1. Fluid & Chemical Balance
NF CHPT 15
Fluid & Chemical Balance

2. The Body’s Fluids Water is the most important solvent in the body
Water transports wastes
Water carries nutrients
Water lubricates joints
Water acts as a shock absorber
Water needs to be replaced and maintained daily

3. Water Makes up 50-60% of our body wt
Best source of water is drinking water
Water also comes from liquids and foods

4. 2 compartments body fluid is in…
Intracellular
Extracellular

5. Intracellular Fluid
The fluid that is inside the cells

6. Extracellular Fluid
Water that is outside the cells

9. Electrolytes
Are chemical compounds that are dissolved, absorbed and distributed in body fluids
Electrolytes carry an electrical charge
Na+ K+ CL- are all electrolytes

10. Normal electrolyte levels
Na+ should be meq/L
K+ should be meq/L
Know these for ever……………

11. IMBALANCE
When electrolytes become unbalanced, the body tries to balance it out to return it to a homeostatic state

12. BLOOD Consists of: 3 liters of plasma 2 liters of blood cells _____
Total of 5 liters

13. Blood cells For every 500 RBC’s (carry stuff)
There are platelets (to clot blood)
There is WBC
Loss of blood means you must replace it with fluid or actual blood transfusion

14. OSMOSIS Helps to keep water and the stuff in it, =
Water moves from an area of less concentration of particles to an area of higher concentration of particles to help spread those particles out and dilute the stuff

15. FILTRATION Like a coffee filter
Your kidneys filter out water and waste through the glomerulous (kidney’s filter) from the hydrostatic pressure behind that water and waste…the water and waste gets pushed out through this kidney filter

16. DIFFUSION
When “stuff” moves from an area of high concentration to an area of low concentration (think of the room deodorizer spray)
Like the room spray, it’s really concentrated coming out of the can then I spray it in the air and the smell diffuses or moves to the other side of the room

17. PASSIVE DIFFUSION
Doesn’t require any energy to do this, it just moves by itself
What kind of energy?????? 

18. ACTIVE TRANSPORT
Like salmon swimming up stream, this requires ATP=energy to help push it through
This goes from an area of low concentration to an area of high concentration
Na+ and K+ do this in a “pump system” when they are regulating themselves in the kidneys

19. FLUID REGULATION Our body regulates fluids through the kidneys
We loose fluids in several ways…
Fluid loss needs to be watched and replaced then maintained daily

20. Monitoring Intake & Output
Keep a record of what goes in and what comes out…legal document
Keep this record over a 24 hour period
Dr. or IVFs determines who needs I&Os watched

21. Measuring I&O Measured in ml or cc and recorded on I & O sheet
Totaled at end of shifts and grand totaled at end of day
Should be compared with previous levels
Includes all routes of Intake and Output

22. Who is on I&Os
Surgical pt is monitored until they are eating and drinking and voiding normal
Pt receiving IVFs
Pt receiving tube feeds, what goes in and what comes out must be watched

23. Who is on I&Os Pt with wound drainage or suction equipment
Pt who has a urinary catheter
Pt who is on diuretic therapy such as lasix or aldactone or hydrochlorothiozide. They are releasing extra body water with these medications

24. KEEPING TRACK You must use your facilities I&O record
I&O should be done EVERY SHIFT usually at 6am-3pm-12midnight and start again at 6am

25. What is fluid intake exactly?
1) It’s the sum of all fluid that the pt took in, it includes:
2)All liquids the pt drank
3)Melted ice chips, the total amt cut in ½
4)Foods that are liquid by the time they are swallowed like ice cream, jello (gelatin), thin cooked cereal
5)IVFs
6)Feeding tube liquids

26. What to measure? Fluids Ice chips Certain foods Tube feeding
IVs and IV Meds
Irrigations
Urine
Diarrhea
Emesis
Drainage
Blood
Aspirated Irrigation fluids

27. How to record fluid in… ALWAYS recorded in ml…
If a pt drank 8oz glass of water, how many cc or ml is this?
Remember that 30mL or cc =1ounce

28. EQUIVALENTS 1 ounce = 30cc or mL 1 tsp = 5cc or mL 1 Tbsp = 15cc or mL
8ounces = 240cc or mL

29. Check the labels Food labels indicate how many ounces it contains
Facility may have little chart of popcicle =?
Water glass = ? 4 oz jello = ?

