Fluid and electrolytes
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
• The body fluid divided in two major
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
2) Interstitial fluid: is found surrounding the
cell and includes lymph.
3) Transcellular: includes cerebrospinal
fluid, pleural, peritoneal and synovial fluid.
• 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
• Is the movement of water across
cell membranes, from the less
concentrated solution to more
concentrated solution. In other
word water move toward higher
– 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
• Sodium is the major determinant of
• Is the continual intermingling of
molecules in liquid, gases by random
movement of the molecules.
• Is the process where by fluid and
solutes moved together across a
membrane from one compartment
4. Active transport:
• substance can move across cell
membranes from a less
concentrated solution to amore
concentrated one by active
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 .
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
• 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
• 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
Type of edema:
• Dependent edma: found in the lowest
• Pitting edma: edema that leaves a
depression or pit after finger
pressure is applied on the swollen
• 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
• Hypernatremia: sodium excess in the
• Sodium is found in many foods, such
as processed cheese, table salt.
• 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 –
– Hypokalemia: potassium deficit in the
– Hyperkalemia: potassium excess in the
• Hypocalcemia: calcium deficit in the
• Hypercalcemia: calcium excess in the
Loss of water and
• Excessive sweating.
• Nasogastric suction.
• Abnormal drainage.
• Impaired swallowing.
Finding associated with
fluid and electrolyte
• Skin: dry pale, cool skin, reduce skin
• Oral cavity: dry mucous
membrane, absence of salivation.
• Weak rapid pulse.
• Decreased blood pressure.
• Decreased central venous pressure
Nursing care plan
– Nursing history:
• Date include fluid and food intake, output.
• Recent fluid losses.
• Sign of fluid deficit.
• Common sign of electrolyte disturbance.
• Fluid volume deficit related to dehydration.
• Fluid volume excess related to heart failure.
• Altered oral mucous membrane related to fluid
• Impaired skin integrity related to dehydration
• Decreased cardiac output related to hypovolemia.
• Altered tissue perfusion related to decreased
• Assess clinical manifestation of hypo or
• Provide fluid and electrolyte orally.
• Intravenous therapy can prescribed for those
• 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
• Provide safety for client