder 5. DM 6. Atherosclerosis

56. Pre-op care: 1. Dialysis to make patient non-toxic 2. Treat all complications 3. Immunosuppressive drug to start 24hrs before transplant; Immuran, Prednisone, Sandimmune 4. Transplanted kidney placed on thigh, usually iliac fossa

57. Post-op care: 1. Reverse isolation 2. Monitor renal functions 3. Respiratory, therapy, deep breathing and coughing exercises 4. Aseptic wound care 5. Oral hygiene 6.NGT to prevent paralytic ileus 7. Early ambulation 8. Health adjustment process 9. Lifetime-immune suppressive drugs