NurseReview.Org - Feeding Adult Patients


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  • NurseReview.Org - Feeding Adult Patients

    1. 1. Feeding Adult Patients
    2. 2. Nutrition <ul><li>Nutrition is an important treatment in any illness. </li></ul><ul><li>Type 2: non-insulin –dependent diabetes. </li></ul><ul><li>Mellitus (NDDM). </li></ul><ul><li>Mild hypertension. </li></ul><ul><li>Proper intake of food is essential for optimal health during illness & healing of wounds. The body needs nutrients at these times. </li></ul>
    3. 3. Factors Influencing Dietary Patterns <ul><li>Health status </li></ul><ul><ul><li>A good appetite is a sign of health </li></ul></ul><ul><ul><li>Anorexia is usually a sign of disease or side effect of drugs </li></ul></ul><ul><ul><li>Nutritional support is an essential part of recovery from medical treatment </li></ul></ul>
    4. 4. Factors Influencing Dietary Patterns <ul><li>Culture and religion. </li></ul><ul><ul><li>Culture, ethnic, and religious patterns and restrictions re food must be considered. </li></ul></ul><ul><ul><li>Special foods and diets given when appropriate. </li></ul></ul><ul><ul><li>Older clients more apt to cling to ethnic food habits, esp. During illness. </li></ul></ul>
    5. 5. Factors Influencing Dietary Patterns <ul><li>Socioeconomic status. </li></ul><ul><ul><li>Food expenses fluctuate, spending depends on $$ available. </li></ul></ul><ul><ul><li>Whether someone is around to prepare the food determines the amount of convenience foods used. </li></ul></ul>
    6. 6. Factors Influencing Dietary Patterns <ul><li>Personal preference </li></ul><ul><ul><li>Individual likes and dislikes provide the strongest influence on diet </li></ul></ul><ul><ul><li>Foods associated with pleasant memories become favorite foods/ foods with unpleasant memories are avoided </li></ul></ul><ul><ul><li>Luxury foods = status </li></ul></ul><ul><ul><li>Individual preferences used to plan therapeutic diet </li></ul></ul>
    7. 7. Factors Influencing Dietary Patterns <ul><li>Psychological factors. </li></ul><ul><ul><li>Individual motivations to eat balanced meals and individual perceptions about diet. </li></ul></ul><ul><ul><li>Food has strong symbolic value. </li></ul></ul><ul><ul><ul><li>Milk=helplessness. </li></ul></ul></ul><ul><ul><ul><li>Meat=strength. </li></ul></ul></ul>
    8. 8. Factors Influencing Dietary Patterns <ul><li>Alcohol and drugs </li></ul><ul><ul><li>Excess use contributes to nutritional deficiencies </li></ul></ul><ul><ul><li>Excess alcohol affects GI organs </li></ul></ul><ul><ul><li>Drugs that appetite intake of essential nutrients </li></ul></ul><ul><ul><li>Drugs can deplete nutrient stores and absorption in the intestines </li></ul></ul>
    9. 9. Factors Influencing Dietary Patterns <ul><li>Misinformation and food fads </li></ul><ul><ul><li>Food myths can be the result of cultural background, popular interest in natural foods, peer pressure, or desire to control diet choices </li></ul></ul><ul><ul><li>Fads may involve erroneous beliefs certain foods are esp. Healthy </li></ul></ul><ul><ul><ul><li>Yogurt better than milk </li></ul></ul></ul><ul><ul><ul><li>Oysters sexual potency </li></ul></ul></ul><ul><ul><li>Don’t be condescending when giving nutritional guidance </li></ul></ul>
