Lect15&16 Fluids&Electrolytes.ppt

8/18/2019 Lect15&16 Fluids&Electrolytes.ppt

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Stressors

AffectingFluid &

ElectrolyteBalance

NUR 101

FALL 2008LECTURE # 15 & #16K. Burger, MSEd, MSN, RN,

CNE


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Body Fluids Water= ost i!ortant nutrient for life. Water= !riary "ody fluid.

Adult #eig$t is %%'() #ater. *oss of +() "ody fluid = ) #eig$t loss SERIOUS *oss of -() "ody fluid = +%) #eig$t loss FATAL Fluid gained eac$ day s$ould = fluid lost eac$

day- /*0day a1erage2 W$at is t$e iniu out!ut !er $our necessaryto aintain renal function330ml!"


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Fu$%ios o Body

Fluid Mediu for trans!ort Needed for cellular eta"olis Sol1ent for electrolytes andot$er constituents

4el!s aintain "ody te!erature 4el!s digestion and eliination Acts as a lu"ricant


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'($!)isms o

Fluid *)i )d Loss*)i

Fluid inta5e+%((l Food inta5e+(((l

67idation ofnutrients/((l+(l of 4-( !er +((Kcal2

Loss “Sensi"le”

Can "e seen.8rine +%((lS#eat +((l

“9nsensi"le”Not 1isi"le.

S5in e1a!oration2

%((l*ungs :((lFeces-((l


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Regulation of Fluids +y,o%!)lmus ;t$irst rece!tors

osorece!tors2 continuosly onitor seruosolarity concentration2. 9f it rises, t$irstec$anis is triggered.4 2; increasing 4-(rea"sor!tion

-i%ui%)"y "(.ul)%io !osterior !ituitaryreleases A>4 antidiuretic $orone2 inres!onse to increasing seru osolarity.Causes renal tu"ules to retain 4-(.

?$irst is a late sign of #ater deficit


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Cosid(" T!is ?$e *("i)%"i$ Cli(%noral !$ysiological aging results in

decreased t$irst ec$anis decreased of s#eat glands decreased renal functiont$ere also ay "e decreased o"ility

and0or cogniti1e function #$ic$ i!actst$eir a"ility to get adeuate fluidinta5e.


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)"i)%ios i Body

Fluids Eld("ly 4a1e lo#er ) of total

"ody fluid t$an younger adults om( 4a1e lo#er ) total "odyfluid t$an en

+4 O 4OU T+IN T+IS IS 77777

Muscle tissue $as ore 4-( content ?4AN

adi!ose tissue


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Fluid

Co!artentsI%")$(llul)" fluid ICF2

Fluid insidet$e cell

'os% -0/2

of t$e "ody’s+20 is int$e ICF.

E/%")$(llul)" FluidECF2

Fluid outside t$e

cell. 13 of "ody’s +20 More !rone to loss / ty!esI%("s%i%i)l fluidaround0"et#een cells

I%")9)s$ul)" !lasa2 fluid in"lood 1essels

?ranscellular ;CSF,Syno1ial fluid etc


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Cosid(" %!is Age 1ariations e7ist in regardsto

4-( content of fluid co!artents 9nfants ='() of 4-( is found in ECF

:() of 4-( is found in 9CF W$at ig$t t$is ean in regardsto fluid loss for an infant3

Re1erse of adultsD

9nfant M6RE R6NE to

fluid *6SSD


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Fluid Balance >ynaic !rocess

Balance "et#een "odyfluids and electrolytes Attraction "et#een ionselectrolytes2 and #aterfluids2 causes fluids too1e across e"ranes andlea1e t$eir co!artents.


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Sol1ent 4-(2

Mo1eent Cell e"ranes aresei!erea"le allo#ing #ater to

!ass t$roug$

Osmosis aor #ay fluids

trans!orted Water s$ifts frolo# solute concentration to$ig$ solute concentration to

reac$ $oeostasis "alance2.


