Professional Documents
Culture Documents
Body Fluids
Mechanisms of
Fluid Gain and Loss
Gain
Fluid intake 1500ml
Food intake 1000ml
Oxidation of
nutrients
300ml
(10ml of H20
Kcal)
per
100
Loss
Sensible
Can be seen.
Urine
1500ml
Sweat
100ml
Insensible
Not visible.
Skin (evaporation) 500ml
Lungs
400ml
Feces
200ml
Regulation of Fluids
Regulation of Fluids
(continued )
Consider This.
Variations in Body
Fluids
Fluid Compartments
Intracellular
fluid (ICF)
Fluid inside
the cell
Most (2/3) of
the bodys
H20 is in the
ICF.
Extracellular Fluid
(ECF)
Fluid outside the cell.
1/3 of bodys H20
More prone to loss
3 types:
Interstitial- fluid
around/between cells
Intravascular- (plasma)
fluid in blood vessels
Transcellular CSF,
Synovial fluid etc
Consider this.
Fluid Balance
Dynamic process
Balance between body fluids
and electrolytes
Attraction between ions
(electrolytes) and water (fluids)
causes fluids to move across
membranes and leave their
compartments.
Solvent (H20)
Movement
Osmolarity
Hypertonic Fluids
Hypertonic fluids have a higher
concentration of particles (high
osmolality) than ICF
This higher osmotic
pressure shifts fluid from the
cells into the ECF
Therefore Cells placed in a
hypertonic solution will shrink
Hypertonic Fluids
Hypotonic Fluids
Hypotonic fluids have less
concentration of particles (low
osmolality) than ICF
This low osmotic pressure
shifts fluid from ECF into cells
Cells placed in a hypotonic
solution will swell
Hypotonic Fluids
Used to dilute plasma
particularly in hypernatremia
Treats cellular dehydration
Do not use for pts with increased
ICP risk or third spacing risk
0.45%NS
0.33%NS
Isotonic Fluid
Isotonic fluids have the same
concentration of particles
(osmolality) as ICF (275-295
mOsm/L)
Osmotic pressure is therefore the
same inside & outside the cells
Cells neither shrink nor swell in an
isotonic solution, they stay the same
Isotonic Fluid
Expands both intracellular and
extracellular volume
Used commonly for: excessive
vomiting,diarrhea
Hmmm.
Consider this.
Solute Movement
other mechanisms
Filtration
Causes include:
Increased output, Hemorrhage,
vomiting, diarrhea, burns,
OR
Fluid shift out of vascular space
( third spacing ) into interstitial
spaces
Dehydration
Assessment
FVD - Hypovolemia
Cardiovascular:
Diminished peripheral pulses; quality 1+
(thready)
Decreased BP & orthostatic hypotension
Increased HR
Flat neck & hand veins in dependent position
Elevated Hematocrit (Hct)
Gastrointestinal:
Thirst
Decreased motility; diminished bowel sounds,
possible constipation
Assessment
FVD Hypovolemia
(continued)
Neuromuscular:
Possible fever
Renal:
Integumentary:
Decreased output
Increased spec grav of
urine
Weight loss
Hypernatremia
Respiratory:
Planning - FVD
Interventions for
FVD - Hypovolemia
NCLEX Practice
Intravenous fluids are ordered for your client
who is experiencing diarrhea and vomiting for
the past 2 days. Which IV solution would the
nurse expect to see prescribed?
a.
D5NS
b.
0.45%NS
c.
D51/2NS
d.
RL
Causes:
Increased Na/H2O retention
Excessive intake of Na (PO or IV)
Excessive intake of H2O ( PO or IV)
(Water intoxication)
Syndrome of inappropriate
antidiuretic hormone (SIADH)
Renal failure, congestive heart failure
Assessment
FVE - Hypervolemia
CV:
Elevated pulse; 4+
bounding, elevated BP,
distended neck & hand
veins, ventricular gallop
(S3)
Hyponatremia
Resp:
Dyspnea, Moist
Crackles,Tachypnea
Integumentary:
Periorbital edema
Pitting or Non-pitting edema
GI:
Increased motility
Stomach cramps
Nausea & Vomiting
Renal:
Weight gain
Decreased spec grav
of urine
Neuromuscular:
Altered LOC,
headache, skeletal
muscle twitching
Planning - FVE
Interventions
FVE - Hypervolemia
Restore normal fluid balance,
prevent further overload
Drug therapy; diuretics
Diet therapy; decrease Na & fluids
Monitor intake and output (I & O)
Monitor weights
Monitor electrolytes
Monitor CV, Resp, Renal systems
Clinical Application
You have been assigned to care for an 80y.o.
client admitted with hypernatremia that has
an IV infusing 0.45% NS @ 100ml/hr via
pump and an indwelling urinary catheter. At
11am you assess an output in the urinary
drainage bag of 150ml dk amber urine. You
also notice that the client is SOB while
speaking on the phone to her daughter.
