Fluid and electrolyte nursing lecture bsn

a lecture of fluid and electrolyte imbalances

1. FLUID AND ELECTROLYTE

2. Anatomy and
Physiology
Assessment Diagnosis
Planning and
Implementation
Learning Outcomes:
•Perform specific nursing skills in the care of
clients with problems on: fluid and electrolytes

3. FUNCTIONS OF WATER IN THE BODY
Transportingnutrients to cells and wastesfrom cells
Transporting hormones, enzymes, bloodplatelets, and red and white
blood cells
Facilitating cellular metabolismand proper cellular chemical functioning
Acting as a solvent for electrolytesand nonelectrolytes
Helping maintain normalbody temperature
Facilitating digestionand promoting elimination
Acting as a tissue lubricant
Anatomy and
Physiology
Assessment Diagnosis
Planning and
Implementation

4. TWO COMPARTMENTS OF FLUID IN THE
BODY
•INTRACELLULAR FLUID (ICF) —
FLUID WITHINCELLS (70%)
•EXTRACELLULARFLUID (ECF) —
FLUID OUTSIDE CELLS (30%)
•INCLUDES INTRAVASCULARAND
INTERSTITIAL FLUIDS

5. VARIATIONS IN FLUID CONTENT
•HEALTHYPERSON —TOTAL BODY WATER IS 50% TO 60% OF BODY
WEIGHT
•AN INFANT HAS CONSIDERABLY MOREBODY FLUID AND ECF THAN
AN ADULT
•MORE PRONE TO FLUID VOLUMEDEFICITS
•SEX AND AMOUNT OF FATCELLS AFFECT BODY WATER
•WOMEN AND OBESE PEOPLE HAVE LESSBODY WATER

6. ELECTROLYTES
•ELECTROLYTES-SUBSTANCES THAT BREAK UP INTO SEPARATELY CHARGED
PARTICLES IN WATER
•CATION-(+) CHARGE-NA, K, CA, MG
•ANION-(-) CHARGE-CL, BICARB (HCO3), PHOSPHATE (HPO4), SULFATE (SO4)
•ECF:MAJOR CATION-SODIUM
• MAJOR ANION-CHLORIDE
•ICF:MAJOR CATION-POTASSIUM
• MAJOR ANION-PHOSPHATE

7. COMMON ELECTROLYTES
•SODIUM (NA
++
)
FUNCTIONS
 REGULATES VOLUMEOF BODY FLUIDS
 MAINTAINS WATER BALANCE
 REGULATES ECF
 INFLUENCES ICF
 GENERATION AND TRANSMISSIONOF NERVE IMPULSES
 SODIUM-POTASSIUM PUMP

8. POTASSIUM (K
+
)
•MAJOR CATIONIN ICF
•RECIPROCAL TO SODIUM
•FUNCTIONS
•REGULATES CELLULAR ENZYMEACTIVITY AND WATERCONTENT
•TRANSMISSION OF NERVEAND MUSCLEIMPULSES
•METABOLISM OF PROTEINS AND CARBOHYDRATES
•REGULATION OF ACID-BASE BALANCE BY CELLULAR EXCHANGEWITH
H
+

9. CALCIUM (CA
++
)
•MOST ABUNDANTELECTROLYTE IN BODY
•99% FOUND IN BONESAND TEETH
•FUNCTIONS
•NERVE IMPULSE TRANSMISSIONAND BLOOD CLOTTING
•CATALYST FOR MUSCLECONTRACTION
•THICKNESS AND STRENGTHOF OFCELL MEMBRANES

10. MAGNESIUM (MG
++
)
•SECOND MOST IMPORTANT CATIONIN ICF
•FUNCTIONS
•METABOLISM OF CARBOHYDRATESAND PROTEINS
•VITAL ENZYMEACTIONS
•PROTEIN AND DNASYNTHESIS
•MAINTAINING INTRACELLULARLEVELS OF POTASSIUM
•MAINTAIN ELECTRICALACTIVITY IN NERVOUSTISSUE AND MUSCLE
TISSUE MEMBRANES