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Osmol)"i%y

Concentration of !articles in solution ?$e greater t$e concentration 6solarity2 ofa solution, t$e greater t$e !ulling force

6sotic !ressure2 Noral seru "lood2 osolarity = -(-G%

6SM05g

A solution t$at $as 49H4 osolarity is onet$at is I seru osolarity = +4-ERTONIC

solution A solution t$at $as *6W osolarity is onet$at is J seru osolarity = +4-OTONICsolution

A solution t$at $as eual osolarity as seru= ISOTONIC solution


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4y!ertonic Fluids 4y!ertonic fluids $a1e a $ig$erconcentration of !articles

$ig$ osolality2 t$an 9CF ?$is !i.!(" osmo%i$ ,"(ssu"( s$ifts fluid fro t$e cellsinto t$e ECF

?$erefore Cells !laced in a$y!ertonic solution #ill s!"i:


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4y!ertonic Fluids 8sed to te!orarily treat $y!o1oleia

8sed to e7!and 1ascular 1olue Fosters noral B and good urinaryout!utoften used !ost o!erati1ely2

Monitor for $y!er1oleia DNot used for renal or cardiac disease.?49NK ; W$y not3

>%) (.:%) NS >%) NS >%) *R

-ulmo)"y Ed(m)


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4y!otonic Fluids 4y!otonic fluids $a1e less

concentration of !articleslo# osolality2 t$an 9CF

?$is lo; osmo%i$ ,"(ssu"(

s$ifts fluid fro ECF intocells

Cells !laced in a $y!otonic

solution #ill s;(ll


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+y,o%oi$ Fluids

8sed to “dilute” !lasa!articularly in $y!ernatreia

?reats cellular d(!yd")%io >o not use for !ts #it$increased 9C ris5 or t$ird

s!acing ris5

(.:%)NS

(.//)NS


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Iso%oi$ Fluid

9sotonic fluids $a1e t$e saeconcentration of !articles

osolality2 as 9CF -%-G%6s0*2

Osmo%i$ ,"(ssu"( is t$erefore t$e

s)m( inside & outside t$e cells Cells neit$er s$rin5 nor s#ell inan isotonic solution, t$ey stayt$e s)m(


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9sotonic Fluid E7!ands "ot$ intracellularand e7tracellular 1olue

8sed coonly fore7cessi1e 1oiting,diarr$ea

(.G) Noral saline >%W Ringer’s *actate


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O%!(" Osmo%i$ F)$%o"s ALBU'IN a seru !rotein 2 Al"uin in t$e seru $as osotic !ro!ertiescalled colloid pressure

Al"uin !ulls 4-( fro t$e interstitialco!artents into t$e intra1ascularco!artents seru2. 4el!s to aintain B.

ersons #it$ lo# seru al"uin le1els tend

to retain fluid in t$eir interstitiallayers.

W$at a"noral assessents ig$t you find in

t$e client #it$ lo# seru al"uin le1els3 Ed(m)<


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+mmm

W$at ty!e of 9 fluid$y!otonic ; isotonic ;

$y!ertonic2ig$t "e of "enefit to t$is client#it$ lo# al"uin le1els3


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Cosid(" %!is

W$en tissue inury occurs,!roteins !at$ologically lea5

fro t$e intra1ascular s!aceinto t$e intersititial s!ace.?ered Third spacing

?$is e7!lains LLLLLLLLLL as asign of t$e inflaatory!rocess.

EE'A


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Solu%( 'o9(m(% iusio

Mo1eent of solu%(s fro $ig$concentration to lo# concentration

9t is a ASS9E o1eent >6WN t$econcentration gradiant. (requires noenergy)

Many "ody !rocesses use diffusion.E7a!le 6- and C6- e7c$ange

Rate is affected "y concentrationgradiant, !erea"ilitysurfaceareat$ic5ness of e"ranes, andsie of !articles.Fic5’s *a#2


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Solu%( 'o9(m(% =o%!("m($!)isms

A$%i9( %")s,o"% reuires energyA?2 to o1e fro lo# concentration

to $ig$ concentration uphill)E7a!le Na 0 K !u!

May "e en$anced "y carrier olecules#it$ "inding sites on cell e"raneE7a!le Hlucose9nsulin !rootes t$e insertion of"inding sites for Hlucose on celle"ranes2.


