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Lecture 2A

Lecture 2A. Fluid & electrolytes (Chapter 7) Integumentary System (chapters 44-46). Homeostasis. The body’s tendency to maintain a state of physiologic balance in constantly changing conditions. Body Fluids. Volume Electrolyte composition pH.

hyacinth-everett
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Lecture 2A

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  1. Lecture 2A Fluid & electrolytes (Chapter 7) Integumentary System (chapters 44-46)

  2. Homeostasis • The body’s tendency to maintain a state of physiologic balance in constantly changing conditions.

  3. Body Fluids • Volume • Electrolyte composition • pH

  4. What is the primary component of body fluid? • Red blood cells • White blood cells • Electrolytes (i.e. sodium, potassium, calcium, etc.) • Water • Oxygen

  5. Water • 60% of body weight is water • Elderly  • 45 – 50% of body weight is water

  6. Water in & out • Water intake and output should be about equal. • Average daily intake/output • 2500 mL • Table 7-1 pg 101

  7. Electrolytes • Substances that dissociate in solution to form ions. • Ion = • Electrically charged particle

  8. Function of Electrolytes • Regulate water • Neuro-muscular activity

  9. Key electrolytes • Sodium (Na) • 135-145 mEq/L • Potassium (K+) • 3.5 – 5.3 mEq/L • Calcium (Ca) • 4.5 – 5.5 mEq/L • Magnesium (Mg) • 1.5 – 2.4 mEq/L • Chloride (Cl-) • 95 – 105 mEq/L

  10. Distribution of Body Fluid • Intracellular fluid (ICF) • Fluid inside the cells • 40% of body weight • Extracellular fluid (ECF) • Outside of cells • 20% body fluid • Where? • Interstitial fluid • Between the cells • Intravascular fluid • In the blood vessels • Transcellular • Body fluids

  11. Body Fluid Movement • Compartments separated by selectively permeable membranes • 4 ways to move • Osmosis • Diffusion • Filtration • Active transport

  12. Osmosis • Water moves from an area of lower solute concentration to an area of higher solute concentration

  13. Osmosis • Water moves towards a higher solute concentration

  14. Isotonic solution • Have the same concentration of solutes as plasma

  15. Hypertonic solution • Have a great concentration of solutes than plasma

  16. Hypotonic solution • Have a lower concentration of solutes than plasma

  17. Diffusion • Solutes move from an area of high solute concentration to an area of low solute concentration

  18. Filtration • Water & Solutes move across membranes driven by fluid pressure • Figure 7-6 pg 104

  19. Active transport • Allows molecules to move into areas of high solute concentration but requires cellular energy • Adenosine triphosphate or ATP

  20. In osmosis what moves, and how? • Water moves from an area of high solute concentration to an area of low solute concentration • Water moves from an area of low solute concentration to an area of high solute concentration • Solutes moves from an area of high solute concentration to an area of low solute concentration • Solute moves from an area of low solute concentration to an area of high solute concentration

  21. In Diffusion what moves, and how? • Water moves from an area of high solute concentration to an area of low solute concentration • Water moves from an area of low solute concentration to an area of high solute concentration • Solutes moves from an area of high solute concentration to an area of low solute concentration • Solute moves from an area of low solute concentration to an area of high solute concentration

  22. Nrs. Dx: Fluid Volume Deficit • AKA: • Dehydration

  23. Common Causes of Fluid Volume Deficit • GI fluid loss • Excess urine output • Hemorrhaging • Inadequate fluid intake

  24. S&S of Fluid Volume Deficit • Fatigue • Alt. mentation • BP? • Postural hypotension • Pulse? • Tachycardia • Weak • Weight? • loss • Skin • Dry • Poor turgor • Urine output • Decreased • Dark

  25. Lab Test for Fluid Volume Deficit • Serum osmolality • h • Hematocrit • h • Urine specific gravity • h

  26. Nursing Plan: Fluid Volume Deficit • I&O • <30 mL / hr REPORT! • Vital Signs • BP • i • Pulse rate • h • Pulse strength • i