What do you think is happening??
What will you do??
SUMMARY
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EVOLVE
Electrolytes
Electrolytes
Cations
Positively charged
Sodium Na+
Potassium K+
Calcium Ca++
Magnesium Mg+
+
Anions
Negatively charged
Chloride Cl Phosphate PO4 Bicarbonate
HCO3
Electrolyte Functions
Regulate water distribution
Muscle contraction
Nerve impulse transmission
Blood clotting
Regulate enzyme reactions (ATP)
Regulate acid-base balance
Sodium Na+
135-145mEq/L
Major Cation
Chief electrolyte of the ECF
Regulates volume of body fluids
Needed for nerve impulse & muscle
fiber transmission (Na/K pump)
Regulated by kidneys/ hormones
Hmmm
Hyper and Hypo Natremia are the most
common electrolyte disturbances. Why do
you think that is?
Hyponatremia
Serum Na+ <135mEq/L
Results from excess of water or loss
of Na+
Water shifts from ECF into cells
S/S: abd cramps, confusion, N/V,
H/A, pitting edema over sternum
Tx: Diet/IV therapy/fluid restrictions
Hypernatremia
Critical Thinking
Hypo / Hyper Natremia
For the client experiencing
FVE & hyponatremia d/t
excessive intake of water,
which IV solution would
you
expect the physician to
order?
a.
D5NS
b.
NS
c.
D5W
d.
NS
Potassium
K+
3.5-5.0 mEq/L
Chief electrolyte of ICF
Major mineral in all cellular fluids
Aids in muscle contraction, nerve &
electrical impulse conduction, regulates
enzyme activity, regulates IC H20
content, assists in acid-base balance
Regulated by kidneys/ hormones
Inversely proportional to Na
Hypokalemia
Hyperkalemia
Serum level >5 mEq/L
Results from excessive intake, trauma,
crush injuries, burns, renal failure
S/S muscle weakness, cardiac
changes, N/V, parathesias of
face/fingers/tongue
Tx:diet/meds/IV therapy/ possible
dialysis
Critical Thinking
Potassium IV additives
Which of the following interventions will the
nurse undertake when administering
parenteral K additives?
Monitor the IV site for phlebitis
Place on cardiac monitor if > 10 mEq
Assure of adequate mixing of K in solution
Monitor for elevated K levels
Monitor for decreased Na levels
!!
!
R
Administer potassium by slow IV
push
method
E
V
NE
Calcium Ca++
4.5-5.5mEq/L
Most abundant in body but:
99% in teeth and bones
Needed for nerve transmission,
vitamin B12 absorption, muscle
contraction & blood clotting
Inverse relationship with Phosphorus
Vitamin D needed for Ca absorption
Hypocalcemia
Chovstek
Trousseau
Hypercalcemia
What are some other conditions that might cause low Ca?
Excessive intake of Ca OR Vitamin D
Excessive intake of OTC antacids
If hypercalcemia is uncorrected, AV block and cardiac
arrest may occur.
Magnesium Mg2+
1.5-2.5mEq/L
Most located within ICF
Needed for activating enzymes,
electrical activity, metabolism of
carbs/proteins, DNA synthesis
Regulated by intestinal
absorption and kidney
Hypomagnesemia
Hypomagnesemia
Hypermagnesemia
Serum>2.5mEq/L
Results from renal failure,
increased intake
S/S: flushing, lethargy, cardiac
changes (decreased HR),decreased
resp, loss of deep tendon reflexes
Tx: restrict intake
diuretic rx
Chloride
Cl-
95-105mEq/L
Most abundant anion in ECF
Combines with Na to form salts
Maintains water balance, acid-base
balance, aids in digestion (hydrochoric acid)
& osmotic pressure (with Na and H20)
Regulated by kidneys
Follows Sodium (Na)
Hypochloremia
Hyperchloremia
Phosphate PO4
2.5-4.5mg/dl
Needed for acid-base
balance,neurological & muscle function,
energy transfer ATP & affects
metabolism of carbs/proteins/lipids, B
vitamin synthesis
Found in the bones
Regulated by intake and kidneys
Inversely proportional to Calcium
Therefore some regulation by PTH as well
Hypophosphatemia
Serum level < 1.8mEq/L
Results from decreased intestinal
absorption and increased
excretion
S/S bone & muscle pain, mental
changes, chest pain, resp. failure
Tx: Diet/ IV therapy
Hyperphosphatemia
a.
b.
c.
d.
Electrolyte homeostasis
Summary
Fluid compartments in the body must
balance
Body systems regulate F&E balance
Assessment of body fluid is important
to determine causes of imbalance
Interventions for imbalances are
based on the cause