    10. 10. Factors Influencing Dietary Patterns <ul><li>Physical Problems </li></ul><ul><ul><li>Teeth </li></ul></ul><ul><ul><li>Loss of neuromuscular control </li></ul></ul><ul><ul><li>Poor state of health </li></ul></ul><ul><li>Psychological Problems </li></ul><ul><ul><li>High point of day </li></ul></ul><ul><ul><li>Very degrading </li></ul></ul>
    11. 11. Types of Diets <ul><li>Regular- (full/house/DAT) </li></ul><ul><ul><li>Allows client selection </li></ul></ul><ul><li>Clear Liquid- clear, bland ie: broth, gelatin, apple juice (little residue, easily absorbed) </li></ul><ul><li>Full Liquid –foods that liquify at room or body temperature. Easily digested & absorbed. </li></ul><ul><ul><li>Milk+ creamed, strained soups </li></ul></ul><ul><ul><li>Pre & post-op patients </li></ul></ul><ul><ul><li>Those who can’t chew or tolerate solids </li></ul></ul>
    12. 12. Types of Diets <ul><li>Pureed - easily swallowed foods, no chewing </li></ul><ul><li>Mechanical or Dental Soft - foods don’t need chewing, avoid tough meats & fruits with tough skins </li></ul><ul><ul><ul><li>Chewing problems </li></ul></ul></ul><ul><ul><ul><li>Lack of teeth </li></ul></ul></ul><ul><ul><ul><li>Sore gums </li></ul></ul></ul>
    13. 13. Types of Diets <ul><li>Soft - low in fiber, easily digested easy to chew and simply cooked. No fatty, rich or fried foods ( Low Fiber Diet) </li></ul><ul><li>High Fiber - Sufficient amt. of indigestible carbohydrates to : </li></ul><ul><ul><li>relieve constipation </li></ul></ul><ul><ul><li>GI motility </li></ul></ul><ul><ul><li>stool weight </li></ul></ul>
    14. 14. Types of Diets <ul><li>Sodium Restricted </li></ul><ul><ul><li>Low levels of sodium = NO SALT </li></ul></ul><ul><ul><li>CHF, Renal failure, cirrhosis, hypertension </li></ul></ul><ul><li>Low Cholesterol </li></ul><ul><ul><li>Cholesterol intake 300mg/day </li></ul></ul><ul><ul><li>Fat intake 30–35% </li></ul></ul><ul><ul><li>Eliminate/reduce fatty foods </li></ul></ul>
    15. 15. Types of Diets <ul><li>Diabetic </li></ul><ul><ul><li>Exchange list of foods </li></ul></ul><ul><ul><li>Imp. For Type I and Type II </li></ul></ul>
    16. 16. <ul><li>Adults usually eat independently but may need to be fed in the presence of physical or cognitive limitations. </li></ul><ul><ul><li>Neurological </li></ul></ul><ul><ul><li>Neuromuscular </li></ul></ul><ul><ul><li>Orthopedic problems </li></ul></ul><ul><li>Loss of control & independence can lead to psychological problems and depression. </li></ul>
    17. 17. Terms re Feeding <ul><li>Dysphagia - difficulty swallowing </li></ul><ul><ul><li>Most common cause of aspiration in adults during feeding </li></ul></ul><ul><li>Aspiration- the inhalation of foreign substance into the lungs </li></ul><ul><ul><li>stroke </li></ul></ul>
    18. 18. Suspect Dysphagia when client <ul><li>Coughs/ gags during eating </li></ul><ul><li>Exhibits multiple attempts @ swallowing </li></ul><ul><li>c/o food getting stuck in throat </li></ul><ul><li>Poor lip & tongue control </li></ul>
    19. 19. Feeding the patient with dysphagia <ul><li>Safety – choking/ aspiration </li></ul><ul><li>Symptoms of dysphagia </li></ul><ul><ul><li>Coughing, choking, drooling, spilling food ( pocketing) </li></ul></ul><ul><ul><li>Provide food that stimulates swallowing </li></ul></ul><ul><ul><li>Don’t feed too quickly </li></ul></ul><ul><ul><li>Thickened foods easier to swallow </li></ul></ul>
    20. 20. Procedure for Feeding <ul><li>Bedpan/washroom first </li></ul><ul><li>Wash hands </li></ul><ul><li>Prepare room </li></ul><ul><li>mid-to-high fowlers </li></ul><ul><li>Dentures </li></ul><ul><li>Bib/napkin </li></ul><ul><li>Prepare tray/food </li></ul>