  27. Nursing Plan: Fluid Volume Deficit • Assess urine • Color • Dark • Specific gravity • Weight of urine compared to a drop of distilled water • h = FVD

  28. Nursing Plan: Fluid Volume Deficit • Daily weight • Same… • Time • Scale • Clothing • FVD  • i wt

  29. Nursing Plan: Fluid Volume Deficit • Assess mental status & breath sounds • Assess skin • Dry • Turgor • Warm • Assess mucus membranes • Moist

  30. Nursing Plan: Fluid Volume Deficit • PUSH FLUIDS!!! • #1 water • Variety • Available • Appealing • Intravenous fluids (I.V.)

  31. Nursing Plan: Fluid Volume Deficit • Educate • I&O • Avoid sun/heat • Vomiting  • Small frequent sips • Tea, ginger ale, flat cola • Caffeine & sugar  • urination • If diarrhea  • drink fruit juice or bouillon not just water

  32. Nrs. Dx: Fluid Volume Excess • Usually due to sodium & water retention • AKA • Hypervolemia

  33. Common causes of Fluid Volume Excess • Renal failure • Heart failure • Too much water intake • Too much sodium intake • Medications

  34. S&S of Fluid Volume Excess • BP • h • Hypertension • Pulse rate • h • Tachycardia • Pulse strength • Full bounding pulse

  35. S&S of Fluid Volume Excess • Respiratory • Rate • h • Cough • Dyspnea • Weight • h • Edema • Excess fluid in the body tissues

  36. Lab tests for Fluid Volume Excess • Serum osmolarity • i • Hematocrit • i • Specific gravity of urine • i

  37. Interdisciplinary Care for Fluid Volume Excess • Medications • Diuretics • Fluid restriction • Rx by MD • Sodium restriction • Action: • Increase water excretion • “Water pills”

  38. Nursing Plan: Fluid Volume Excess • Baseline weight • Baseline vital signs • Monitor • I&O • VS • Skin turgor • Edema

  39. Nursing Plan: Fluid Volume Excess • Report • Dizziness • Orthostatic hypotension • Tachycardia • Muscle cramping

  40. Nursing Plan: Fluid Volume Excess • Monitor labs • K* • Glucose • Notify MD for abnormal

  41. Nursing Plan: Fluid Volume Excess • Administer meds per MD order • Fluid restrictions • Sodium restrictions

  42. Nursing Plan: Fluid Volume Excess • Provide • Oral hygiene • Rest • Elevate feet • Semi-fowler position

  43. Nursing Plan: Fluid Volume Excess • Educate (about diuretics) • Increase urine • Take in AM • Change position slowly • Weight daily • Decrease salt • h potassium • Report to MD

  44. With fluid Volume deficit you would expect the blood pressure to be what? • Increased (hypertension) • Decreased (hypotension)

  45. Why are respiratory problems common with Fluid Volume deficit? • The blood flows to the feet • There is no blood to circulate the oxygen • Increased respiratory rate causes a decreases in effective breathing • It is not common with fluid volume deficit, it is common with fluid volume excess

  46. Why are respiratory problems common with Fluid Volume excess? • Excess fluid pools into the lungs • The blood does not circulate as well • Oxygen can not be carried in watery blood • Peripheral edema causes their feet to swell

  47. Kidney failure usually leads to which of the following nursing diagnosis? • Fluid volume deficit • Fluid volume excess

  48. Sodium Imbalance • What is the chemical sign for sodium? • So • Sa • S • N • Na

  49. What is the normal serum sodium level • 135 – 145 mEq/L • 13 – 15 mEq/L • 3.5 – 5.3 mEq/L • 35 – 45 mEq/L • Uh, what??

  50. Sodium imbalance • Sodium and fluid volume frequently go together.

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