11. CHLORIDE (CL
-
)
•CHIEF EXTRACELLULARANION
•FUNCTIONS
•WORKS WITH SODIUMTO MAINTAIN OSMOTIC
PRESSURE OF BLOOD
•REGULATESACID-BASE BALANCE
•BUFFERING ACTION DURINGO
2/CO
2EXCHANGE
•PRODUCTION OF HYDROCHLORICACIDIN
DIGESTION

12. BICARBONATE (HCO
3
-
)
•MAJOR CHEMICALBASE BUFFER
•FOUND IN ECFAND ICF
•FUNCTION
•ESSENTIAL FOR ACID BASE BALANCE. WORKS WITH
CARBONICACIDTO MAKE UP THE BODY’S ACID BASE
BUFFERSYSTEM

13. PHOSPHATE (PO
4
-
)
•MAJOR ANION IN BODY CELLS
•BUFFER IN ICF AND ECF
•FUNCTIONS
•MAINTAINS BODY’S ACID-BASE BALANCE
•CELL DIVISIONAND TRANSMISSIONOF HEREDITY
•CHEMICAL REACTIONSUSE OF VITB, CHO
METABOLISM, NERVE AND MUSCLEACTION

14. OTHER ELECTROLYTES
•SULFATE
•ANION
•ICF
•EXCRETEDIN THE KIDNEY
•LACTIC ACID
•ANION
•FACILITATESDIFFUSIONTO AND FROM CAPILLARIES

15. FLUID AND ELECTROLYTE MOVEMENT
Osmosis –Fluid passes from areas of lowsolute concentration
to areas of highsolute concentration

16. FLUID AND ELECTROLYTE MOVEMENT
Diffusion –tendency of solutes to move freelyfrom areas of high
concentration to lowconcentration (down hill)

17. FLUID AND ELECTROLYTE MOVEMENT
Active Transport–requires energyto move through a cell
membranefrom area of lesser concentration to one of greater
concentration

18. FLUID AND ELECTROLYTE MOVEMENT
Filtration –passage of fluidthrough a permeablemembrane.
Movement is from high to low pressure

19. FACTORS THAT INFLUENCE FLUID BALANCE
•AGE: YOUNG AND OLD
•ENVIRONMENT
•DIET
•STRESS
•ILLNESS

20. NURSING ASSESSMENTS
•IDENTIFY PATIENTSAT RISK FOR IMBALANCES.
•DETERMINE A SPECIFICIMBALANCE IS PRESENT AND ITS SEVERITY, ETIOLOGY,
AND CHARACTERISTICS.
•DETERMINE EFFECTIVENESSOF PLAN OF CARE.
Anatomy and
Physiology
Assessment Diagnosis
Planning and
Implementation

21. PARAMETERS OF ASSESSMENT
•NURSING HISTORYAND PHYSICALASSESSMENT
•FLUID INTAKEAND OUTPUT
•DAILY WEIGHTS
•LABORATORYSTUDIES

22. LAB STUDIES TO ASSESS FOR
IMBALANCES
•COMPLETE BLOODCOUNT
•SERUM ELECTROLYTES
•URINEPH AND SPECIFIC GRAVITY
•ARTERIALBLOOD GASES

23. TESTS AND INDICATORS OF FLUID AND ELECTROLYTE
BALANCE
•OSMOLALITY: 280-300 MOM
•SPECIFIC GRAVITY OF URINE: 1.010-1.030
•HEMATOCRIT: 40%
•BUN: 5-20
•SODIUM: 135-145

24. RISK FACTORS FOR IMBALANCES
•PATHOPHYSIOLOGY UNDERLYING ACUTEAND CHRONICILLNESSES
•ABNORMAL LOSSESOF BODY FLUIDS
•BURNS
•TRAUMA
•THERAPIESTHAT DISRUPT FLUID AND ELECTROLYTEBALANCE

25. REGULATION OF BODY FLUID
3. FLUID OUTPUT
ROUTES OF FLUID OUTPUT:
1. KIDNEY
-FILTERS 180 ML OF PLASMA = 1400-1500 ML
OF URINE/DAY
2. SKIN
-SYMPATHETIC NERVOUS SYSTEM > ACTIVATES
THE SWEAT GLANDS
= 500-600CC/DAY –INSENSIBLE WATER LOSS

