Meeting the Needs of the Patient

8/2/2019 Meeting the Needs of the Patient

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Unit - 1o MEETING THE NEEDS OF THE PATIENT;

Topic-Fluid & electrolyte imbalance.

In order to maintain health and all the functionsof the body normally, fluid, electrolyte (& acidbase) balance should be maintained normal.

This electrolyte & acid base balance is called ashomeostasis. MEANS MAINTENANCE OFNORMAL BIOLOGICAL FUNCTIONS IN THEBODY WITH NORMAL FLUID & ELECTROLYTE

BALANCE.This balance is maintained by intake & outputof water & electrolytes, their distribution in thebody & On capacity of renal function.


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Without fluid in the bodyskin dries with

cracks & temperature increases, minddeteriorates and finally death occurs.

So fluid & electrolyte balance is very essential

for life.


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WATER & SUNLIGHT IS ESSENTAL

FOR LIFE


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Fluid & electrolyte imbalances:

Fluid imbalances;i) Hypovolemia

ii)Hypervolemia.

Electrolyte imbalances:

SODIUM- i)Hyponatremia , ii)Hypernatremia.

POTASIUM- i)Hypokalemia, ii)Hyperkalemia.

CALCIUM-i)Hypocalcemia, ii)Hypercalcemia.

MAGNESIUM- i)Hypomagnesemia, ii)Hypermagnesemia.

CHLORIDE- i)Hypochloremia, ii)Hyper chloremia.


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Distribution of body fluids

Body fluids are distributed in two forms

i) Intra-cellular fluid &

ii) extra cellular fluid

i) Intracellular;

Intracellular fluid found within cell membrane.

It consists of dissolved substances essential forFluid electrolyte imbalance.

Our body consists of70% of INTRACELLULARFLUID.

Large portion ofpotassium is found in Intra-

cellular fluid.


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ii) Extracellular;

Extracellular fluid is found outside the cell

membrane. It Consists of both interstitial & intravascular

fluid.

Interstitial fluid consists of24% of total fluids.

Intravascular consists of 6% of total body fluids.

Factors influencing the amount of the body fluids

age, gender, body fluids.


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FLUID BALANCE DEPENDS UPON THEBALANCE OF INTAKE & OUTPUT.

REGULATION OF BODY FLUIDSFLUID INTAKE IS REGULATED PRIMARILY

BY THE THIRST MECHANISM.

THE THIRST CONTROL CENTER ISLOCATION IN THE HYPOTHALAS IN THEBRAIN.

PHSYOLOGICAL FACTORS,DRY PHARENGEAL MUCUS MEMBRANES

& ANGEOTENSIN CREATE A SENSATION.


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1. Regulation of fluid output;

2. Fluid output is done by, gastrointestinal

tract(feaces), kidneys , skin & lungs.3. The kidneys are the major regulatory organs

regulate of fluid balance.

4. Approximately 1ml per 1 kg for 1 hour of urineis produced.

5. From gastrointestinal tract about 1oo to 15o ml islost in the stools(FEACES).

6. From skin through sweat fluid is lost, from lungsalso fluid is lost.


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FLUID INTAKE IS REGULATED BY THIRST

MECHANISM IN HYPOTHALAMUS. FLUIDOUTPUT IS DONE BY

KIDNEYS,GASTROINTESTINAL TRACT,SKIN &LUNGS.

BESIDE THE INTAKE OF THE FLUIS IN BODYVARIOUS TISSUE FLUIDS ARE PRODUCED.

SALIVA-1500ml

Gastric juice-1500ml

Bile juice-800ml

Pancreatic juice-1400ml

Intestinal juice-1500ml


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TOTAL INTAKE OF FLUID IS 2600ml

INTAKE OF WATER IN FOOD - 1000ml

Water produced by metabolism -400ml

NORMAL INTAKE OF FLUIDS

INTAKE OF ORAL FLUIDS 1200ml


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NORMALOUTPUT

URINE 1500ml

Stool150ml

Lungs500ml

Skin450ml

Total Normalout put

26ooml


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Fluid & electrolyte imbalances:

Fluid imbalances;i) Hypovolemia

ii)Hypervolemia.

Electrolyte imbalances:

SODIUM- i)Hyponatremia , ii)Hypernatremia.

POTASIUM- i)Hypokalemia, ii)Hyperkalemia.

