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fluid and electrolyte imbalance
normal physiology of fluid regulation
FLUID IMBALANCES- fluid volume excess, fluid volume deficit, third spacing,
ELECTROLYTE IMBALANCES- hypo and hypernatremia, hypo and hyperkalemia, hypo and hypercalcemia
fluid and electrolyte imbalance
normal physiology of fluid regulation
FLUID IMBALANCES- fluid volume excess, fluid volume deficit, third spacing,
ELECTROLYTE IMBALANCES- hypo and hypernatremia, hypo and hyperkalemia, hypo and hypercalcemia
fluid and electrolyte disturbance in human bodybhartisharma175
it explain about definition of fluid and electrolyte disturbance, causes and different types of fluid disturbance. diagnostic evaluation and their emergent management along with supportive management.
Fluid balance is an aspect of the homeostasis of body in which the amount of water in the body needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes (salts in solution) in the various body fluids are kept within healthy ranges.
The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).
fluid and electrolyte disturbance in human bodybhartisharma175
it explain about definition of fluid and electrolyte disturbance, causes and different types of fluid disturbance. diagnostic evaluation and their emergent management along with supportive management.
Fluid balance is an aspect of the homeostasis of body in which the amount of water in the body needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes (salts in solution) in the various body fluids are kept within healthy ranges.
The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).
Sodium is necessary for the body to maintain fluid balance and is critical for normal body function. It also helps to regulate nerve function and muscle contraction.
Hyponatremia and Hyponatremia.
What is an electrolyte imbalance?
An electrolyte imbalance means that the level of one or more electrolytes in your body is too low or too high. It can happen when the amount of water in your body changes. The amount of water that you take in should equal the amount you lose. If something upsets this balance, you may have too little water (dehydration) or too much water (overhydration). Some of the more common reasons why you might have an imbalance of the water in your body include:
1. Certain medicines
2. Severe vomiting and/or diarrhea
3. Heavy sweating
4. Heart, liver or kidney problems
5. Not drinking enough fluids, especially when doing intense exercise or when the weather is very hot
6. Drinking too much water
Hypercalcaemia certainly possesses some diagnostic challenges
Cases are too different in ways of presentation and management do need a lot of things to be checked out. This is merely an approach for such patients.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Evaluation of antidepressant activity of clitoris ternatea in animals
FLUIDS AND ELECTROLYTES
1. Fluid, Electrolyte, and Acid-Fluid, Electrolyte, and Acid-
Base BalanceBase Balance
Focus 7
Nursing 53A
Judy Ontiveros, RN, PHN, MSN
2. ObjectivesObjectives
• Describe how fluid volume and electrolytes are
regulated to maintain homeostasis.
• Describe fluid and electrolyte balance.
– Examine fluid volume imbalance and preventative
interventions.
– Define and discuss the major electrolytes in the
maintenance of homeostasis
– Explain the proper distribution of fluid in each body fluid
compartment and the effect of mal-distribution
• Define and discuss the major electrolytes
essential in the maintenance of homeostasis
3. ObjectivesObjectives
• Define populations particularly vulnerable to fluid
and electrolyte imbalance.
• Discuss preventative measures to electrolyte
imbalance.
• List common diagnostic tests related to fluid and
electrolyte status.
• Discuss the nursing purpose responsibilities of
each procedure.
• Examine altered means of fluid intake and the
related nursing responsibilities/technical skills.
5. Fluid and Electrolyte BalanceFluid and Electrolyte Balance
• Homeostasis
– Balance of fluids, electrolytes, acids and bases
• Physiologic processes that control intake and output
– Body composed of 46 – 60% of adult weight
– Every illness has potential to upset the balance
6. Maintaining Fluid BalanceMaintaining Fluid Balance
• Intake should equal fluid output
– Intake at 2000 mL
– Output at 1500 mL
– Difference within 200 – 300 mL
13. Regulating Body FluidsRegulating Body Fluids
• Fluid intake
– Thirst
• Fluid output
– Urine
– Insensible loss
– Feces
• Maintaining
homeostasis
– Kidneys
– ADH
– Renin-angiotensin-
aldosterone system
– Atrial natriuretic system
14.
15.
16.
17.