26. REGULATION OF BODY FLUID
3. LUNGS
= 400ML/DAY LOSS THROUGH EXPIRATION
4. GIT
= 100-200 CC/DAY

27. NORMAL FLUID BALANCE
•INTAKE: 2500 ML/DAY
•URINE OUTPUT: 1500 ML/DAY
•INSENSIBLE LOSS: 1000 ML/DAY

28. SOURCES OF INTAKE MEASUREMENTS:
1. ORAL FLUIDS
2. ICE CHIPS
3. FOODS THAT ARE OR TEND TO BECOME LIQUID AT ROOM
TEMPERATURE
4. TUBE FEEDINGS
5. PARENTERALFLUIDS

29. SOURCES OF OUTPUT FOR MEASUREMENTS
1.URINARY OUTPUT
2.VOMITUS AND LIQUID FECES
3.DIAPHORESIS
4.RAPID, DEEP RESPIRATORY RATE
5.DRAINAGE
6.BLOOD LOSSES

30. EQUIPMENT;
•GLASS CUP
•I&O BEDSIDE FORM
•I&O RECORD
•GRADUATED CYLINDER FOR URINE AND OTHER
OUTPUT MEASUREMENTS
•BEDPAN OR URINAL

31. LOCHIA: PAD COUNT
1.SCANT: 1-INCH STAIN ON PAD IN 1 HOUR
2.LIGHT/SMALL: 4 INCHES IN 1 HOUR
3.MODERATE: 6 INCHES IN 1 HOUR
4.HEAVY/LARGE: PAD SATURATED IN 1 HOUR
•EXCESSIVE: PAD SATURATED IN 15 MIN
•CAN ESTIMATE BLOOD LOSS BY WEIGHING PADS:
•500 ML = 1 LB. OR 454 G

32. FLUID IMBALANCES
Anatomy and
Physiology
Assessment Diagnosis
Planning and
Implementation

33. FLUID VOLUME DEFICIT
•A DECREASE IN INTRAVASCULAR, INTERSTITIAL, AND/OR INTRACELLULAR FLUID IN THE BODY
•CAUSES:
•EXCESSIVE FLUID LOSS
•INSUFFICIENT FLUID INTAKE
•FAILURE OF REGULATORY MECHANISMS
•FLUID SHIFTS WITHIN THE BODY

34. FLUID VOLUME EXCESS
•TYPICALLY RESULTS FROM CONDITIONS IN WHICH SODIUM AND WATER ARE RETAINED.
•CAUSES:
•HYPOTONIC-RENAL FAILURE, PUMP FAILURE, SIADH
•ISOTONIC-INCREASED VENOUS PRESSURE, INCREASED ALDOSTERONE, DECREASED CAPILLARY
ONCOTIC PRESSURE, INCREASED INTERSTITIAL ONCOTIC PRESSURE

35. ELECTROLYTE IMBALANCE: SODIUM
•PRIMARY REGULATOR OF VOLUME, OSMOLALITY, AND DISTRIBUTION OF EXTRACELLULAR FLUID
•LOW SODIUM: WATER DRAWN INTO CELLS OF THE BODY
•HIGH SODIUM: WATER DRAWN OUT OF CELLS

36. PROMOTING FLUID AND ELECTROLYTE BALANCE
Anatomy and
Physiology
Assessment Diagnosis
Planning and
Implementation

37. PROMOTING FLUID BALANCE
•CONSUME 6 TO 8 GLASSES OF WATER DAILY
•AVOID EXCESS AMOUNTS OF FOODS OR FLUIDS HIGH IN SALT, SUGAR AND CAFFEINE
•EAT A WELL-BALANCED DIET
•LIMIT ALCOHOL INTAKE BEFORE, DURING AND AFTER STRENUOUS EXERCISE, PARTICULARLY WHEN ENVIRONMENTAL
TEMPERATURE IS HIGH
•MAINTAIN NORMAL BODY WEIGHT
•LEARN ABOUT AND MONITOR SIDE EFFECTS OF MEDICATIONS THAT AFFECT F AND E BALANCE
•RECOGNIZE POSSIBLE RISK FACTORS FOR FLUID AND ELECTROLYTE IMBALANCE SUCH AS PROLONGED OR REPEATED
VOMITING, DIARRHEA
•SEEK PROMPT PROFESSIONAL HEALTH CARE FOR NOTABLE SIGNS OF FLUID IMBALANCE