    21. 21. Procedure for Feeding <ul><li>Relaxed pace </li></ul><ul><li>Small bites/spoonfuls </li></ul><ul><li>Rocking motion of utensil on tongue </li></ul><ul><li>Maintain sitting 15-30 min. pc. </li></ul>
    22. 22. Indications for Enteral Feeding <ul><li>Clients unable to eat </li></ul><ul><ul><li>ie: comatose with functional GI system </li></ul></ul><ul><ul><li>Ventilated patients </li></ul></ul><ul><ul><li>Post-op oral, head or neck surgery </li></ul></ul><ul><li>Clients who will not eat </li></ul><ul><ul><li>Older adults </li></ul></ul><ul><ul><li>Confused clients </li></ul></ul><ul><li>Unable to maintain adequate oral nutrition </li></ul><ul><ul><li>Cancer, sepsis, infection, trauma, head injury </li></ul></ul>
    23. 23. Intubation <ul><li>Placemnt of a tube into the stomach or intestine through the mouth, nasopharynx, (Nasogastric/Levine), or through an artificial opening made in the abdominal wall of the stomach (gastrostomy) or small intestine (jejunostomy) </li></ul><ul><li>Nasogastric= short term </li></ul><ul><li>Gastrostomy= long term, surgically inserted directly into the stomach(gastrostomy) or small intestine (jejunostomy) </li></ul>
    24. 24. Nasogastric tube <ul><li>Through nose into stomach (infants through the mouth, nostrils too small) </li></ul><ul><li>Only with a physician’s order </li></ul><ul><li>Ensure correct tube placement </li></ul><ul><li>Purpose </li></ul><ul><ul><li>Nutrition for clients with impaired swallowing, unconscious, or inability to ingest food </li></ul></ul>
    25. 25. Nasogastric tube <ul><li>Small bore tube for tube feeding </li></ul><ul><li>Large bore tube for stomach decompression and irrigation </li></ul><ul><li>Formulas for tube feedings commercially prepared , provide complete nutritional balance and some do not require any digestion </li></ul><ul><li>Imp. If necessary to rest the bowel ie: Crohn’s Disease </li></ul>
    26. 26. Tube Feedings <ul><li>Additional water post: </li></ul><ul><ul><li>Feedings </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Prescribed times </li></ul></ul><ul><li>Medications </li></ul><ul><ul><li>Liquid/ dissolved </li></ul></ul><ul><ul><li>No enteric coated or time released capsules </li></ul></ul><ul><ul><li>Do not mix meds with formula. Give meds. prior to formula </li></ul></ul>
    27. 27. Tube feeding schedule <ul><li>Continuous </li></ul><ul><ul><li>Over 24 hrs </li></ul></ul><ul><li>Cyclic </li></ul><ul><ul><li>Prescribed period ( ie:16hrs) </li></ul></ul><ul><li>Bolus </li></ul><ul><ul><li>Prescribed volume over 30-60 min. 4-6 X/day. </li></ul></ul><ul><ul><li>Physician orders frequency, amount, & type of feeding </li></ul></ul>
    28. 28. Problems with tube feeding <ul><li>Dry mouth </li></ul><ul><li>Sore mouth </li></ul><ul><li>Thirst </li></ul><ul><li>Feeling deprived </li></ul>
    29. 29. Do’s and don’ts re tube feeding <ul><li>Do not hurry/force feeding </li></ul><ul><ul><li>Abdominal distention & discomfort </li></ul></ul><ul><li>Clean not sterile technique </li></ul><ul><li>Formula @ room temp. </li></ul><ul><ul><li>Warm= bacterial growth </li></ul></ul><ul><ul><li>Cold= gastric cramping & discomfort, liquid is not warmed by the mouth and esophagus </li></ul></ul>