18. Fluid and Electrolyte BalanceFluid and Electrolyte Balance
• Volume imbalance:
• Net volume gain
– hypervolemia
• Net volume loss
- hypovolemia
• Water intoxication
– overhydration
27. Regulating Acid-Base BalanceRegulating Acid-Base Balance
• Low pH = acidic
• High pH = alkalinic
• Body fluids maintained between pH of 7.35
and 7.45 by
• Buffers
• Respiratory system
• Renal system
28. Figure 52-10 Carbonic acid–bicarbonate ratio and pH.Figure 52-10 Carbonic acid–bicarbonate ratio and pH.
• Prevent excessive
changes in pH
• Major buffer in ECF
is HCO3 and H2CO3
• Other buffers
include:
– Plasma proteins
– Hemoglobin
– Phosphates
34. LungsLungs
• Regulate acid-base balance by eliminating or
retaining carbon dioxide
• Does this by altering rate/depth of
respirations
• Faster rate/more depth = get rid of more CO2
and pH rises
• Slower rate/less depth = retain CO2 and pH
lowers
35.
36.
37. KidneysKidneys
• Regulate by selectively excreting or
conserving bicarbonate and hydrogen ions
• Slower to respond to change
38.
39.
40.
41. Arterial Blood GasArterial Blood Gas
• pH 7.35-7.45
• PaO2 80-100 mm Hg
• PaCO2 35-45 mm Hg
• HCO3 22-26 mEq/L
• Base Excess -2 - +2 mEq/L
• SaO2 95-98%
42. Factors Affecting Body Fluid,Factors Affecting Body Fluid,
Electrolyte, and Acid-Base BalanceElectrolyte, and Acid-Base Balance
• Age
• Gender
• Body size
• Environmental temperature
• Lifestyle
43. Risk Factors for Fluid, Electrolyte,Risk Factors for Fluid, Electrolyte,
and Acid-Base Imbalancesand Acid-Base Imbalances
• Chronic diseases
• Acute conditions
• Medications
• Treatments
• Extremes of age
• Inability to access food and fluids
44. Specific IllnessesSpecific Illnesses
• COPD, Asthma,
Cystic Fibrosis
• CHF
• Kidney disease
• Diabetes Mellitus
• Cushing’s or
Addison’s disease
• Cancer
• Malnutrition, anorexia
nervosa, bulimia
• Ileostomy
• Gastroenteritis
• Bowel obstruction
• Head injury
• Fever, draining
wounds, fistulas
• Surgery
45. Medications to MonitorMedications to Monitor
• Diuretics
– Water depletion
– Electrolyte depletion
• Corticosteroids
– Water retention
• NSAIDS/Opoiods
– Constipation
46. Treatments that affect fluid balanceTreatments that affect fluid balance
• Chemotherapy
• IV therapy or TPN
• Nasogastric suction
• Enteral Feedings
• Mechanical Ventilation
47. Fluid ImbalancesFluid Imbalances
• Isotonic loss of water and electrolytes (fluid
volume deficit)
• Isotonic gain of water and electrolytes (fluid
volume excess)
• Hyperosmolar loss of only water
(dehydration)
• Hypo-osmolar gain of only water
(overhydration)
61. Collecting Assessment DataCollecting Assessment Data
• Nursing history
• Physical assessment
• Clinical measurement
• Review of laboratory test results
• Evaluation of edema
64. Desired OutcomesDesired Outcomes
• Maintain or restore normal fluid balance
• Maintain or restore normal balance of
electrolytes
• Maintain or restore pulmonary ventilation and
oxygenation
• Prevent associated risks
• Tissue breakdown, decreased cardiac output,
confusion, other neurologic signs
65. Nursing InterventionsNursing Interventions
• Monitoring
• Fluid intake and output
• Cardiovascular and respiratory status
• Results of laboratory tests
• Assessing
• Client’s weight
• Location and extent of edema, if present
• Skin turgor and skin status
• Specific gravity of urine
• Level of consciousness, and mental status
66. Nursing InterventionsNursing Interventions
• Fluid intake modifications
• Dietary changes
• Parenteral fluid, electrolyte, and blood
replacement
• Other appropriate measures such as:
• Administering prescribed medications and
oxygen
• Providing skin care and oral hygiene
• Positioning the client appropriately
• Scheduling rest periods
67. • Monitoring daily Intake and Output (I&O)
• Monitoring daily Weight -same time (am),
same clothes
– 1 Kg.(2.2 lbs) is equal to 1 Liter(1000 mL) of
fluid loss or gain
• Orthostatic Blood Pressure monitoring
– L_____ S_____ St______
68. Laboratory tests-Laboratory tests-
• Electrolytes- Metabolic Panel
– Serum Na
– Serum K
– Blood Urea Nitrogen (BUN)
– Creatinine
– Glucose
• Urine osmolality (Sp. Gravity)
• H & H or CBC
69.
