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Presentation on theme: "FLUID, ELECTROLYTE, AND ACID-BASE BALANCE"— Presentation transcript:

NUR Chapter 14

2 Body fluids Extracellular fluids (ECF)
Interstitial fluid - fills the spaces between most cells of the body Intravascular fluid - plasma (WBC, RBC and platelets in this fluid) Interstitial fluid is 15% of body weight Intravascular fluid is 5% of body weight

3 Body fluids Intracellular fluids (ICF) Liquids within cell membranes
40% of body weight Intracellular – 40% of body weight

4 Components in body fluids
Electrolyte an element that when dissolved can carry an electrical current Cations - (+) ; Anions - (-) neuromuscular function acid-base balance Cations – positively charged Anions – negatively charged

5 Components of body fluids
Minerals ingested compounds serve as catalysts in nerve response, muscle contraction, and metabolism of nutrients in foods, regulate electrolyte balance

6 Movement of body fluids
Diffusion Area of higher concentration to an area of lower concentration till even distribution Osmosis Movement of a pure solvent, e.g. water through a semipermeable membrane from a solution that has a lower solute concentration to one that has a higher solute concentration

7 Osmotic pressure Drawing power of water (dependent on the number or molecules in solution) Isotonic Hypotonic Hypertonic Isotonic - Solution with same osmolality as blood plasma Hypotonic - Lesser concentration than blood plasma Hypertonic - Greater concentration than blood plasma

8 Movement of body fluids
Filtration Water and diffusible substances move together in response to fluid pressure Active transport Requires energy Able to move larger molecules and go from less to greater concentration

9 Fluid Intake Hypothalamus - thirst control center
Oral fluid intake requires an alert state Osmoreceptors - monitor osmolality

10 Fluid Output Loss through the kidneys and GI tract Insensible Sensible
not perceived by the person Sensible perceived by the person occurs through excessive perspiration

11 Cations Sodium (Na+) Most abundant in the extracellular fluid
Maintains water balance, transmits nerve impulses, contracts muscles Values mEq/L Found in processes meats, snacks, canned foods, and table salt

12 Cation Potassium (K+) Major intracellular cation
Regulates neuromuscular excitability, muscular contraction, and acid-base Value mEq/L Found in whole grains, fruits, and vegetables

13 Cation Calcium (Ca2+) Cardiac conduction, blood coagulation, bone growth and formation, & muscular relaxation Value mEq/L Found in dairy products

14 Cation Magnesium (Mg2+) Second most important of intracellular fluids
Enzyme activities, muscular excitability Value mEq/L

15 Electrolyte Imbalances
Hyponatremia GI losses, sweating, & diuretics S/S: N/V/D, abd cramps, personality change Hypernatremia Ingestion of large amounts S/S: Dry tongue and mucous membranes, restlessness, convulsions, thirst, dry skin

16 Electrolyte imbalances
Hypokalemia Causes: K+ wasting diuretics N/V/D polyuria S/S: weak, irregular pulse hypotension weakness

17 Electrolyte imbalances
Hyperkalemia Causes: Renal failure S/S: irregular slow pulse, weakness, irritability

18 Electrolyte Imbalances
Hypocalcemia Causes: Vitamin D deficiency S/S: Numb and tingling fingers and circumoral region, muscle cramps Hypercalcemia Causes: osteoporosis, prolonged immobilization S/S: decreased muscle tone, weakness, lethargy, kidney stones

19 Electrolyte imbalances
Hypomagnesemia Causes: malnutrition and alcoholism polyuria S/S: muscular tremors, hyperactive deep tendon reflexes Hypermagnesemia Causes: Renal failure S/S: hypoactive deep tendon reflexes, shallow and slow respirations

20 Acid - Base Balance Blood pH - 7.35 - 7.45 paCO2 - 35 - 45
Bicarbonate (HCO3) mEq/L

21 Respiratory Acidosis pH < 7.35 paCO2 > 45 mm Hg
Causes: Respiratory failure Hypoventilation Resp muscles paralysis Airway obstruction

22 Respiratory Alkalosis
pH > 7.45 paCO2 < 35 mm Hg Causes: excessive exhalation of CO2 (hyperventilation)

23 Metabolic Acidosis pH < 7.35 bicarbonate - < 22 mEq/L
Causes: Starvation, DKA, Diarrhea, drug use

24 Metabolic Alkalosis pH > 7.45 bicarbonate > 26 mEq/L
Causes: excessive vomiting, prolonged gastric suctioning

25 Fluid & Electrolyte Imbalances
Burns - body fluid loss Renal D/O - abnormal retention of Na, Cl, K GI Disturbances - Loss of fluid, potassium, and chloride Exercise

26 S/S electrolyte imbalance
Head: irritability Fontanels: depressed, bulging Eyes: sunken periorbital edema Mouth: mucous membranes CV: neck veins, edema, blood pressure Resp: Crackles

27 Imbalances GI: abdomen, V/D Renal: Oliguria or anuria (FVD, FE)
Diuresis (FVE) Increased urine spec. gravity (FVD) Skin (Temp) increased - met acidosis, hypernatremia decreased - FVD

28 Replacement of fluids and electrolytes
Types of IV fluids Isotonic Hypertonic Hypotonic

29 IV complications Infiltration Phlebitis Fluid overload Bleeding
IVF enter SQ space Phlebitis vein inflammation S/S: pain, redness, warmth Fluid overload Fluids given too rapidly Bleeding

30 Discontinuing an IV Stop infusion Remove tape 1 - 2 minute pressure

31 Blood transfusions Large bore catheter (18 ga or larger)
Give with normal saline Baseline vital signs Double check with two RNs Begin transfusion slowly Observe closely for first 15 min

32 Transfusion Reactions
Caused by: blood incompatibility allergic sensitivity S/S: fever, chills, rash, hypotension, shock Treatment: stop transfusion, give NS, save tubing, prepare for emergency drugs


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