    30. 30. Do’s and don’ts re tube feeding <ul><li>Formula can hang for 8hrs. ( check directions) </li></ul><ul><li>Change tubing q24hrs. Or according to policy </li></ul><ul><li>Check tube position q8hrs. And ac feeds/meds </li></ul><ul><li>Clamp b/t feedings </li></ul><ul><li>30-60 ml water before and after feedings, meds, residual checks </li></ul>
    31. 31. Procedure for checking tube placement <ul><li>X-ray- best and most accurate </li></ul><ul><li>Air insertion and listen with stethoscope </li></ul><ul><li>Aspirate gastric contents </li></ul><ul><ul><li>Determines tube placement and checks for digestion of previous feeding ( should be less than 50mls ) Note -any gastric contents should be returned to the stomach so the chemical balance is not disturbed. </li></ul></ul><ul><ul><li>Check pH of aspirate with pH paper </li></ul></ul>
    32. 32. Aspirate pH <ul><li>Stomach is acidic 1-4 </li></ul><ul><li>Intestine is 7 or greater </li></ul><ul><li>Pleural secretions 6 </li></ul><ul><li>Wait at least 1 hr after feedings to check </li></ul><ul><li>Feeding is not given if no bowel sounds are heard, abdomen is distended, too much residual, or tube dislodged </li></ul>
    33. 33. Position for tube feeding <ul><li>Fowlers before and after </li></ul><ul><ul><li>Prevents aspiration </li></ul></ul><ul><li>Regulate the flow of the feeding 6mls/min </li></ul><ul><li>Gravity/ feeding pump </li></ul><ul><li>Flush tube well post feeding </li></ul><ul><li>Clamp tube post flushing </li></ul><ul><li>Intake/output </li></ul><ul><li>Avoid introducing air into tubing </li></ul>
    34. 34. Fluid Intake and Output <ul><li>3 main sources of fluids and electrolytes </li></ul><ul><ul><li>Fluids ingested in liquids </li></ul></ul><ul><ul><li>Food that is eaten </li></ul></ul><ul><ul><li>H2O as a byproduct of oxidation of foods and body substances </li></ul></ul><ul><li>Total daily intake approximately </li></ul><ul><li>2100-2900mls </li></ul>
    35. 35. Fluid Loss <ul><li>Fluids are lost </li></ul><ul><ul><li>Skin </li></ul></ul><ul><ul><li>Lungs </li></ul></ul><ul><ul><li>Feces </li></ul></ul><ul><ul><li>Urine output = majority </li></ul></ul><ul><li>Total daily loss = 2100 –2900mls </li></ul>
    36. 36. Regulation of Body Fluids <ul><li>Fluid Intake primarily regulated by: </li></ul><ul><ul><li>Thirst mechanism in hypothalamus </li></ul></ul><ul><li>The thirst mechanism is affected by: </li></ul><ul><ul><li>plasma osmolality </li></ul></ul><ul><ul><li>plasma volume </li></ul></ul><ul><ul><li>Dry mucus membranes </li></ul></ul><ul><ul><li>Other factors </li></ul></ul>
    37. 37. Regulation of Body Fluids <ul><li>Those at risk for dehydration include: </li></ul><ul><ul><li>Infants </li></ul></ul><ul><ul><li>Elderly </li></ul></ul><ul><ul><li>Neurologically impaired </li></ul></ul><ul><ul><li>Psychologically impaired </li></ul></ul><ul><li>Must be conscious and alert </li></ul>
    38. 38. Fluid Output <ul><li>Kidneys </li></ul><ul><li>Lungs </li></ul><ul><li>Skin </li></ul><ul><li>GI tract </li></ul>
    39. 39. Kidneys <ul><li>Major regulators fluid balance </li></ul><ul><ul><li>blood flow to kidneys urinary output </li></ul></ul><ul><ul><li>Amount of urine produced influenced by ADH & aldosterone (stimulated by changes in blood volume) </li></ul></ul><ul><ul><li>Urine output = 1.5L/day in adults or 60 mls/hr </li></ul></ul><ul><ul><li>Where Na goes H2O follows </li></ul></ul>