70. Implementing and DocumentingImplementing and Documenting
I & OI & O
• Evaluating Outcomes
– HCT ( hematocrit )
• Range of 40 – 54% males
• Range of 38 – 47% Females
• Increased values = FVD
• Decreased Values = FVE
– Specific Gravity – 1.010-1.-25
• High = FVD
• Low = FVE
71. Promoting Fluid andPromoting Fluid and
Electrolyte BalanceElectrolyte Balance
• Consume 6-8 glasses water daily
• Avoid foods with excess salt, sugar, caffeine
• Eat well-balanced diet
• Limit alcohol intake
• Increase fluid intake before, during, after
strenuous exercise
• Replace lost electrolytes
72. Promoting Fluid andPromoting Fluid and
Electrolyte BalanceElectrolyte Balance
• Maintain normal body weight
• Learn about, monitor, manage side
effects of medications
• Recognize risk factors
• Seek professional health care for
notable signs of fluid imbalances
73. Practice Guidelines Facilitating Fluid IntakePractice Guidelines Facilitating Fluid Intake
• Explain reason for required intake and amount
needed
• Establish 24 hour plan for ingesting fluids
• Set short term goals
• Identify fluids client likes and use those
• Help clients select foods that become liquid at
room temperature
• Supply cups, glasses, straws
• Serve fluids at proper temperature
• Encourage participation in recording intake
• Be alert to cultural implications
74. Planning and Implementation ofPlanning and Implementation of
I & OI & O
• Assessing each patient’s situation
– Age
• Infants and Children
– Greater fluid turnover – high metabolic rate
– Kidneys immature – lose more water
– Respirations rapid –
– Body surface area larger than adult – Increases insensible
losses
– Fluid and electrolyte losses occur very rapidly
• Elderly
– Thirst response diminished
– Nephrons less functional to conserve water
– Increase risk of dehydration
– Risks of HD, CRF, multiple medications
increases risk for fluid and electrolyte imbalance
75. Practice Guidelines Restricting Fluid IntakePractice Guidelines Restricting Fluid Intake
• Explain reason and amount of restriction
• Help client establish ingestion schedule
• Identify preferences and obtain
• Set short term goals; place fluids in small
containers
• Offer ice chips and mouth care
• Teach avoidance of ingesting chewy,
salty, sweet foods or fluids
• Encourage participation in recording
intake
76. Correcting ImbalancesCorrecting Imbalances
• Oral replacement
– If client is not vomiting
– If client has not experienced excessive fluid
loss
– Has intact GI tract and gag and swallow
reflexes
79. Correcting ImbalancesCorrecting Imbalances
• Intravenous Fluids
– Hypotonic
• osmotic pressure less to that of
plasma.
• 0.45% Na CL or half normal saline
• used for dehydration and
• promotes waste elimination of
kidneys
80. Intravenous FluidsIntravenous Fluids
• Isotonic
– osmotic pressure equal to that of plasma
• Example #1 - 5% dextrose in H2O (D5W)
– supplies free water to aid in renal excretion of solutes
– expands intracellular and extracellular volumes
• Example #2 - Lactated Ringers,
0.9% NaCL or normal saline (NS)
– expands vascular volume
– contains multiple electrolytes in physiological
concentrations
– used to treat hypovolemia, burns, and diarrhea
– used to treat mild metabolic acidosis
81. Intravenous FluidsIntravenous Fluids
• Hypertonic
– osmotic pressure above that of plasma
• Example #1 - 5% dextrose in 0.45% NaCl
(D5 ½ NS)
– treats hypovolemia
– maintains hydration
– draws fluid out of the intracellular and
interstitial spaces into the vascular space
– expands volume
82. Intravenous FluidsIntravenous Fluids
• Hypertonic
– Example #2 - 5% dextrose 0.9%
NaCl (D5NS)
• replaces calories and electrolytes
• temporary treatment of
hypovolemia
83. EvaluationEvaluation
• Collect data as identified in the
plan of care
• If desired outcomes are not
achieved, explore the reasons
before modifying the care plan
Editor's Notes
25.4- Fluid intake is regulated through THIRST CENTER- HYPOTHALAMUS,
psychological factors
dry pharyngeal mucous membranes,
Angiotension I create the sensation of thirst.
Major PHYSIOLOGICAL stimuli to the thirst center are
increase plasma concentration
decreased blood volume.
osmoreceptors which detect the fluid loss continually monitor osmolality
Fluid output occurs through the kidney and Gastrointestinal tract average daily fluid loss is 2600-3000 ccs
LYMPHATIC SYSTEM sponges up excess fluid that’s not reabsorbed by the capillaries – LYMPH DUCTS- return fluid and some protein to the subclavian veins and empty into the right atrium..
