NURSING STUDENTS #Fluid and electrolytes# note#medical surgical

1. 1
Fluids and Electrolytes
They’re important when they’re important
Prepared By:
MEERA GAUTAM
Roll.no-7
B.sc Nursing 2nd year

2. 2
Total body water (TBW)

3. 3
• Fluid compartments are separated by
membranes that are freely permeable to
water – but impermeable to solutes.
• Movement of fluids is due to:
– hydrostatic pressure differentials
– osmotic pressure differentials

4. 4
Fluid Balance

5. 5
Fluid Balance
The body tries to maintain homeostasis of
fluids and electrolytes by regulating:
• Volumes
• Solute charge and osmotic load

6. 6
Solute Homeostasis
• Electrolytes – charged particles
– Cations – positively charged ions
• Na+, K+ , Ca++, H+
– Anions – negatively charged ions
• Cl-, HCO3
- , PO4
3-
• Non-electrolytes - Uncharged particles
• Proteins, urea, glucose, O2, CO2

7. 7
Maintained by:
• Ion transport
• Water movement
• Kidney function
These functions act to keep body fluids:
– Electrically neutral
– Osmotically stable (specified number of
particles per volume of fluid)
Solute Homeostasis

8. 8
Where sodium goes, water follows.
Diffusion – movement of particles down a
concentration gradient.
Osmosis – diffusion of water across a selectively
permeable membrane
Active transport – movement of particles up a
concentration gradient; requires energy
Solute Homeostasis

9. 9

10. 10
Regulation of body water
The default is get rid of it
The control processes include:
Release of ADH (antidiuretic hormone)
Thirst

11. cont…..
Any of the following:
• Decreased amount of water in body
• Increased amount of Na+ in the body
• Increased blood osmolality
• Decreased circulating blood volume
Results in:
• Stimulation of osmoreceptors in hypothalamus
• Release of ADH from the posterior pituitary
• Increased thirst
And thus: water consumption and conservation

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Volume Abnormalities
Isotonic fluid loss
• ↓ECF volume, weight loss, dry skin and
mucous membranes, ↓ urine output:
hypovolemic shock

13. Cont……
Isotonic fluid gain
• ↑ECF volume, weight gain, decreased
hematocrit, diluted plasma proteins,
distended neck veins, ↑ B.P:
anasarca
13

14. Cont……
.
14
Edema
the accumulation of fluid within the interstitial space
Causes:
• increased hydrostatic pressure
• venous obstruction, lymphedema, CHF, renal failure
• lowered plasma osmotic pressure (protein loss)
• liver failure, malnutrition, burns
• increased capillary membrane permeability
• Inflammation, sepsis

15. 15
Cont…….
Results in:
• increased distance for diffusion
• impaired blood flow
• slower healing
• increased risk of infection
• pressure sores over bony prominences
• impaired organ function (brain, liver, gut, kidney)

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Electrolytes

17. Electrolyte balance
• Na + (Sodium)
• Predominant extracellular cation
• 136 -145 mEq / L
• Pairs with Cl- , HCO3
- to neutralize charge
• Most important ion in water balance
• Important in nerve and muscle function
• Reabsorption in renal tubule regulated by:
• Aldosterone
• Renin/angiotensin
• Atrial Natriuretic Peptide (ANP)

18. Electrolyte balance
• K + (Potassium)
• Major intracellular cation
• 150- 160 mEq/ L
• Regulates resting membrane potential
• Regulates fluid, ion balance inside cell
• Regulation in kidney through:
• Aldosterone
• Insulin

19. Electrolyte balance
• Cl ˉ (Chloride)
• Major extracellular anion
• 105 mEq/ L
• Regulates tonicity
• Reabsorbed in the kidney with sodium
• Regulation in kidney through:
• Reabsorption with sodium
• Reciprocal relationship with bicarbonate

20. Risk factors
If there is electrolytes imbalance then;
Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Hypocalcemia
Hypercalcemia
Hypomagnesemia
Hypermagnesemia

21. Hypophosphatemia
Hyperphosphatemia
Respiratory Acidosis(Carbonic Acid Excess)
Respiratory Alkalosis(Carbonic Acid Deficit)
Metabolic Acidosis(Basic Bicarbonate Deficit)

22. Nursing Managements
And
Nursing Care
Assessed the general condition of the patient.
Maintain the intake and output chart strictly.
Regular monitor the body weight.
 Daily ingest the quality and type of fluids(to
include six to eight glasses of water)that
promote healthy hydration and urinary
functioning.
Evaluate use of food diets, diuretics, laxatives,
and alcohol, identififying potential risks to
health.

23. So what does this mean in
the real world?