    40. 40. Insensible Losses <ul><li>Immeasurable </li></ul><ul><ul><li>Evaporation through the skin </li></ul></ul><ul><ul><ul><li>Affected by humidity </li></ul></ul></ul><ul><ul><li>Lungs </li></ul></ul><ul><ul><ul><li>Respiratory rate and depth </li></ul></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><ul><li>Loss through skin & lungs </li></ul></ul></ul><ul><li>Infants lose more H2O from their skin than adults </li></ul>
    41. 41. Sensible Losses <ul><li>Measurable </li></ul><ul><li>Fluid losses from </li></ul><ul><ul><li>Urination </li></ul></ul><ul><ul><li>Defecation </li></ul></ul><ul><ul><li>Wounds </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><li>Normally GI losses 100mls/day </li></ul><ul><li>In cases of severe diarrhea , losses may exceed 5,000ml/day </li></ul>
    42. 42. Intake and Output Measurement <ul><li>Many illnesses cause changes in the body’s ability to maintain balance. </li></ul><ul><li>Require accurate measure In & Out </li></ul><ul><li>Institution policies </li></ul><ul><li>Physician orders </li></ul><ul><li>RN initiates </li></ul><ul><li>Data for assessment </li></ul><ul><li>Monitor patient’s condition </li></ul>
    43. 43. Indications for intake and output <ul><li>Special medications ( diuretics) </li></ul><ul><li>Post-op patients </li></ul><ul><li>I/V therapy </li></ul><ul><li>Indwelling catheters </li></ul><ul><li>Feeding tubes </li></ul><ul><li>Low oral intake </li></ul><ul><li>Intake =output in 48-72hr. period </li></ul>
    44. 44. Indications for intake and output <ul><li>Risk for Fluid Volume Deficit </li></ul><ul><ul><li>Intake < output </li></ul></ul><ul><li>Risk for Fluid Volume Excess </li></ul><ul><ul><li>Intake > output </li></ul></ul><ul><li>Urine output < 30 mls/hr x 2 consecutive hrs. indicates renal disease or dehydration </li></ul>
    45. 45. Daily Weights <ul><li>Deficient or Excess </li></ul><ul><li>Same time each day </li></ul><ul><li>Same scale </li></ul><ul><li>Same clothing </li></ul><ul><li>Fluid retention can be detected early b/c 5-10lbs of fluid is retained before edema appears. </li></ul><ul><li>5 lbs fluid= approx. 2.5 L fluid volume </li></ul>
    46. 46. Intake Items include <ul><li>Items that are liquid at room temperature </li></ul><ul><ul><li>H2O, milk, juice, beverages, ice cream, jello, liquid part of soup </li></ul></ul><ul><li>Tube feedings ( not pureed foods, considered solids) </li></ul><ul><li>I/V fluids </li></ul><ul><li>Irrigating fluids that are not returned </li></ul>
    47. 47. Output items <ul><li>Urine </li></ul><ul><li>Diarrhea </li></ul><ul><li>Profuse diaphoresis </li></ul><ul><li>Vomit </li></ul><ul><li>Drainage from suction devices </li></ul><ul><li>Wound drainage </li></ul><ul><li>Bleeding </li></ul>
    48. 48. Measurement <ul><li>Wear gloves </li></ul><ul><li>Urine output </li></ul><ul><ul><li>Mexican hat for females </li></ul></ul><ul><ul><li>Urinal for males </li></ul></ul><ul><ul><li>Mls. or cc’s </li></ul></ul><ul><ul><li>Infants, weigh diaper, subtract wt. of dry diaper from wt. of wet diaper. Count # of wet diapers. Be cautious of weight of stool. </li></ul></ul>
    49. 49. Measurement <ul><li>Patient participation </li></ul><ul><ul><li>Instructions </li></ul></ul><ul><ul><li>Explanation </li></ul></ul><ul><ul><li>Equipment </li></ul></ul><ul><ul><li>Recording </li></ul></ul><ul><ul><ul><li>Bedside record- individual items </li></ul></ul></ul><ul><ul><ul><li>Permanent record- totals for time frame designated by institutional policy. Kept on chart. </li></ul></ul></ul>