GASTROINTESTINAL SYSTEM –besides the fluid absorbed from the dietary intake the GI tract produced PRODUCTION OF GLANDULAR AND TISSUE SECRETIONS 7 -9 liters, all than about 100 ml of this fluid is reabsorbed.
RENAL SYSTEM-THE KIDNEYS ARE THE Major regulatory organs of fluid balance
Chemical buffer system in extracellular fluid Carbonic acid- bicarbonate which responds to changes in pH within seconds . We have the excretion of CO2 from the lungs and the excretion of hydrogen and bicarbonate ions which is controlled by the kidneys
2nd buffering system in plasma proteins such as albumin, fibrinogen, prothrombin which can bind or release hydrogen to correct acidosis or alkalosis.
Pg 563-564
Fluids exist in compartments in the body yet fluid is in a continual state of exchange between the compartments the amounts in the compartments remain relatively constant.
Intracellular fluid compartment- makes up 2/3 of the body’s fluid and provide cells with internal aqueous medium necessary for their chemical functions 70% anything that affects fluid loss at the cellular level has significant implications for the entire body.
Extracellular fluid compartment – fluid found outside cells body’s transportation system 30% Extracellular compartment carries water, electrolytes, nutrients, and oxygen, makes up the other 1/3 of fluid it is further divided into:
Intravascular fluids - fluid within arteries, veins, and capillaries 6%
Interstitial fluids - fluid is everywhere in body 22%
Third spacing- occurs when fluid shifts from the vascular space into a space where it is not accessible as extracellular fluid; it remains in the body, but is not available for use, causing an isotonic fluid volume deficit, example fluid may be trapped in the interstitial space as edema, or peritoneal or pleural cavities
Transcellular fluids - in spaces in the cerebrospinal canals of the brain, and in lymph tissue, synovial joints and eyes. 2%
Figure 52-4 Diffusion: The movement of molecules through a semipermeable membrane from an area of higher concentration to an area of lower concentration.
Figure 52-3 Osmosis: Water molecules move from the less concentrated area to the more concentrated area in an attempt to equalize the concentration of solutions on two sides of a membrane.
An example of the filtration pressure changes within a capillary bed arterial blood pressure exceeds colloid osmotic pressure resulting in movement of water and dissolved substances out of the capillary into the interstitial space, on the venous end blood pressure is less than colloid osmotic pressure resulting in movement of water and dissolved substances into the capillary
Hydrostatic pressure - arterial blood enter the capillaries at a pressure greater than interstitial pressure
So fluid and solutes move from the capillaries toward the cells. At the venous end of the capillary bed because the hydrostatic pressure is less than interstitial pressure, fluid and waste products move from the cells back into the capillaries.
Osmotic pressure is the drawing power for water to depends on the number of molecules of solution. A solution with high solute concentration has a high osmotic pressure and draws water to itself.
Osmolality - is the osmotic dissolved particles needed to produced one unit of force is expressed in Milliosmoles – or OSMOLS MSM/KG
Osmolarity - measurement of milliosmoles per liter of solution
Figure 52-5 Schematic of filtration pressure changes within a capillary bed. On the arterial side, arterial blood pressure exceeds colloid osmotic pressure, so that water and dissolved substances move out of the capillary into the interstitial space. On the venous side, venous blood pressure is less than colloid osmotic pressure, so that water and dissolved
substances move into the capillary.
Figure 52-6 An example of active transport. Energy (ATP) is used to move sodium molecules and potassium molecules across a semipermeable membrane against sodium’s and potassium’s concentration gradients (i.e., from areas of lesser concentration to areas of greater concentration).
566-567 Osmosis - the movement of H2O through a semi-impermeable membrane from an area of lesser concentration of particles to an area of greater concentration of particles.
Osmosis is the diffusion of water across a semi-permeable (or differentially permeable or selectively permeable) membrane. The cell membrane, along with such things as dialysis tubing and cellulose acetate sausage casing, is such a membrane. The presence of a solute decreases the water potential of a substance. Thus there is more water per unit of volume in a glass of fresh-water than there is in an equivalent volume of sea-water. In a cell, which has so many organelles and other large molecules, the water flow is generally into the cell.
Diffusion -
passive process by molecules move through a cell membrane from an area of higher concentration to an area of lower concentration
Diffusion example is gas exchange between O2 and CO2 across the alveoli and capillaries.
Active Transport - molecules move from an area of lower concentration to an area of higher concentration with an expenditure of energy adenosine triphosphate (ATP)
Active transport example is sodium potassium pump there is active movement of sodium from inside the cell to outside the cell
ADH from pituitary gland to kidney, especially in crisis to shut off pee.