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Fil%")%io

Sol1ent AN> solute o1eent assage fro an area of 4ig$ ressure to

an area of *o# ressure?ered +yd"os%)%i$ -"(ssu"( E7a!leArterioles $a1e $ig$er !ressure t$an 9CF

Fluid, o7ygen and nutrients o1e intocellsenules $a1e lo#er !ressure t$an 9CFFluid, car"on dio7ide and #astes o1e out

of cells


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Fluid 1olue deficit

F> 4y!o1oleia2 Loss o >o%! +20 )d(l($%"oly%(s "om ECF

Causes include9ncreased out!ut, 4eorr$age,1oiting, diarr$ea, "urns,6R

Fluid s$ift out of 1asculars!ace “t$ird s!acing” 2 intointerstitial s!aces


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>e$ydration

Iso%oi$ d(!yd")%io = 4-( &electrolyte loss in eual

aounts diarr$ea and 1oiting

+y,("%oi$ d(!yd")%io = 4-( loss

greater t$an electrolyte losse7cessi1e !ers!iration, dia"etesinsi!idus


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AssessentF> ; 4y!o1oleiacontinued2

N(u"omus$ul)" >ecreased CNS acti1itylet$argy to coa2

ossi"le fe1er S5eletal uscle #ea5ness 4y!eracti1e >?R

R()l >ecreased out!ut 9ncreased s!ec gra1 ofurine

Weig$t loss

4y!ernatreia

I%(.um(%)"y? >ry out$ & s5in

oor turgor tenting2 itting edea Sun5en eye"alls

R(s,i")%o"y? 9ncreased rate andde!t$


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Nursing >iagnosis F>

(i$i(% Fluid olum(

R0? loss of H9 Fluids 1ia1oitingAEB ele1ated 4ct, dry ucous

e"ranes, decreased out!ut,t$irst


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lanning F>

Client #ill deonstratefluid "alance ae" oist

ucous e"ranes,"alanced 9 & 6easureents, 4ct WN*,

"y @.


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9nter1entions forF> 4y!o1oleia

re1ent furt$er fluid loss 6ral re$ydration t$era!y

9 t$era!y Medications antieetics, antidiarr$eals Monitor C, Res!, Renal, H9 status

Monitor electrolytes ; !ossi"lesu!!leent r7 M6N9?6R WE9H4? and 9 & 6


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Fluid olue E7cessFE 4y!er1oleia

Fluid o1erload is an e7cessof "ody fluid o9("!yd")%io

E7cess fluid 1olue in t$e

intra1ascular area!y,("9ol(mi) E7cess fluid 1olue in

interstitial s!aces (d(m)


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Nursing >iagnosis FE

Fluid 9olum( e7cess

R0? e7cessi1e 4-( inta5e

AEB confusion, $eadac$e,

uscle t#itc$ing, a"doinalcra!s, ele1ated B and 4R,$y!onatreia.


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lanning FE

Client #ill deonstrate fluid"alance "y "alanced 9 & 6

easureents, Seru Na WN*,etc. "y @.


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9nter1entionsFE 4y!er1oleia

Restore noral fluid "alance,!re1ent furt$er o1erload

>rug t$era!y diuretics >iet t$era!y decrease Na &fluids

Monitor inta5e and out!ut 9 &

62 Monitor #eig$ts Monitor electrolytes

Monitor C, Res!, Renal systes


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Clinical A!!lication

Pou $a1e "een assigned to care for an(y.o. client aditted #it$ $y!ernatreiat$at $as an 9 infusing (.:%) NS Q+((l0$r 1ia !u! and an ind#ellingurinary cat$eter. At ++a you assess anout!ut in t$e urinary drainage "ag of+%(l d5 a"er urine. Pou also noticet$at t$e client is S6B #$ile s!ea5ing ont$e !$one to $er daug$ter.

W$at do you t$in5 is $a!!ening33

W$at #ill you do33


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S8MMARP

Want ore 9nforation333C4ECK 68? ?4E

WEB*9NKSFor C$a!ter :+ on

E6*E


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Electrolytes

Wor5 #it$ fluids to 5ee! t$e "ody$ealt$y and in "alance

?$ey are solu%(s t$at are found in1arious concentrations and easured inters of illieui1alent E2 units

Can "e negati1ely c$arged )ios2 or!ositi1ely c$arged $)%ios2

For $oeostasis "ody needs?otal "ody AN96NS = ?otal "ody CA?96NS


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Electrolytes

C)%ios

ositi1elyc$arged

Sodiu Na< otassiu K< Calciu Ca


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Sodiu Na<

+/%+:%E0* Maor Cation C$ief electrolyte of t$e ECF Regulates 1olue of "ody fluids Needed for ner1e i!ulse &

uscle fi"er transission Na0K!u!2

Regulated "y 5idneys0 $orones


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4y!ernatreia Seru Na


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Critical ?$in5ing4y!o 0 4y!er Natreia