    50. 50. Fluids and Electrolyte Balance <ul><li>H2O – the indispensable nutrient </li></ul><ul><li>60% total adult body weight </li></ul><ul><li>70-80% total infant body weight </li></ul><ul><li>Body Fluids </li></ul><ul><ul><li>H2O and dissolved substances </li></ul></ul><ul><ul><ul><li>H2O major constituent of the body </li></ul></ul></ul><ul><ul><ul><li>H2O = Solvent in which substances are dissolved or suspended </li></ul></ul></ul>
    51. 51. Fluids and Electrolyte Balance <ul><li>Solutes = substances dissolved in a solution </li></ul><ul><ul><li>Electrolytes: Na, K, Cl </li></ul></ul><ul><ul><li>Minerals </li></ul></ul><ul><ul><li>Glucose </li></ul></ul><ul><ul><li>Urea </li></ul></ul><ul><ul><li>Bilirubin </li></ul></ul>
    52. 52. Functions of the Fluid System <ul><li>Transportation of Nutrients to cells </li></ul><ul><li>Removing wastes from cells </li></ul><ul><li>Homeostasis- maintaining a stable physical & chemical environment in the body </li></ul>
    53. 53. Body Fluid Distribution <ul><li>2 Basic Compartments </li></ul><ul><ul><li>Intracellular- inside the cells, must be balanced with extracellular </li></ul></ul><ul><ul><li>Extracellular- outside the cells, further divided into </li></ul></ul><ul><ul><ul><li>Interstitial fluid in the spaces b/t cells </li></ul></ul></ul><ul><ul><ul><li>Intravascular or plasma- liquid portion of blood, watery, colorless fluid portion in which blood cells are suspended </li></ul></ul></ul><ul><li>Hint: Inter= between </li></ul><ul><li>Intra= within/ inside </li></ul>
    54. 54. Fluids and Electrolyte Balance <ul><li>Many solutes in the intracellular fluid compartment are the same as those located in the extracellular fluid space. However the proportion of the substances is different </li></ul><ul><li>ie: K > intracellular </li></ul><ul><li>Body fluids & electrolytes shift from compartment to compartment to maintain Homeostasis </li></ul>
    55. 55. Fluids and Electrolyte Balance <ul><li>Homeostasis maintained by: </li></ul><ul><ul><li>Diffusion- solutes from areas to concentrations across semipermeable membrane until = </li></ul></ul><ul><ul><ul><li>Remember in diffusion solutes move </li></ul></ul></ul><ul><ul><li>Osmosis- passive movement of fluid from areas with more fluid and fewer solutes to areas with less fluid and more solutes across a membrane </li></ul></ul><ul><ul><ul><li>Remember in osmosis fluid moves </li></ul></ul></ul><ul><ul><li>Active transport </li></ul></ul><ul><ul><ul><li>ATP( adenosine triphosphate) pushes against concentration gradient </li></ul></ul></ul><ul><ul><ul><li>Solutes from concentration to concentration </li></ul></ul></ul>
    56. 56. Fluids and Electrolyte Balance <ul><ul><li>Filtration-removing particles from a solution by allowing the liquid portion to pass through a membrane ( ex. Nephron of the kidney) </li></ul></ul><ul><li>All body fluids contain similar substances although concentration may vary: </li></ul><ul><ul><li>Electrolytes </li></ul></ul><ul><ul><li>Minerals </li></ul></ul><ul><ul><li>Cells </li></ul></ul>
    57. 57. Fluids and Electrolyte Balance <ul><li>Electrolytes </li></ul><ul><ul><li>Substances which dissolve in solution </li></ul></ul><ul><ul><li>Split into charged ions </li></ul></ul><ul><ul><li>Conduct an electrical current </li></ul></ul><ul><ul><li>+ charged = cations( Na +, K+, Ca+) </li></ul></ul><ul><ul><li>- charged = anions ( Cl-) </li></ul></ul><ul><ul><li>Vital for body functioning </li></ul></ul><ul><ul><ul><li>Neuromuscular </li></ul></ul></ul><ul><ul><ul><li>Acid/base balance </li></ul></ul></ul>
