Chapter 37 Fluid, Electrolyte, and Acid-Base Balance Fundamentals of Nursing: Standards & Practices, 2E Chapter 37 Fluid, Electrolyte, and Acid-Base Balance

Physiology of Fluid and Acid-Base Balance Fluid Compartments Cells, blood vessels and tissue space contain the body’s fluid Terms used to described compartmentalized body fluid are Intracellular fluid: within the cell Extracellular fluid: within the blood vessels Interstitial fluid: between cells; fluid that surrounds cells Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Terms used to describe movement of molecules in body fluids are Solute: substance dissolved in a solution Solvent: liquid that contains a substance in solution Permeability: capability of a substance, molecule, or ion to diffuse through a membrane (covering of tissue over a surface, organ, or separating spaces) Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Semipermeable: selectively permeable (all membranes in the body allow some solutes to pass through the membrane without restriction but will prevent the passage of other solutes) Permeable membranes allow fluid and solutes to pass into and out of the cell. Blood vessels have permeable membranes that bathe and feed the cells. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Body Fluid Distribution Water represents 45% to 75% of the body’s total weight. Body fat is essentially free of water, making the ratio of water to body weight greater in leaner people than in obese people. Ingesting liquids and food products replenishes body fluid. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Electrolytes An electrolyte is a compound that, when dissolved in water or another solvent, forms or dissociates into ions. Review Table 37-1 regarding distribution of electrolytes in body fluids. Copyright 2002 by Delmar, a division of Thomson Learning

Movement of Body Fluids Physiological forces transport molecules of water, foods, gases, wastes, and ions to maintain a balance between extracellular and intracellular fluid volumes. Review Table 37-2 regarding movement of body fluids. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Regulators of Fluid Balance Fluid and Food Intake and Loss Skin Lungs Gastrointestinal Tract Kidneys Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Acid-Base Balance Acid-base balance refers to the homeostasis of the hydrogen ion concentration in body fluids. Acid is a substance that donates hydrogen ions. Base is a substance that accepts hydrogen ions. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Regulators of Acid-Base Balance Buffer Systems Respiratory Regulation of Acid-Base Balance Renal Control of Hydrogen Ion Concentration Copyright 2002 by Delmar, a division of Thomson Learning

Factors Affecting Fluid and Electrolyte Balance Age Lifestyle Copyright 2002 by Delmar, a division of Thomson Learning

Disturbances in Electrolyte and Acid-Base Balance Electrolyte Disturbances Sodium Hyponatremia is a deficit in the extracellular level of sodium. Hypernatremia is an excess in the extrcellular level of sodium. Potassium Hypokalemia is a decrease in the extracellular level of potassium. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Hyperkalemia is an increase in the extracellular level of potassium. Calcium Hypocalcemia is a decrease in the extracellular level of calcium. Hypercalcemia is an increase in the extracellular level of calcium. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Magnesium Hypomagnesemia is a decrease in the extracellular level of magnesium and usually occurs with hypokalemia and hypocalcemia. Hypermagnesemia refers to an increase in the extracellular level of magnesium. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Phosphate Hypophosphatemia is a decreased extracellular level of phosphorus. Hyperphosphatemia is an increased extracellular level of phosphorus. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Chloride Hypochloremia is a decrease in the extracellular level of chloride. Hyperchloremia is an increase in the extracellular level of chloride. Review Table 37-3 The Clinical Management of Clients Experiencing Common Electrolyte Disturbances. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Acid-Base Disturbances Laboratory Data Respiratory Acidosis (Carbonic Acid Excess) Respiratory Alkalosis (Carbonic Acid Deficit) Metabolic Acidosis (Bicarbonate Deficit) Metabloc Alkalosis (Bicarbonate Excess) Review Table 37-4 Respiratory and Metabolic Acidosis and Alkalosis Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Assessment Health History Physical Examination Daily Weight Vital Signs Intake and Output Edema Skin Tugor Buccal (Oral) Cavity Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Eyes Jugular and Hand Veins Neuromuscular System Diagnostic and Laboratory Data Hemoglobin and Hematocrit Indices Osmolality Urine pH Serum Albumin Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Nursing Diagnosis Excess Fluid Volume Deficient Fluid Volume Risk for Deficient Fluid Volume Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Other Nursing Diagnosis Impaired Gas Exchange Decreased Cardiac Output Risk for Infection Altered Oral Mucous Membrane Deficient Knowledge Copyright 2002 by Delmar, a division of Thomson Learning

Outcome Identification and Planning Expected outcomes for clients with fluid imbalances are not only specific to their primary diagnosis, but also require inclusion of outcomes relative to interventions. Achievement of the goals and the client’s expected outcomes indicates resolution of the problem. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Implementation Monitor Daily Weight Measure Vital Signs Measure Intake and Output Provide Oral Hygiene Review Procedure 37-1 on measuring intake and output Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Oral Fluid Therapy Nothing by Mouth Restricted Fluids Forced Fluids Maintain Tube Feeding Monitor Intravenous Therapy Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Monitor Intravenous Therapy Parenteral Fluids Equipment Review Table 37-5 on common intravenous solutions Preparing an Intravenous Solution. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Review Procedure 37-2 on preparing an intravenous solution. Initiating IV Therapy Administering IV Therapy Review Procedure 37-3 on administering an IV solution. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Managing IV Therapy Review Procedure 37-4 on managing IV therapy and dressing change. Blood Transfusion Review Procedure 37-5 on administering a blood transfusion. Complementary Therapy Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Evaluation Evaluation is an ongoing process for clients with fluid, electrolyte, and acid-base imbalances. Nurse should focus on the client’s responses when evaluating whether timeframes and expected outcomes are realistic. Copyright 2002 by Delmar, a division of Thomson Learning