2. FLUIDS AND ELECTROLYTES

3. DISTRIBUTION OF BODY FLUIDS
2 compartments
Intracellular
Extracellular

4. INTRACELLULAR
ICF
within the cells
40% of body weight

5. EXTRACELLULAR (ECF) -outside cell
INTERSTITIAL-fluid between cells and outside blood vessels
INTRAVASCULAR-blood plasma
LYMPH
ORGAN FLUIDS

6. ELECTROLYTES
Element or compound that separates into ions when dissolved in water or another solvent

7. CATIONS-positively charged electrolytes
ANIONS-negatively charged electrolytes
Differs in ICF and ECF but total number in each compartment should be the same
Commonly measured in MILLIEQUIVALENTS

8. MOVEMENT OF BODY FLUIDS
Fluids and electrolytes constantly shift compartments to meet metabolic needs
Movement depends on cell membrane permeability

9. DIFFUSION
solute in solution moves from area of higher concentration to an area of lower concentration
Example-cream poured into black coffee

10. OSMOSIS
movement of water across a semipermeable membrane from area of lower concentration to one of higher concentration.
Example-boiling a hot dog

11. OSMOLARITY ISOTONIC- HYPERTONIC same osmotic pressure
solutions expand the body’s fluid volume without causing a fluid shift
HYPERTONIC
solution of higher osmotic pressure
solutions pull fluid from cells

12. Hypotonic-
Solution of lower osmotic pressure
Solution moves into cell

14. HYDROSTATIC PRESSURE
Force of the fluid pressing out against a surface

15. REGULATION OF BODY FLUIDS
HOMEOSTASIS-
The process that maintains body fluids in balance
Hormonal controls
Fluid intake
Fluid output

16. FLUID INTAKE
REGULATED PRIMARILY THROUGH THIRST MECHANISM
Hypothalamus

17. OSMORECEPTORS Monitor osmotic pressure in blood
Osmolality increases-stimulates hypothalamus-thirst occurs
Salty foods
Hypovolemia-hemorrhage or excessive vomiting

19. HORMONAL REGULATION
ANTIDIURETIC HORMONE-ADH
ALDOSTERONE
RENIN

20. ADH-ANTIDIURETIC HORMONE
Posterior pituitary gland
Prevents diuresis
Causes body to save water
Works on renal system
Returns water to systemic circulation

21. ALDOSTERONE Adrenal cortex Acts on renal tubule Reabsorption of sodium
Leads to water retention
Excretion of potassium and hydrogen

22. RENIN
Enzyme
Responds to decrease in renal perfusion secondary to decreased blood volume
Produces angiotensin I-angiotensin II-vasoconstrictor

24. OUTPUT REGULATION
ORGANS OF WATER LOSS
KIDNEYS
SKIN
LUNGS
GI TRACT

25. KIDNEYS ( ml) urine
major organs of fluid balance
filter 180 L of blood per day

26. SKIN (500-600 ml) sweat sympathetic nervous system activates
sweat glands

27. LUNGS (400 ml) exhaled
Oxygen devices can increase loss

28. GI TRACT (100-200 ml) lost site of almost all fluid gain
3-6 L is secreted and reabsorbed daily

29. INSENSIBLE WATER LOSS
Continuous
Not perceived

30. SENSIBLE WATER LOSS Excess perspiration Perceived by the client
Noted by nurse on inspection

31. CATIONS

32. SODIUM Most abundant cation in ECF Maintain water balance
Nerve impulse transmission
Regulation of acid-base balance
Cellular chemical reactions
Regulated by diet and aldosterone
Normal mEq/L

33. POTASSIUM Predominant in ICF Regulates metabolic activities
Glycogen deposits in liver and muscle
Transmit nerve impulse
Cardiac rhythm
Muscle contraction
Regulated by diet and renal excretion
Body does not conserve well
Normal mEq/L

34. CALCIUM Stored in bone, plasma and cells 99% in bone 1% in ECF
50% bound to albumin
40% free ionized calcium

35. CALCIUM
Necessary for bone and teeth formation, blood clotting, hormones, cell membrane s, cardiac conduction, nerve impulses and muscle contraction
Hypocalcemia- Trousseau’s sign, Chvotek’s sign
Normal ionized 4-5 mEq/L (total mg/dl)

36. MAGNESIUM
Enzyme activities, neurochemical activities, cardiac and skeletal muscle excitability
Regulated by diet, kidneys and parathyroid hormone
Positive Chvostek’s sign if Mag is low
Normal mEq/L
Definition of CHVOSTEK'S SIGN. : a twitch of the facial muscles following gentle tapping over the facial nerve in front of the ear that indicates hyperirritability of the facial nerve.

