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Intravenous Therapy Module Fluid and Electrolyte Balance.

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Presentation on theme: "Intravenous Therapy Module Fluid and Electrolyte Balance."— 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  Nonelectrolytes

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 Water CompartmentInfant % Adult Man % Adult Woman % Elderly Person % Extracellular Intravascular4455 Interstitial25111015 Intracellular48453525 Total-body water77605045 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 CationsAnions

9 Electrolytes  Major intracellular electrolytes  Potassium – major cation of ICF; has a reciprocal relationship with sodium  Magnesium – 2 nd. 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 (275-310 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  O 2 and CO 2 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+, Ca 2 +, H, Cl-, PO 4 - and Mg 2 + 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 500-600 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  Hemorrhage  Decreased cardiac output  Trauma  Pain  Fear  Surgery  dehydration  Other conditions that can stimulate the secretion of ADH (retention of water)

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

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 Fluid Volume 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 edemaLungs clear Source: Phillips, L. (2001). Manual of I.V. Therapeutics (3 rd. Edition), Philadelphia: F. A. Davis

33 Quick Assessment Guide for Fluid Imbalance Body System Assessed Fluid Volume Excess Fluid Volume 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 (3 rd. Edition), Philadelphia: F. A. Davis

34 Quick Assessment Guide for Fluid Imbalance Body System Assessed Fluid Volume Excess Fluid Volume Deficit LipsDry, 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 (3 rd. Edition), Philadelphia: F. A. Davis

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

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