568 figure 25.4-
NEURO ENDOCRINE SYSTEM it regulates body fluid volume by producing and secreting hormones that stimulate or inhibit osmotic receptors in the carotid arteries and aortic arch –HORMONES & BAROCEPTORS-
Anti diuretic Hormone which released by the posterior pituitary gland, reduces the production of urine by causing the kidney tubules to reabsorb water. When fluid volume deficit occurs ( as in vomiting, diarrhea, or hemorrhage) the amount of ADH in the blood increases and the water reabsorbed by the kidney tubules is returned to the circulating blood volume.
In response to decreased blood flow or pressure in the kidney specialized receptors in the nephrons, release renin. Renin causes the conversion of angiotensin I to angiotensin II which acts directly on the nephron to cause Na+ and H2O retention. Angiontension II also stimulates the adrenal cortex to release aldosterone which causes kidneys tubules to excrete K+ and retain Na+; as a result the kidneys reabsorb water and return it to the blood volume.
RENAL SYSTEM-THE KIDNEYS ARE THE Major regulatory organs of fluid balance. It can take from a few hours to several days to regulate acid base abnormalites.
precise control of body water and solute concentrations is a function of several hormones acting on both the kidneys and vascular system, but there is no doubt that antidiuretic hormone is a key player in this process.
Antidiuretic hormone, also known commonly as arginine vasopressin, is a nine amino acid peptide secreted from the posterior pituitary. Within hypothalamic neurons, the hormone is packaged in secretory vesicles with a carrier protein called neurophysin, and both are released upon hormone secretion.
Physiologic Effects of Antidiuretic Hormone
Effects on the Kidney
The single most important effect of antidiuretic hormone is to conserve body water by reducing the loss of water in urine. A diuretic is an agent that increases the rate of urine formation. Injection of small amounts of antidiuretic hormone into a person or animal results in antidiuresis or decreased formation of urine, and the hormone was named for this effect.
Fluid volume excess-. The defining characteristics are a direct or indirect result of an increase in fluid intake or decrease in excretion of fluid without compensation by intercompartmental fluid shifts or other regulatory mechanisms
It can occur because of A. Excessive intake Na Cl B. rapid administration of sodium rich infusions, C. disease that impair regulatory mechanisms, like renal failure, congestive heart failure
Deficient fluid volume or low blood volume The defining characteristics are a direct or an indirect result of a rapid change in fluid output or a lack of intake without compensation by fluid shifts or other homeostatic mechanisms. It occurs when water is lost from the body but there is no loss of electrolytes, as a result serum sodium concentrations increases in the vascular fluid water is drawn into the blood from the interstitial space and cells resulting in cell dehydration.
Dehydration can be caused by:
Hyperventilation
Prolonged fever
Diabetic ketoacidosis
Enteral feedings without water intake
Fluid volume excess-. The defining characteristics are a direct or indirect result of an increase in fluid intake or decrease in excretion of fluid without compensation by intercompartmental fluid shifts or other regulatory mechanisms
It can occur because of A. Excessive intake Na Cl B. rapid administration of sodium rich infusions, C. disease that impair regulatory mechanisms, like renal failure, congestive heart failure
Deficient fluid volume or low blood volume The defining characteristics are a direct or an indirect result of a rapid change in fluid output or a lack of intake without compensation by fluid shifts or other homeostatic mechanisms. It occurs when water is lost from the body but there is no loss of electrolytes, as a result serum sodium concentrations increases in the vascular fluid water is drawn into the blood from the interstitial space and cells resulting in cell dehydration.
Dehydration can be caused by:
Hyperventilation
Prolonged fever
Diabetic ketoacidosis
Enteral feedings without water intake
Water intoxication is overhydration and occurs when more water is gained that electrolytes the result is low serum osmolality and low serum Na+ levels. Water is drawn into the cells causing them to swell. Water intoxication occurs in conditions which both fluid and electrolytes are lost through heavy exercise, or heavy sweating and only water is replaced,
An example of the filtration pressure changes within a capillary bed arterial blood pressure exceeds colloid osmotic pressure resulting in movement of water and dissolved substances out of the capillary into the interstitial space, on the venous end blood pressure is less than colloid osmotic pressure resulting in movement of water and dissolved substances into the capillary
Hydrostatic pressure - arterial blood enter the capillaries at a pressure greater than interstitial pressure
So fluid and solutes move from the capillaries toward the cells. At the venous end of the capillary bed because the hydrostatic pressure is less than interstitial pressure, fluid and waste products move from the cells back into the capillaries.
Osmotic pressure is the drawing power for water to depends on the number of molecules of solution. A solution with high solute concentration has a high osmotic pressure and draws water to itself.