37. ANIONS

38. CHLORIDE Major anion in ECF Transport follows sodium
Regulated by dietary intake and kidneys
Normal mEq/L

40. BICARBONATE Major chmical base buffer in the body ECF and ICF
Essential to acid-base balance
Regulated by kidneys
Venous-measured as CO2 (normal mEq/L

41. PHOSPHORUS-PHOSPHATE REGULATION
Nearly all phosphorus in body exists as phosphate
Regulation of acid-base balance
Promotes neuromuscular action and carbohydrate metabolism
Regulated by diet, renal excretion, intestinal absorption and PTH
Inverse relationship with calcium
If one rises, the other falls

42. ACID-BASE BALANCE
pH is a measurement of hydrogen ions in arterial blood
More hydrogen-more acidic-lower pH
Less hydrogen-more alkaline-higher pH

45. Acid Base Balance
Exists when the rate that body produces acids or bases equals the rate they are excreted
Necessary to maintain cell membrane integrity
Maintains speed of cellular enzymatic reactions
Normal arterial blood pH=

46. Carbon dioxide Bicarbonate CO2
Combines with water in the body to create carbonic ACID
Regulated by lungs
Bicarbonate
HCO3
Base
Regulated by kidneys

48. SODIUM IMBALANCES Hypernatremia Hyponatremia
Treatment depends on cause
Associated with normal, decreased or increased ECF
Kidney disease, GI loss, sweating, diuretics
Will see Serum Na <135
Will see Urine sp gravity <1.01
Hypernatremia
Excess water loss or sodium excess
Body attempts to conserve water
Ingestion, hypertonic saline, water deprivation

49. HYPONATREMIA HYPERNATREMIA
Apprehension, postural hypotension and dizziness, abd cramps, N/V/D, tachycardia, convulsions, coma
Thirst, dry/flushed skin/dry/sticky tongue/mucous membranes, fever, agitation, convulsions, restlessness, irritability

50. POTASSIUM IMBALANCES Hypokalemia Hyperkalemia Most common
Cause-diuretics
Little tolerance for fluctuations
Hyperkalemia
Severe will have marked cardiac conduction problems
Primary cause-renal function

51. HYPOKALEMIA HYPERKALEMIA
Diarrhea, vomiting, sweating, excessive IV’s without KCL, diabetic treatment with insulin
Weakness, fatigue, decreased muscle tone, distention, decreased bowel sounds, dysrhthmias, paresthesias, weak/irreg pulse
Renal failure, FVD, cell damage-burns/trauma, IV’s with KCL, acidosis, potassium-sparing diuretics, rapid infusion of stored blood
Anxiety, dysrhthmias, paresthesias, weakness, abdominal cramps and diarrhea

52. CALCIUM IMBALANCES Hypocalcemia Hypercalcemia
Thyroid and parathyroid disease, Vit D deficiency, renal insufficiency
Hyperactive reflexes, tetany, muscle cramps , Chvostek’s sign
Hypercalcemia
Symptom of underlying disease
Malignancy, osteoporosis, prolonged bedrest
Anorexia, N/V, weakness, low back pain (kidney stones) decreased LOC, personality changes, cardiac arrest

53. MAGNESIUM IMBALANCES Hypomagnesemia Hypermagnesemia
Malnutrition, alcoholism, absorption, diuretics
Muscle tremors, hyperactive DTR’s, Chvostek’s sign, confusion, dysrhythmias
Hypermagnesemia
Renal failure, excess intake
Hypoactive DTR’s, decreased depth and rate of resp, hypotension, flushing

54. CHLORIDE IMBALANCES Hypochloremia Hyperchloremia
Vomiting, drainage, diuretics
Rarely occur as single disease
No single set of symptoms with either
Hyperchloremia
Increased sodium, or decreased bicarbonate

55. FLUID IMBALANCES FVD-fluid volume deficit Fever, burns,hge,
decreased intake, hypertonic fluids, diuresis
Dry MM, poor skin turgor, thirst, confusion, oliguria, dry sticky tongue, increased body temp, flushed skin, convulsions, coma
FVE-fluid volume excess
CHF, RF, Excessive sodium intake, excess water intake
Edema, hypertension, JVD, crackles, taunt and shiny skin, convulsions, coma

56. NURSING ACTIONS FOR PATIENTS ON IV THERAPY
Measure I&O at least Q shift
Assess lab values
Physical assessment
Assess weight (daily)
Vital signs
Skin turgor

57. PARENTERAL REPLACEMENT OF FLUIDS
PERIPHERAL
CENTRAL

58. TYPES OF REPLACEMENT
TPN
IV SOLUTIONS

59. TYPES OF IV SOLUTIONS
ISOTONIC
HYPERTONIC
HYPOTONIC

60. ISOTONIC FLUIDS Same osmotic pressure as blood Expands fluid volume
No fluid shift from ICF to ECF

61. ISOTONIC Dextrose in Water solution- Saline Solution-
Dextrose 5% in Water (D5W)
Saline Solution-
0.9% sodium chloride (NS)
Multiple Electrolyte Solution-
Lactated Ringer’s (LR)

62. ISOTONIC

63. HYPERTONIC SOLUTIONS Solution of higher osmotic pressure
Pulls fluid from the cells
Causes cells to shrink

64. HYPERTONIC FLUIDS
D10W
3-5% sodium chloride (NS)
D5NS
D51/2NS
D5LR

65. HYPERTONIC

66. HYPOTONIC SOLUTIONS Solution of lower osmotic pressure
Solutions move into the cells
Causes cells to swell

67. HYPOTONIC SOLUTIONS
0.45% sodium chloride (½ NS)

68. HYPOTONIC

69. Phlebitis
Infiltration