Presentation is loading. Please wait.

Presentation is loading. Please wait.

Intravenous Therapy Module

Similar presentations

Presentation on theme: "Intravenous Therapy Module"— Presentation transcript:

1 Intravenous Therapy Module
Fluid and Electrolyte Balance

2 Body Fluids Comprise 45-77% of the body’s weight Vary depending on Age
Lean body mass sex

3 Body Fluids Contain these dissolved substances Electrolytes Gases

4 Body Fluids Divided into two main compartments Intracellular (ICF)
Extracellular (ECF)

5 Body Fluids ICF – fluid within the cells (64-70%)
ECF – all fluid outside the cells (30-36%) Intravascular fluid (plasma) Interstitial fluids (fluid surrounding tissue cells and includes lymph)

6 Water as a Percentage of Body Weight
Compartment Infant % Adult Man % Woman % Elderly Person % Extracellular Intravascular 4 5 Interstitial 25 11 10 15 Intracellular 48 45 35 Total-body water 77 60 50 Source: Taylor, Lillis & LeMone, page 1273.

7 Electrolytes Electrically charged ions which are dissolved in a solution positive charged ions – cations negative charged ions – anions Homeostasis requires an equal number of total cations and anions When not in balance, the person is at risk for alterations in health

8 Cations Anions

9 Electrolytes Major intracellular electrolytes
Potassium – major cation of ICF; has a reciprocal relationship with sodium Magnesium – 2nd. Most important cation in ICF; mostly found in cells of heart, bone, nerve and muscle tissues Phosphate – Major anion in body cells; acts as a buffer anion in both ICF and ECF Sulfate – anion found primarily within cells and is associated with cellular protein

10 Electrolytes Major extracellular electrolytes
Sodium – Chief electrolyte of ECF; moves across cell membranes by active transport Chloride – Chief extracellular anion; found in blood, interstitial fluid, and lymph Bicarbonate – the major chemical base buffer within the body; found in both ECF and ICF

11 Fluid and Electrolyte Movement
Transportation of materials between the fluid compartments is accomplished through Osmosis Diffusion Active transport Filtration

12 Osmosis Major method of transporting water
Water shifts and thus balance depends on osmosis Water passes from an area of lesser concentration to one of greater concentration

13 Osmolarity Concentration of particles in a solution
Osmolarity of plasma ( mOsm/L) 3 types of solutions Isotonic – same osmolarity as plasma Hypotonic – less osmolarity than plasma Hypertonic – greater osmolarity than plasma25 30 35

14 Diffusion Tendency of solutes and gases to move throughout a solvent
Solute and gases move from an area of greater concentration to an area of lower concentration O2 and CO2 exchange in the lung’s alveoli and capillaries by diffusion

15 Active Transport Requires energy for the movement of substances through a cell membrane Moves from an area of lesser concentration to an area of higher concentration Amino acids, glucose, Na+, K+, Ca2+, H, Cl-, PO4- and Mg2+ are believed to use active transport

16 Filtration Moves from an area of high pressure to one of lower pressure Controls the movement of body fluid between the intravascular and interstitial space through two opposing forces Colloid osmotic pressure (oncotic pressure) Hydrostatic pressure

17 Filtration Pressure Difference between
Colloid osmotic pressure (certain substances which have a high molecular weight hold fluid in the vessels) example: plasma proteins AND Hydrostatic pressure (force exerted by a fluid against the container wall) example: pressure of plasma and blood cells in the capillaries

18 Filtration Facilitates fluid exit from the arterioles (+ pressure) into the interstitial compartment and eventually into the venules (- pressure) Also involved in the proper functioning of the glomeruli of the kidneys

19 Body Water Balance Result of physiologic homeostatic responses to
Fluid gains (oral intake & cellular catabolism) Fluid losses (urine, evaporation from the skin, vapor loss through the lungs, and feces)

20 Thirst Major regulator of intake Stimulated by receptors in the CNS
Individuals ingest fluids when these receptors are activated Illness, an altered LOC, or a depressed thirst response (as in the aged) may result in hypovolemia – Fluid Volume Deficit

21 Kidneys Primary organ of fluid balance
Excrete end products of cellular metabolism Eliminate excess fluids Normally filter 170L of plasma daily in the adult

22 Kidneys Must produce a minimum of mL of urine to clear the blood of wastes Usual daily amount of urine production varies from 1-2 liters