Osmolality - is the osmoticdissolved particles needed to produced one unit of force is expressed in Milliosmoles – or OSMOLS MSM/KG
Osmolarity - measurement of milliosmoles per liter of solution
Hypertonic have greater concentration of solutes than plasma will move water out of cells. Solutions have lower water potential
Hypotonic as lesser concentration of solutes that plasma don will move water into cells . (higher water potential).
Isotonic has the same osmolality as blood plamsa . This type prevents shifting of fluid and electrolytes from intracellular fluid.
solutions have equal (iso-) concentrations of substances. Water potentials are thus equal, although there will still be equal amounts of water movement in and out of the cell, the net flow is zero.
Deficit: abnormal losses through skin, anorexia third spacing, nausea,
Excessive sweating, inability to access fluids, polyuria, impaired swallowing,
Fever, confusion, NG suction, depression, bleeding, prolonged rapid respiration,
Vomiting, diarrhea
symptomatology: decreased BP, pulse, urine output <30 ml/ hour, decreased skin turgor, dry mucus membranes, sunken eyeballs, hemoconcentration, elevated temperature, concentrated urine weakness, confusion.
Excess:,
It can occur because of A. Excessive intake Na Cl B. rapid administration of sodium rich infusions, C. disease that impair regulatory mechanisms, like renal failure, congestive heart failure
Symptomatology: weight gain > 2lbs in 24 hours, elevated BP, full bounding pulses, moist, labored respirations, large volume of pale urine, pitting edema, crackles, Auscultate in lungs, dyspnea, distended jugular veins
Electrolyte imbalance:
An electrolyte disorder is an imbalance of certain ionized salts (i.e., bicarbonate, calcium, chloride, magnesium, phosphate, potassium, and sodium) in the blood.
Description
Electrolytes are ionized molecules found throughout the blood, tissues, and cells of the body. These molecules, which are either positive (cations) or negative (anions), conduct an electric current and help to balance pH and acid-base levels in the body. Electrolytes also facilitate the passage of fluid between and within cells through a process known as osmosis and play a part in regulating the function of the neuromuscular, endocrine, and excretory systems.
Respiratory acidosis is high paco2 due to alveolar hypoventilation which causes co2 to be retained. c arbonic acid levels increase and the pH falls below 7.35. the kidneys attempt to compensate by retaining HCO3, however, they are slow to respond, so compensation may require several days time. Related factors, acute lung conditions that impaired alveolar gas impair, aspiration of an foreign object ,pulmonary edema. Or chronic lung disease, narcotic or sedative overdose that depresses the respiratory center in the brain, cardiac arrest, pneumonia or Hemothorax, obesity. S&S: acute conditions: increased pulse and resp rate, headache, dizziness, confusion, decreased level of consciousness, palpitations, warm flushed skin, ventricular fib
Treatment focuses on improving ventilation, bronchodilators to reduce spasm and ANTIBIOTICS, assessing respiratory status and lung sounds frequently, O2 as needed
Respiratory Alkalosis: is a low PaCO2 due hyperventilation. An increase resp rate or depth cause CO2 to be excreted faster than normal. When CO2 level is high the respiratory center is stimulated; however, when CO2 level is low as in respiratory alkalosis , the respiratory center depresses or even ceases respirations. The kidneys try to compensate by excreting more bicarbonate and retaining more hydrogen. Related factors hyperventilation, hypoxemia, high fever, CNS lesions, pulmonary emboli, bacteremia, anxiety
Interventions: look at cause anxiety? Focus interventions on decreasing anxiety,
Instruct client to breath more slowly or to breathe into a paper bag or apply a rebreather mask to inhale CO2, monitor ABG’s and vital signs
Metabolic Acidosis
Is a low HCO3 level in relation to the amount of carbonic acid levels in the body this may be from renal failure and the inability of the kidneys to excrete hydrogen ions and produce HCO3. the resp center attempt to compensate by increasing rate and depth of respirations excreting CO2 and causing carbonic acid levels to fall. Related factors conditions that increase non volatile acids in the blood, like DM, impaired renal function
Conditions that cause a loss of bicarbonate like prolonged diarrhea, acidify drugs like ammonium chloride used alkalosis or to acidify the urine.
