Download fluid-and-electrolyte_tw

Terry White, MBA, BSN
Body fluid and electrolyte:
About 46 to 6o % of the average adult
weight is water.
Water may serve as:
Medium of metabolic reaction with cells.
Transporter for nutrients, waste products, and
other substance.
A lubricant.
Shock absorber.
Regulate and maintain body temperature.
The proportion of water decreases with
aging because fat, age and sex effect of
total body water.
(Infant 70 – 80%).
Distribution of body fluids:
The body fluid divided in two major
compartments:
A) Intracellular fluid (ICF):
Is found in the cells of the body. its
constitute 2/3 of the total body fluid in the
adult.
b) Extracelluar fluid (ECF):
is found out side of cell and account 1/3 of the total
body fluid.
it’s subdivided into three compartments:
1) Intravascular fluid or plasma: is found within
vascular system.
2) Interstitial fluid: is found surrounding the cell and
includes lymph.
3) Transcellular: includes cerebrospinal fluid, pleural,
peritoneal and synovial fluid.
Composition of Fluids
plasma
interstitial
intracellular
Na
140
146
12
K
4
4
150
Ca
5
3
10
Mg
2
1
7
Cl
103
104
3
HCO
24
27
10
SO4
1
1
-
HPO4
2
2
116
Protein
16
5
40
Cations
Anions
Function of ICF & ECF:
ICF: is vital to normal cell function, its
contain solutes such as oxygen, electrolytes
and glucose. It provides a medium to
metabolic process.
ECF: it is the transport system that carries
nutrients and waste product from the cell.
Movement of body fluid and
electrolyte:
1. Osmosis:
Is the movement of water across cell
membranes, from the less concentrated
solution to more concentrated solution.
In other word water move toward
higher concentration.
•Solutes are substance dissolved in liquid.
•Crystalloid: salts that dissolved readily in to
true solution.
•Colloids: substance such as large protein
molecules that do not dissolved in true
solution.
Sodium is the major determinant of serum
osmolality.
2. Diffusion:
Is the continual intermingling of molecules
in liquid, gases by random movement of
the molecules.
3. Filtration:
Is the process where by fluid and solutes
moved together across a membrane
from one compartment to another.
4. Active transport:
substance can move across cell
membranes from a less concentrated
solution to amore concentrated one by
active transport.
Regulating body fluid:
The average adult drinks about 1500ml per
day, but need to 2500ml per day, this added
volume is acquired by the food.
The thirst center is located in the brain, this
center trigger by osmotic pressure and
angiotensin II .
Hormonal regulation
Regulation of ECF
Fluid out put:
Urine: normal urine out put 1500ml per
24hrs or at least 30ml per hours.
Insensible loss: through the skin as
perspiration and through the lung a water
vapor in the expired air.
Loss through the intestine (feces)
Obligatory losses: approximately 500ml of
fluid must be exerted through the kidney to
eliminate metabolic waste product and
feces, respiration and perspiration to
maintain body temperature.
The average daily fluid out put for an adult
2500ml/ day.
Client at risk for fluid and electrolyte
imbalance:
Post operative client.
Client with sever trauma or burn.
Client with chronic disease as congestive
heart failure.
Client who are NPO.
Client with intravenous infusion.
Client with special drainage.
Client who receiving diuretic
Factor effecting fluid and electrolyte
balance:
Age: infant have greater water need and
greater loss due to greater metabolic
rate.
Environment: excess heat stimulates the
sympathetic nervous system and cause
person to sweat.
Diet: in nutritional deficiency, the body
preserved the protein by breaking down the
fat and glycogen.
Stress: water retention and increase the
production antiduritic hormone.
Illness: burn, renal disorder
Disturbances in fluid and electrolyte:
Hypovolemia: decrease blood volume
Hypovolemic shock when intravascular fluid is
depleted.
Hypervolimia: increase blood volume.
Edema: is collection of fluids in the tissue.
Type of edema:
Dependent edma: found in the lowest part
body.
Pitting edma: edema that leaves a
depression or pit after finger pressure is
applied on the swollen area.
Pitting odema
Sodium (Na):
Is the most abundant cation in the extracelluar
fluid and major contributor to serum
osmolality.
Function of sodium:
controlling and regulating water balance.
Maintaining blood volume
Transmitted nerve impulses.
Normal level is 135 – 145 mg/dl.
Hyponatremia: sodium deficit in the
blood.
Hypernatremia: sodium excess in the
blood.
Sodium is found in many foods, such
as processed cheese, table salt.
Potassium:
Is the major cation in intracellular fluid.
Function of potassium:
Maintain ICF osmolality.
Transmitting nerve impulses.
Regulate cardiac impulses.
Skeletal and smooth muscle function.
Regulate acid base balance
•Potassium is found in many fruits and
vegetables, meat, fish, milk.
•Normal level of potassium is 3.5 – 5.3meq/l.
•Hypokalemia: potassium deficit in the
blood.
•Hyperkalemia: potassium excess in the
blood.
Hypocalcemia: calcium deficit in the
blood.
Hypercalcemia: calcium excess in the
blood.
Loss of water and electrolyte:
Vomiting.
Diarrhea.
Excessive sweating.
Ployuria.
Fever.
Nasogastric suction.
Abnormal drainage.
Anorexia.
Nausea
Impaired swallowing.
Finding associated with fluid and
electrolyte imbalance:
Skin: dry pale, cool skin, reduce skin Turgor.
Oral cavity: dry mucous membrane,
absence of salivation.
Weak rapid pulse.
Decreased blood pressure.
Decreased central venous pressure
Decreased urine out put.
Increased hematocrit.
Thirst.
Flat neck vein.
Fluid volume excess:
Excess intake of sodium – containing
intravenous fluid.
Excess of ingestion of sodium in diet.
Heart failure.
Renal failure.
Liver cirrhosis.
Clinical manifestation:
Weight gain.
Fluid intake greater than out put.
Moist mucous membrane.
Tachycardia.
Increased blood pressure.
Distended neck vein.
Dyspnea and crackles.
Mental confusion.
Acid – Base Balance
Nursing care plan
Assessment:
• Nursing history:
Date include fluid and food intake, output.
Recent fluid losses.
Sign of fluid deficit.
Common sign of electrolyte disturbance.
Medication.
Clinical measurement:
• Daily weights, vital sign, fluid intake
and output (I&O), serum electrolyte,
complete blood count (CBC). Serum
osmolality, urine specific gravity.
Nursing diagnosis:
Fluid volume deficit related to dehydration.
Fluid volume excess related to heart failure.
Altered oral mucous membrane related to fluid volume
defects.
Impaired skin integrity related to dehydration
Decreased cardiac output related to hypovolemia.
Altered tissue perfusion related to decreased cardiac
output.
Implementation:
Assess clinical manifestation of hypo or
Hypervolimia.
Provide fluid and electrolyte orally.
Foods.
Intravenous therapy can prescribed for those
reason
Provide salts if needed.
Provide glucose for metabolism.
Provide water soluble vitamins
Monitor intake & output.
Monitor lapratory finding.
Provide frequent oral care.
Monitor weight.
Assess for edma.
Place patient in fowler position.
Assess breathing sound, inspiration and
expiration (crackles).
Provide safety for client