23 Urine Production Influenced by two hormonal regulatory systems
Antidiuretic hormone (ADH) – stored and released by the pituitary gland Aldosterone – mineral corticoid secreted by the adrenal cortex

24 Antidiuretic Hormone Maintains osmotic pressure of the cells by controlling renal water retention or excretion When osmotic pressure of the ECF is > cells – ADH secretion is increased, causing renal retention of water When osmotic pressure of the ECF is < cells – ADH secretion is decreased, causing renal excretion of water

25 Antidiuretic Hormone Other conditions that can stimulate the
secretion of ADH (retention of water) Hemorrhage Decreased cardiac output Trauma Pain Fear Surgery dehydration

26 Drugs that increase the secretion of ADH
Antidiuretic Hormone Drugs that increase the secretion of ADH Morphine Barbiturates Nicotine Some anesthetics Some tranquilizers

27 Antidiuretic Hormone Can be inhibited by Alcohol
Decreased concentration of ECF Hypervolemic states

28 Aldosterone Regulated by renin-angiotension system
When blood flow to the kidney is decreased, the glomerulus of the nephron releases the enzyme renin Circulating renin converts a plasma protein in the liver into the vasoconstrictor angiotensin I When angiotensin I enters the lungs, it is converted into antiotensin II Angiotensin II stimulates the adrenal cortex to increase aldosterone secretion Leads to ECF volume expansion

29 Aldosterone Regulates fluid volume by stimulating the kidneys to reabsorb Na+ and water Na+ is exchanged for K+ or H+ K+ and H+ are thus affected by aldosterone

30 Aldosterone Secretion is increased in response to Decreased Na+
Increased extracellular K+ Hypovolemia Stress states

31 Assessment of Fluid and Electrolyte Status
Comparison of total I & O Urine volume and concentration Skin and tongue turgor Degree of moisture in oral cavity Body weight Thirst Neuromuscular irritability Tearing and salivation Appearance and temperature of skin Facial appearance Edema Vital signs Neck and hand vein filling Results of hemodynamic monitoring Source: Metheny, N. (2000). Fluid and Electrolyte Balance.

32 Quick Assessment Guide for Fluid Imbalance
Body System Assessed Fluid Volume Excess Deficit Neurologic Changes in orientation; Confusion Cardiovascular Bounding pulse; Increased pulse rate; Jugular vein distention; Overdistended hand veins that are slow to empty (>3s) Decreased pulse rate; Decreased BP; Narrow pulse pressure; Slow hand filling (>3s) Respiratory Moist crackles; Respiratory rate > 20 bpm; Dyspnea Pulmonary edema Lungs clear Source: Phillips, L. (2001). Manual of I.V. Therapeutics (3rd. Edition), Philadelphia: F. A. Davis

33 Quick Assessment Guide for Fluid Imbalance
Body System Assessed Fluid Volume Excess Deficit Integument Warm, moist skin; Fingerprinting over sternum Decreased turgor over sternum and forehead; Decreased skin temperature Eyes Periorbital edema (suggests significant fluid retention) Dry conjunctive; Sunken eyes; Decreasing tearing Mouth Sticky, dry mucous membranes Source: Phillips, L. (2001). Manual of I.V. Therapeutics (3rd. Edition), Philadelphia: F. A. Davis

34 Quick Assessment Guide for Fluid Imbalance
Body System Assessed Fluid Volume Excess Deficit Lips Dry, cracked Tongue Extralongitudinal furrows Body Weight Mild: <5% over normal; Moderate: 5% to 10% over normal; Severe: >15% over normal Mild: <5% less than normal; Moderate: 5% to 10% less than normal; Severe: >15% less than normal Source: Phillips, L. (2001). Manual of I.V. Therapeutics (3rd. Edition), Philadelphia: F. A. Davis

35 References Phillips, L. Manual of I.V. Therapeutics, 3rd edition. Philadelphia, F. A. Davis Co., 2001. Smith, S., Duell, D., and Martin, B. Clinical Nursing Skills, 5th edition. Upper Saddle River, Prentice-Hall, Inc., 2000. Taylor, C., Lillis, C., and LeMone, P., Fundamental of Nursing, 4th edition. Philadelphia, Lippincott Co., 2001.

Download ppt "Intravenous Therapy Module"

Similar presentations

Ads by Google