For t$e cliente7!eriencing

FE & $y!onatreia d0t

e7cessi1e inta5e of #ater,#$ic$ 9 solution #ould

you

e7!ect t$e !$ysician to

order3

a. >%NS". NS

c. >%W

d. NS

For t$e cliente7!eriencing

F> and $y!ernatreiad0t e7cessi1e #aterloss,

#$ic$ 9 solution #ould

you e7!ect t$e !$ysician

to order3a. >% NS

". >%R*

c. >%W

d. NS


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4y!o5aleia

Seru le1el J /.%E0* Results fro decreased inta5e, loss 1iaH90Renal & !otassiu de!letingdiuretics

*ife t$reateningall "ody systesaffected

SS uscle #ea5ness & leg cra!s,decreased H9 otility, cardiacarr$yt$ias

T/? diet0su!!leents09 t$era!y

* $i 5 "


54/77

*ets t$in5 a"out @4y!o5aleia

W$at are soe edical conditions t$at ay cause a$y!o5aleia3Renal >isease 0 C4F dilutional2Meta"olic Al5alosisCus$ings >isease Na retention leads to K loss 2

W$at are soe conditions t$at ig$t cause actualloss of !otassiu fro t$e "ody3H9 losses ; nasogastric suctioning, 1oiting,

diarr$eaCertain diuretic t$era!ies9nadeuate inta5e ; "ody cannot conser1e K,need 6 inta5e2

Cardiac arrest ay occur #$en seru K le1els fall

"elo# -.% E0*. W$y39ncreased cardiac uscle irrita"ility leads to


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4y!er5aleia

Seru le1el I% E0* Results fro e7cessi1e inta5e,

traua, crus$ inuries, "urns,renal failure SS uscle #ea5ness, cardiacc$anges, N0, !arat$esias of

face0fingers0tongue T/?diet0eds09 t$era!y0 !ossi"ledialysis

* t t$i 5 " t


56/77

*ets t$in5 a"out @4y!er5aleia

W$at are soe edical conditions t$at ay cause$y!er5aleia3Renal >isease=ost coon causeBurns and ot$er aor tissue trauaMeta"olic AcidosisAddison’s >isease Na loss leads to Kretention 2

W$at are soe conditions t$at ig$t cause!otassiu le1els to rise in t$e "ody3Certain diuretic t$era!iesE7cessi1e inta5e ; ina!!ro!riate su!!leents2

Cardiac arrest ay occur #$en seru K le1elsrise a"o1e E0*. W$y3>ecreased electrical i!ulse conduction leads

C iti l ?$i 5i


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Critical ?$in5ingotassiu 9 additi1es

W$ic$ of t$e follo#ing inter1entions #illt$e

nurse underta5e #$en adinistering

!arenteral K additi1es3Monitor t$e 9 site for !$le"itislace on cardiac onitor if I +( EAssure of adeuate i7ing of K in solution

Monitor for ele1ated K le1elsMonitor for decreased Na le1elsAdinister !otassiu "y slo# 9 !us$ et$od

N E 2 E

R @ @ @


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Calciu Ca needed for Ca a"sor!tion


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4y!ocalceia

Seru Ca J :./E0* Results fro lo# inta5e, loo!

diuretics, !arat$yroid disorders,renal failure SS osteoalacia, EKH c$anges,nu"ness0tingling in fingers,

uscle cra!s 0 tetany, seiures,C$o1ste5 Sign & ?rousseau Sign T/? diet09 t$era!y

C$ t 5


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C$o1ste5?rousseau

* t t$i 5 " t


61/77

*ets t$in5 a"out @4y!ocalceia

W$at are soe edical conditions t$at ay cause$y!ocalceia34y!o!arat$yroidis lo# ?4 le1els = decreased releaseof Ca fro "ones2

S0 t$ryoid surgery lo# Calcitonin = decreasedrelease of Ca fro "ones2 Acute !ancreatitisCro$ns >isease4y!er!$os!$ateia ESRF2

W$at are soe ot$er conditions t$at ig$t cause lo#Ca3

H9 losses ; nasogastric suctioning, 1oiting, diarr$ea*ong ter io"iliation*actose intolerance

9f $y!ocalceia is !rolonged, t$e "ody #ill utiliestored Ca fro "ones.W$at co!lication ig$t arise3