    58. 58. Fluids and Electrolyte Balance <ul><li>Minerals </li></ul><ul><ul><li>Ingested </li></ul></ul><ul><ul><li>Catalysts in nerve response, muscle contraction, regulating electrolyte balance </li></ul></ul><ul><li>Cells </li></ul><ul><ul><li>Basic units of all living tissue </li></ul></ul><ul><ul><li>RBC’s, WBC’s </li></ul></ul><ul><ul><li>Within body fluids </li></ul></ul>
    59. 59. Fluids and Electrolyte Balance <ul><li>Body fluids are not stagnant – fluids and electrolytes shift from compartment to compartment to facilitate body processes such as acid/ base balance. </li></ul><ul><li>K+ most abundant intracellular cation </li></ul><ul><li>Na+ most abundant in extraellular fluid </li></ul><ul><li>Where Na+ goes H2O follows </li></ul><ul><li>Na+ retained K+ excreted </li></ul>
    60. 60. Variables Affecting Fluid and Electrolyte Balance <ul><li>Age </li></ul><ul><ul><li>Infants </li></ul></ul><ul><ul><ul><li>have more H2O </li></ul></ul></ul><ul><ul><ul><li>Greater risk for loss </li></ul></ul></ul><ul><ul><ul><li>Kidneys immature – not able to concentrate urine </li></ul></ul></ul><ul><ul><li>Elderly </li></ul></ul><ul><ul><ul><li>Less body H2O </li></ul></ul></ul><ul><ul><ul><li>Decreased renal function- not able to concentrate urine </li></ul></ul></ul><ul><li>Body size </li></ul><ul><ul><li>Fat does not contain H2O </li></ul></ul><ul><ul><li>body H2O in females b/c more fat deposits in breasts and hips , obese have body H2O </li></ul></ul>
    61. 61. Fluids and Electrolyte Balance <ul><li>Environmental Temperature – </li></ul><ul><ul><li>temperature sweating fluid loss = loss of Na+ and Cl- ions. </li></ul></ul><ul><li>Life style </li></ul><ul><ul><li>Inadequate diet- </li></ul></ul><ul><ul><ul><li>body breaks down glycogen and fat stores. </li></ul></ul></ul><ul><ul><ul><li>Next destroys protein stores </li></ul></ul></ul><ul><ul><ul><li>Decrease in serum protein (hypoalbuminemia) </li></ul></ul></ul><ul><ul><ul><li>Decrease osmotic pressure and fluid shifts from circulating blood to interstitial spaces. </li></ul></ul></ul><ul><ul><li>Stress- fluid volume </li></ul></ul><ul><ul><li>Exercise- insensible H2O losses </li></ul></ul>
    62. 62. Fluids and Electrolyte Balance <ul><li>Fluid Disturbances </li></ul><ul><ul><li>Fluid Volume Deficit -H2O and electrolytes are lost. </li></ul></ul><ul><ul><ul><li>At Risk </li></ul></ul></ul><ul><ul><ul><ul><li>Decreased oral intake </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Vomiting </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Diarrhea </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Gastric suction </li></ul></ul></ul></ul><ul><ul><ul><li>The very young and very old quickly affected by these losses. </li></ul></ul></ul>
    63. 63. Fluids and Electrolyte Balance <ul><li>Fluid Volume Excess </li></ul><ul><ul><li>H2O and Na+ are retained = Hypervolemia with unchanged levels of electrolytes </li></ul></ul><ul><ul><li>At Risk </li></ul></ul><ul><ul><ul><li>Renal failure </li></ul></ul></ul><ul><ul><ul><li>CHF </li></ul></ul></ul>
    64. 64. Fluids and Electrolyte Balance <ul><li>Healthy bodies maintain a very precise fluid, electrolyte and acid-base balance. </li></ul><ul><li>Factors that can disturb balance </li></ul><ul><ul><li>Insufficient intake </li></ul></ul><ul><ul><li>GI and Kidney function disturbances </li></ul></ul><ul><ul><li>Excessive perspiration or evaporation </li></ul></ul><ul><ul><li>Volume losses </li></ul></ul>