Nursing Interventions:treatment focuses on correcting the metabolic defect, IV sodium bicarbonate, IF ORDERED, monitor ABG’s, Monitor LOC, Monitor I&O
Metabolic Alkalosis
Is a high HCO3 level because of excessive acid losses or due to increased ingestion or retention of bases; like when someone ingests bicarbonate of soda as an antacid. When metabolic alkalosis depresses the respiratory center the lungs attempt to compensate respirations become slow and shallow, CO2 is retained and HCO3 levels increase. The kidneys also try to compensate by excreting K+ and NA+ with the excess bicarbonate and by retaining hydrogen related factors include excessive acid loss from vomiting or gastric suctioning, excessive use of K+ losing diuretics, ingestion of bicarbonate like antacids, abrupt relief of chronic respiratory acidosis, hypokalemia, Hyperaldosteronism, Cushings syndrome
Nursing Interventions: Causative interventions.
pH measures the relative acidity or alkalinity of the blood
Normal pH is 7.35 – 7.45 cellular function is seriously affected at
<7.20 or >7.50 , 6.8O or 7.80 are incompatible
with life
Pa O2 is an indirect measure of blood oxygen content it is the pressure exerted by O2 dissolved in the plasma of the arterial blood
Pa Co2 reflects the respiratory component of acid-base status. It is the partial pressure of CO2 in the arterial blood.
HCO3 measures the metabolic component of acid base status
Base Excess also reflects the metabolic component of acid base status.
Sa O2 is the percentage of hemoglobin that is saturated with oxygen
Sodium helps the kidneys to regulate the amount of water the body retains or excretes. Consequently, individuals with elevated serum sodium levels also suffer from a loss of fluids, or dehydration. Hypernatremia can be caused by inadequate water intake, excessive fluid loss (i.e., diabetes insipidus, kidney disease, severe burns, and prolonged vomiting or diarrhea), or sodium retention (caused by excessive sodium intake or aldosteronism). In addition, certain drugs, including loop diuretics, corticosteroids, and antihypertensive medications may cause elevated sodium levels.
Symptoms of hypernatremia include: thirst, orthostatic hypotension, dry mouth and mucous membranes, dark, concentrated urine, loss of elasticity in the skin, irregular heartbeat (tachycardia), irritability, fatigue, lethargy, heavy, labored breathing, muscle twitching and/or seizures.
– interventions dietary sodium restriction, give water with feedings to keep Na+ and BUN levels WNL, monitor I &O
Up to 1% of all hospitalized patients develop hyponatremia, making it one of the most common electrolyte disorders. Diuretics, certain psychoactive drugs (i.e., fluoxetine, sertraline, haloperidol), specific antipsychotics (lithium), vasopressin, chlorpropamide, the illicit drug "ecstasy," and other pharmaceuticals can cause decreased sodium levels, or hyponatremia. Low sodium levels may also be triggered by inadequate dietary intake of sodium, excessive perspiration, water intoxication, and impairment of adrenal gland or kidney function.
Symptoms of hyponatremia include: nausea, abdominal cramping, and/or vomiting, headache, edema (swelling), muscle weakness and/or tremor, paralysis, disorientation, slowed breathing, seizures, coma.
risk factors loss of GI fluids, adrenal insufficiency, sweating, diuretics, , gain of hypotonic tube feedings, oral ingestion of water, excess of administration on D5W, AIDS, malignancy tumors, head injury
Nursing interventions: monitoring I&O, checking specific gravity of urine, encourage diet high in sodium
HYPERKALEMIA
Increased oral or IV intake especially in renal disease, stored blood
Decreased output as from taking angiotensin converting enzyme inhibitor with potassium rich salt substitutes or potassium sparing diuretics, renal failure, post op oliguria addinsons disease
Hyperkalemia may be caused by ketoacidosis (diabetic coma), myocardial infarction (heart attack), severe burns, kidney failure, fasting, bulimia nervosa, gastrointestinal bleeding, adrenal insufficiency, or Addison's disease. Diuretic drugs, cyclosporin, lithium, heparin, ACE inhibitors, beta blockers, and trimethoprim can increase serum potassium levels, as can heavy exercise. The condition may also be secondary to hypernatremia (low serum concentrations of sodium). Symptoms may include: weakness, nausea and/or abdominal pain, irregular heartbeat (arrhythmia), diarrhea, muscle pain
Nursing inteventions: monitor cardiac status, adm diuretics, Hold K+ supplements, and K+ sparing diuretics, Monitor K+ levels closely, teach at risk clients to avoid K+ laden foods and drinks, such as coffee, tea, cocoa, dried fruits, dried beans, whole grain breads.
HYPORKALEMIA POTASSIUM certain medications such as diuretics and laxatives, excess vomiting, diarrhea, GI suctioning, diet low in potassium, renal failure
Severe dehydration, aldosteronism, Cushing's syndrome, kidney disease, long-term diuretic therapy, certain penicillins, laxative abuse, congestive heart failure, and adrenal gland impairments can all cause depletion of potassium levels in the bloodstream. A substance known as glycyrrhetinic acid, which is found in licorice and chewing tobacco, can also deplete potassium serum levels. Symptoms of hypokalemia include: weakness, paralysis, increased urination, irregular heartbeat (arrhythmia), orthostatic hypotension
muscle pain, tetany.
