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Fluids and Electrolytes
1
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 1
• After reading this chapter, the student should be able to
do the following: Define the key terms as listed.
• List, describe, and compare the body fluid
compartments.
• Discuss active and passive transport processes and give
two examples of each.
• Discuss the role of specific electrolytes in maintaining
homeostasis.
• Describe the cause and effect of deficits and excesses of
sodium, potassium, chloride, calcium, magnesium,
phosphorus, and bicarbonate.
• Differentiate between the role of the buffers, lungs, and
kidneys in maintenance of acid-base balance.
• Discuss the role of the nursing process for fluid,
electrolyte, and acid-base balances.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 2
Fluids (Water)
• Functions
– Delivery of nutrients to the cells and carry
waste products from the cells
– Provides a medium in which chemical
reactions, or metabolism, can occur within the
cell
– Acts as a lubricant for tissues
– Assists in heat regulation via evaporation
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 3
1
Fluids (Water)
• Percentage of body weight that is water
depends on several factors.
– Age
•
•
•
•
Premature infant: 90%
Newborn: 70-80%
Twelve years to adult: 50-60%
Older adults: 45-55%
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 4
Fluids (Water)
• Amount of Fat
– Fat contains relatively little water.
– The female has proportionately more body fat
than the male, which means that the female
has less body fluid.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 5
Fluid Compartments
• Extracellular Fluid
• Between the cells or in the tissue
• Accounts for approximately 27% of the fluid in the
body
• Examples: lymph, cerebrospinal fluid, and
gastrointestinal secretions
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 6
2
Intake and Output
• The normal daily loss of fluids must be met
by the normal daily intake.
• Daily water intake and output is
approximately 2 to 2.5 liters.
• Fluid leaves the body through the kidneys,
lungs, skin, and GI tract.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 7
Intake and Output
• Intake includes all fluids entering the body.
– This also includes tube feedings and parenteral intake such as
intravenous fluids, blood components, and total parenteral
nutrition.
• Output includes all fluids leaving the body.
– Examples are urine and vomitus.
– Also included is drainage from surgical wounds
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 8
Intake and Output
• The kidneys play an extremely
important role in fluid balance.
– Output of 1 to 2 L of urine per day.
• The kidneys must excrete a minimum of 30 ml/hr
of urine to eliminate waste products form the
body.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 9
3
• Several methods are used by the body to
move fluids, electrolytes and other solutes,
or dissolved substances into and out of
cells.
– Passive Transport Processes
• No cellular energy is required to move substances
from a high concentration to a low concentration.
– Active Transport Processes
• Cellular energy is required to move substances
from a low concentration to a high concentration.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 10
Passive Transport
• Diffusion: Example is the lungs and
exchange of gases in the aveoli
– This is the movement of particles in all
directions through a solution or gas.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 11
Passive Transport
• Osmosis
– This is the movement of water from an area of
lower concentration to an area of higher
concentration.
– It equalizes the concentration of ions or
molecules on both sides of the membrane.
– The flow of water will continue until the
number of ions or molecules on both sides are
equal.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 12
4
Passive Transport
• Filtration
– A force behind filtration is called hydrostatic
pressure, or the force pressing outward on a
vessel wall.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 13
Active Transport
• Requires energy
• Force that moves molecules into cells
without regard for their positive or negative
charge and against concentration factors
that would prevent entry via diffusion
• Substances actively transported through
the cell membrane include sodium,
potassium, calcium, iron, hydrogen, amino
acids, and glucose.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 14
Active Transport
• Electrolytes
– Electrolytes develop tiny electrical charges
when they dissolve in water and break up into
particles known as ions.
• Cations have a positive charge.
• Anions have negative charge.
– A balance exists between the electrolytes; for
each positively charged cation, there must be
a negatively charged anion.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 15
5
Active Transport
• Sodium
– A cation
– Most abundant electrolyte in the body
– Normal level: 134 to 142 mEq/L
– Functions of sodium: regulates water balance
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 16
Active Transport
• Potassium
– Normal level is 3.5 to 5 mEq/L
– Well-balanced diet usually provides adequate
potassium; approximately 65 mEq is required
each day.
– The main route of potassium excretion is the
kidneys.
– The main function is regulation of water and
electrolyte content within the cell.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 17
Active Transport
• Potassium
– Hypokalemia
• Decrease in body’s potassium to a level below 3.5
mEq/L
• The major cause of loss is renal excretion.
• Potassium can be depleted due to excessive GI
losses from gastric suctioning or vomiting and the
use of diuretics.
• This can affect skeletal and cardiac function.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 18
6
Active Transport
• Potassium
– Hyperkalemia
• Increase in the body’s serum potassium level
above 5 mEq/L
• The major cause of excess potassium is renal
disease; severe tissue damage causes potassium
to be released from the cell.
• This can cause cardiac arrest.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 19
Active Transport
• Chloride
– An extracellular anion.
– Normal level is 96 to 105 mEq/L.
– The main route of excretion is the kidneys.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 20
Active Transport
• Calcium
– A positively charged ion.
– Normal level is 4.5 mEq/L.
– Of calcium in the body, 99% is concentrated
in the bones and teeth.
– Vitamin D, calcitonin, and parathyroid
hormone are necessary for absorption and
utilization of calcium.
– The best food sources are milk and cheese.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 21
7
Figure 22-4, A & B
(From Lewis, S.M., Heitkem per, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and
management of clinical problems. [6th ed.]. St. Louis: Mosby.)
Tests for hypocalcemia. A, Chvostek’s sign.
B, Trousseau’s sign.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 22
Acid-Base Balance
• Acid-base balance means homeostasis of
the hydrogen ion concentration in the body
fluids.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 23
Slide show over
• Time to get something to eat!
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 24
8