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FLUID AND ELECTROLYTES

FLUID AND ELECTROLYTES. NPN 205. FLUIDS. 50-60% of the human body is water ( decreases with age) Body fluids are classified according to their location with most of the body’s fluids found within the cell Intracellular

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FLUID AND ELECTROLYTES

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  1. FLUID AND ELECTROLYTES NPN 205

  2. FLUIDS • 50-60% of the human body is water (decreases with age) • Body fluids are classified according to their location with most of the body’s fluids found within the cell • Intracellular • Extracellular (mainly responsible for transport of nutrients and wastes) • Fluid compartments are separated by selectively permeable membranes that control movement of water and solutes • The process of homeostasis involves delivery of oxygen and nutrients to the cells and removal of waste

  3. Transport of Water and Fluids • Osmolality: concentration of a solution determined by the number of dissolved particles per kilogram of water. Osmolality controls water movement and distribution in body fluid compartments • Diffusion: the random movement of particles in all directions through a solution • Active transport: movement of solutes across membranes; requires expenditure of energy • Filtration: transfer of water and solutes through a membrane from a region of high pressure to a region of low pressure • Osmosis: movement of water across a membrane from a less concentrated solution to a more concentrated solution

  4. Fluid Pressures (Starling’s Law) • ECF and ICF fluid shifts occur related to changes in pressure within the compartments • Fluid flows only when there is a difference in pressure • 3 types of body fluids • Isotonic • Hypotonic • Hypertonic

  5. Hydrostatic Pressure and Colloid Osmotic Pressure • Tissue fluids and plasma in the capillaries have hydrostatic and colloid osmotic pressure • Hydrostatic pressure forces fluid and solutes through the capillary walls • When the hydrostatic pressure inside the capillary is greater than the pressure in the surrounding interstitial space, fluids and solutes inside the capillary they are forced out into the interstitial space • This also happens in the reverse

  6. Albumin’s Role in F/E Balance • Reabsorption prevents too much fluid from leaving the capillaries • Albumin is a large molecule and will not pass through the capillary membrane • When fluid filters through the capillary, the protein albumin remains behind • When the concentration of albumin increases, fluid begins to move back into the capillary wall by osmosis • The pulling force of albumin in the intravascular space is called plasma colloid oncotic pressure

  7. Plasma Colloid Osmotic Pressure

  8. Regulation of Fluid Volume • Kidneys • Capillary pressure forces fluid through the walls and into the tubule • At this point H2O or electrolytes are then either retained or excreted • The urine becomes more dilute or more concentrated based on the needs of the body

  9. Regulation of Fluid Volume, cont. • Antidiuretic hormone (ADH) • Produced by the hypothalamus • Stored in the pituitary gland • Restores blood volume by increasing or decreasing excretion of water • Increased osmolality or decreased blood volume stimulates the release of ADH • Then the kidneys reabsorb water • Also may be released by stress, pain, surgery, and some meds

  10. Regulation of Fluid Volume, cont. • Renin-angiotensin-aldosterone system • Renin secreted in kidney • Amount of renin produced depends on blood flow and amount of Na in the blood • Produces angiotensin II (vasoconstrictor) • Angiotensin causes peripheral vasoconstriction • Angiotensin II stimulates the production of aldosterone

  11. Regulation of Fluid Volume, cont. • Aldosterone • Secreted by the adrenal gland response to angiotensin II • The adrenal gland may also be stimulated by the amount of Na and K + in the blood • Causes the kidneys to retain Na and H2O • Leads to increases in fluid volume and Na levels • Decreases the reabsorption of K+ • Maintains B/P and fluid balance

  12. Regulation of Fluid Volume, cont • Atrial natriuretic peptide or factor (ANP) (ANF) • Cardiac hormone • Released in response to increased pressure in the atria (increased blood volume) • Opposes the renin-angiotensin-aldosterone system • Stimulates excretion of Na and H2O • Suppresses renin level • Decreases the release of aldosterone • Decreases ADH release • Reduces vascular resistance by causing vasodilation

  13. Fluid shifting • 1st space shifting- normal distribution of fluid in both the ECF compartment and ICF compartment. • 2nd space shifting- excess accumulation of interstitial fluid (edema) • 3rd space shifting- fluid accumulation in areas that are normally have no or little amounts of fluids (ascites)

  14. REGULATION OF FLUID VOLUME

  15. Diagnostic Tests for F/E • Urine studies • Urine pH Urine specific gravity • Urine osmolarity • Urine creatinine clearance • Urine sodium • Urine potassium

  16. Blood Studies • Serum Hematocrit = 40-54%/men, 38-47% for women • Serum Creatinine = 0.6 – 1.5 mg/dl • BUN = 8-20 mg/dL • Serum osmolality • Serum Albumin – 3.5-5.5 g/dL • Serum Electrolytes

  17. ASSESSMENT FOR F/E BALANCE • History of potential factors which place patient at risk • Vital signs • I/O • Body weight • Skin • Mucus membranes • Vascular system

  18. Hypovolemia: isotonic extracellular fluid deficit Deficiency of both water & electrolytes Caused by decreased intake, vomiting, diarrhea, fluid shift Dehydration: hypertonic extracellular fluid deficit Deficiency of water Caused by water loss related to high blood glucose, inadequate ADH production, high fever, excess sweating FLUID VOLUME DEFICITE

  19. Assessment of Fluid Deficit • Hypotension • Weak rapid pulse • Temperature decreased if hypovolemic, and increased in dehydration • Weight loss • Skin turgor poor in dehydration and possible edema in hypovolemic • Concentrated urine and blood

  20. Treatment of Deficit • Correct cause • IV fluids • I and O • Skin care • Assist with ADL’s

  21. Extracellular: isotonic fluid excess Excess of both water and electrolytes Caused by retention of water and electrolytes related to kidney disease; overload with isotonic IV fluids Intracellular: water excess Excess of body water without excess electrolytes Caused by over-hydration in the presence of renal failure; administration of D5W FLUID VOLUME EXCESS

  22. Isotonic Hypertension Bounding pulse Crackles, dyspnea Weight gain Edema in extremities JVD Irritable, confused Hypotonic Systolic B/P ^ Decreased pulse Increased respirations Weight gain Cerebral edema Irritable, confused FLUID VOLUME EXCESS/Assessment

  23. Isotonic Correct cause Restrict H2O and Na Diuretics Digitalis Possible dialysis Hypotonic Correct cause Restrict H2O intake IV fluids with E-lytes FLUID VOLUME EXCESS/ Treatment

  24. Isotonic Monitor for excess excretion of H2O R/T diuretics Maintain fluid restriction Consult dietary for salt restrictions Watch for skin problems HOB ^ 30 degrees Hypotonic IV’s and meds as ordered I/O Oral care and ice chips Safety precautions Seizure precautions FLUID VOLUME EXCESS/Nursing Care

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