Assess clients on digitalis medications Digitalis Medicines
Commonly Used Brand Names in the United States: Lanoxicaps (digoxin), Lanoxin (digoxin), commonly used to treat CHF for digitalis toxicity Hypokalemia potentiates these type of drugs. Administer potassium. Educate client on potassium laden foods.
HYPORKALEMIA POTASSIUM certain medications such as diuretics and laxatives, excess vomiting, diarrhea, GI suctioning, diet low in potassium, renal failure
Severe dehydration, aldosteronism, Cushing's syndrome, kidney disease, long-term diuretic therapy, certain penicillins, laxative abuse, congestive heart failure, and adrenal gland impairments can all cause depletion of potassium levels in the bloodstream. A substance known as glycyrrhetinic acid, which is found in licorice and chewing tobacco, can also deplete potassium serum levels. Symptoms of hypokalemia include: weakness, paralysis, increased urination, irregular heartbeat (arrhythmia), orthostatic hypotension
muscle pain, tetany.
Assess clients on digitalis medications Digitalis Medicines
Commonly Used Brand Names in the United States: Lanoxicaps (digoxin), Lanoxin (digoxin), commonly used to treat CHF for digitalis toxicity Hypokalemia potentiates these type of drugs. Administer potassium. Educate client on potassium laden foods.
HYPOCALCEMIA): meds diuretics, laxatives, hypoparthyroidism, renal failure Thyroid disorders, kidney failure, severe burns, sepsis, vitamin D deficiency, and medications such as heparin and glucogan can deplete blood calcium levels. Lowered levels cause: muscle cramps and spasms tetany and/or convulsions, mood changes (depression, irritability), dry skin, brittle nails, facial twitching.
Chvosteks sign= When the facial nerve is tapped at the angle of the jaw, the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcaemia and hyperexcitability of nerves
Trousseau’s sign = carpal spasm can be elicited by compressing the upper arm and causing ischemia to the nerves distally
Nursing interventions: seizure precautions for severe cases, monitor airway, safety precautions for confusion, education for perimenopausal women regarding the need of CA+ supplements.
Help to Characterize the Nature and Severity of Fluid/Electrolyte Imbalance
Highly recommended: sodium, potassium, chloride, bicarbonate (electrolytes), blood urea nitrogen (BUN), creatinine
Recommended: calcium, glucose, hemoglobin, hematocrit, serum osmolality
Optional: urinalysis, urine sodium, urine osmolality
Urinalysis test includes, urine ph, acidity, and protein and specific gravity
Specific gravity (which is directly proportional to urine osmolality which measures solute concentration) measures urine density, or the ability of the kidney to concentrate or dilute the urine over that of plasma. Dipsticks are available that also measure specific gravity in approximations. Most laboratories measure specific gravity with a refractometer.
Specific gravity between 1.002 and 1.035 on a random sample should be considered normal if kidney function is normal. Since the sp gr of the glomerular filtrate in Bowman's space ranges from 1.007 to 1.010, any measurement below this range indicates hydration and any measurement above it indicates relative dehydration.
Generalized symptomatology weakness, fatigue, body edema (anasarca) pitting and non pitting edema in dependent areas such as legs, sacrum, and scrotum.
Ascites
Sudden weight gain > 2lbs/week ( 1 liter =2.2lbs or 1 kg ) daily wgt
Peripheral venous distention
Bulging fontanels in an infant
Pulmonary progressive worsening of dyspnea, from dyspnea on exertion to orthopnea, and finally to dyspnea at rest.
Increased respiratory rate
Respiratory rhythm rate may become irregular or apneic
Crackles present from fluid congestion in alveol
Possible pulmonary edema from severe fluid congestion in alveoli 2ndary to left ventricular failure.
Possible pleural effusion with audible pleural rub from congestion in pleural spaces.
Cardiac tachycardia, bounding pulse, HTN systolic BP>140mm Hg or diastolic BP >90mm Hg, possible pericardial effusion with audible rub from pericardial rub for fluid congestion in pericardium
GI anorexia, Nausea and vomiting
Renal increased output if kidney can compensate, decreased output if kidney damage is part of etiology
used to tx. edema & 3rd spacing;solutions are used to replace electrolytes and shift fluids from the ICF to ECF; cell decreases in size because salt sucks; D10,D5NS,D51/2NS,D5RL(55dextros in ringers lactated)