30. FLUID OUTPUT What liquids do you count as output? Urine emesis
Blood loss diarrhea
Wound or tube drainage
Aspirated drainage such as NG output
The wt of a chux pad or diaper must be counted

31. How will you know if the patient has had enough in and enough out?
#1 check with what Dr. wants
Patient’s with normal kidney function should urinate 30mLs/hr
Children should urinate 10-15mLs/hr
Usually what goes in should come out. Dr. starts initial IV order so be calculating

34. Let’s do a problem INTAKE (I’s) 6 ounces of juice in for breakfast
2 ounces of milk in for breakfast
8 ounces water in for lunch
16 ounces pop in for dinner
How many mLs did this pt take in

35. OUTPUT (O’s)
350mLs in a.m.
220mLs at noon
530mLs H.S.
How many mLs out did the pt have

36. What’s wrong with this picture?

37. FLUID IMBALANCES Due to: water or fluid movement or
water or fluid loss

38. HYPOVOLEMIA Low volume in the extracellular compartments Due to:
1) Inadequate fluid intake
2) Fluid loss in excess of fluid intake like vomiting
3) 3rd spacing
4) injury such as an amputated limb in MVA

39. Treatment of hypovolemia
Replacement of fluids by oral or IV
Oral when not severe
IVFs when loss is severe
If due to 3rd spacing, may need protein (albumin) so that water will follow protein back into the blood vessels

40. HYPERVOLEMIA Too much water in = edema
Fluid goes to dependent places like feet
Pitting edema is extreme fluid overload
Edema doesn’t occur unless the body has 3 liters over what it needs

41. Treatment of hypervolemia
If untreated, circulatory failure will occur because there is too much fluid for the heart to pump around…drown
Treatment includes…

42. Treatment of hypervolemia
Treat the disorder causing the overload, if it’s the slow heart, meds to increase the pumping action of the heart are needed
Reduce or limit oral intake
Reduce salt, where salt goes, water…
Stop IVFs
Administer drugs to release water like lasix, hydrochlorothiazide or aldactone
Use a combination of all of these

43. Lasix (furosemide) Diuretic – people call this a “water pill”
Side Effects:
can work too much = dehydration
Hypokalemia = change in heart rhythm called a dysrhythmia (bad heart beat)
Decrease BP
So now you’ll have dizzy, confusion, nausea

44. Third spacing
Remember low proteins caused lots of water to move out of the cells and into the other spaces because there was no protein to follow?
Causes swelling, can lead to hypotension and shock, your body thinks it has no fluid because it’s NOT in the right places

45. Treatment of 3rd spacing
An infusion of albumin which is protein found in plasma (plasma is the fluid in blood, cytoplasm-like jelly with waste and electrolytes in it).
The water will move back in to the spaces to follow the albumin then you can take the water and albumin out with lasix
Pt will urinate a lot

46. Intravenous Solutions
Their purpose is to:
Maintain or restore fluid balance when pt can’t take p.o.
To maintain or replace electrolytes
To provide a source of calories

47. Names of some IVFs Normal saline 0.9% NS Dextrose 5% + water D5W
5% Dextrose+ .45% NS D5 1/2 NS
5% Dextrose + .45%NS + 20Kmeq KCL
D5 1/2% NS+20meqKCL

48. REMEMBER… If you forgot to record it, IT WASN”T DONE
Don’t be lazy and forget to do all of your job 

50. The End