Fractures late sign 2


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4y!ercalceia

Seru Ca I %./E0* Results fro $y!er!arat$yroidis,

soe cancers, !rolongedio"iliation SS uscle #ea5ness, renalcalculi, fatigue, altered *6C,

decreased H9 otility, cardiacc$anges

T/? edication0 9 t$era!y


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Magnesiu Mg-<

+.%-.%E0* Most located #it$in 9CF Needed for acti1atingenyes, electrical acti1ity,eta"olis of car"s0!roteins,

>NA synt$esis Regulated "y intestinala"sor!tion and 5idney


65/77

4y!oagneseia

Seru J +.%E0* Results fro decreased inta5e, !rolongedN6 status, c$ronic alco$olis &

nasogastric suctioning SS? uscle #ea5ness, $)"di)$ $!).(s,ental c$anges, $y!eracti1e refle7es &ot$er $y!ocalceia S0S.

T/? re!laceent 9 t$era!y

restore noral Ca le1els Mgiics Ca2 seiure !recautions


66/77

4y!oagneseia

Coon in critically ill !atients

Associated #it$ $ig$ ortality rates 9ncreases cardiac irrita"ility and1entricular dysr$yt$ias es!ecially in !atients #it$ recent M9

Maintenance of adeuate seru Mg $as"een s$o#n to reduce ortality rates!ost M9


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4y!eragneseia

SeruI-.%E0* Results fro renal failure,

increased inta5e S0S flus$ing, let$argy,cardiac c$anges decreased4R2,decreased res!, loss of

dee! tendon refle7es ?7 restrict inta5e diuretic r7


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C$loride Cl

G%+(%E0* Most a"undant anion in ECF

Co"ines #it$ Na to for salts Maintains #ater "alance, acid"ase"alance, aids in digestion

$ydroc$oric acid2 & osotic !ressure#it$ Na and 4-(2 Regulated "y 5idneys Follo#s Sodiu Na2


69/77

4y!oc$loreia

Seru le1el G'E0* Results fro !rolonged 1oiting

& suctioning SS eta"olic al5alosis, ner1ee7cita"ility, uscle cra!s,

t#itc$ing, $y!o1entilation,decreased B if se1ere T/? diet09 t$era!y


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4y!erc$loreia

Seru le1el I +('E0* Results fro e7cessi1e inta5e or

retention "y 5idneys ; eta"olicacidosis SS Arr$yt$ias, decreased cardiacout!ut, uscle #ea5ness, *6C

c$anges, Kussauls’

s res!irations T/? restore fluid & electrolyte"alance


71/77

$os!$ate 6:

-.%:.%g0dl Needed for acid"ase"alance,neurological & usclefunction, energy transfer A? &affects eta"olis ofcar"s0!roteins0li!ids, B 1itainsynt$esis

Found in t$e "ones Regulated "y inta5e and 5idneys 9n1ersely !ro!ortional to Calciu

?$erefore soe regulation "y ?4 as #ell


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4y!o!$os!$ateia

Seru le1el J +.E0* Results fro decreased

intestinal a"sor!tion andincreased e7cretion

SS "one & uscle !ain, ental

c$anges, c$est !ain, res!.failure T/? >iet0 9 t$era!y


73/77

4y!er!$os!$ateia

Seru le1elI -.'E0* Results fro renal failure, lo# inta5eof calciu

SS? neurouscular c$anges tetany2,EKH c$anges, !arat$esiafingerti!s0out$

T/? >iet $y!ocalceic inter1entions Medications !$os!$ate "inding

?$e "ody can tolerate$y!er!$os!$ateia fairly #ell B8? t$eacco!anying $y!ocalceia is a larger!ro"leD


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Electrolyte


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Electrolyte$oeostasis

?$is eans to aintain"alance@ to control "y

"alancing t$e dietaryinta5e of electrolytes#it$ t$e renal e7cretion

and rea"sor!tion ofelectrolytes

9nter1entions for F0E


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9nter1entions for F0E"alance

Assess !atient carefully notec$anges

Monitor 9 & 6 9nta5e & 6ut!ut2 Monitor #eig$t c$anges Monitor urine Monitor 1s Monitor la" results and d7 test Maintain !ro!er 9 t$era!y


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Documents

Lect15&16 Fluids&Electrolytes.ppt