CALCIUM-i)Hypocalcemia, ii)Hypercalcemia.

MAGNESIUM- i)Hypomagnesemia, ii)Hypermagnesemia.

CHLORIDE- i)Hypochloremia, ii)Hyper chloremia.


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REGULATION OF electrolytes

Sodium

Potassium

Calcium

Magnesium

chloride


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Sodium regulation; Sodium is the most abundantcation in the extracellular fluid.

The functions of sodium include; Maintaining balance of extracellular fluid , bythis it

controls the movements of water between the fluidcompartments.

Transition of nerve impulses. Neuro muscular and myocardial impulse transmission.

Normal sodium level is 135 to 145 meq/lit.

Sodium is regulated by salt intake , aldosterone &urinary

Output. When the renal function is normal the excretionof urine sodium can be increased to keep the serumsodium level with in normal limits.


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Potassium regulation: potassium is the main intracellularcat ion .

It helps in maintaining the fluid balance of the intracellularfluid.

It regulates neuro muscular excitability and muscularcontraction.

Potassium also is needed for glycogen formation, proteinsynthesis and correction of acid base imbalances.potassium ion is regulated by kidneys.

Any condition which decreases urine output decreasespotassium excretion. If the aldosteron level is highthere is increased excretion of potassium level.Another mechanism of regulation is exchange withsodium ion in renal tubule . Normal potassium levelis 3.5 to5.3 Meq /L.

l h b d


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CALCIUM REGULATION; calcium is the most abundantelement in the body. Functions of calcium

maintenance of celmembrane.

Conduction of nerve impulses in skeletal muscle.Stimulation of depolarization & contraction of cardiac

muscle.

Helps in blood coagulation.

Growth & formation of bones.

Muscle relaxation.

calcium in extracellular fluid is regulated by the action of

thyroid & parathyroid gland.Parathyriod hormone controls the balance among the bone

calcium,gastro intestinal absorption & kidneys does theexcretion of calcium. Normal serum calcium is 4 to 5

Meq/L.


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Magnesium regulation;

Magnesium is the second most important cat

ion in the intracellular fluid. The mainactivities are :

1. Perceptions of the metabolic activities of the

cells.2. Enzyme activity.

3. Muscular excitability.

4. The normal range of serum magnesium is1.5 to 2.4 Meq/q.

Magnesium is primarily execrated

through renal mechanism.


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Chloride regulation: chloride are found in theextracellular and intracellular fluids. The chloride

ion balances the cations with in the extracellularfluid. The ion exchanges helps to maintain theelectrical neutrality.

Chloride is regulated through kidneys . Thedietary intake of chloride and the amountexcreated in the urine are closely related. Thenormal serum chloride level ranges from 100

to 106 MEq/L.


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FACTORS AFFECTING FLUID,ELECTROLYTE &BASE IMBALANCE.

Body fluids are not stable , they shift from onecompartment to compartment., and various factors areaffecting them, they are:

DIFFUSION

OSMOSIS FILTERATION

HYDROSTATIC PRESSURE

ACTIVE TRANSPORTATION DIALYSIS

SELECTIVE PERMIABILITY OF MEMBRANE.


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Diffusion : Diffusion is the term applied to thespreading or scattering of molecules of gases or liquids.When two gases or liquids are brought into contact,the continual movement of molecules will soon producea uniform mixture & are separated by thin . In the body: Fluids, electrolytes and other substances takes placemovement by diffusion.

Osmosis: The diffusion of water molecules from lesserconcentration area to the greater concentration area iscalled osmosis. The principle of osmosis can be applied

clinically in the administration of intravenous fluids.Usually the solutions given as intravenous infusion, areisotonic having same concentration as blood plasma.This prevents sudden shifts of fluid, electrolytes fromvessels to interstitial fluids.


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Filtration ; It is the process by which water anddiffusible substances move together in response to

fluid pressure. This process is active in capillary beds ,where pressure differences determine the movement ofwater, electrolytes and other dissolved substancesbetween the capillaries and interstitial f luid.

Hydrostatic pressure :hydrostatic pressure is thepressure exerted by a fluid within a closed system.Counterbalancing the osmotic pressure of the plasmawhich attracts fluid into the vascular system, is the

hydrostatic pressure of the blood flowing through thecapillaries which pushes the fluid out of the vascularsystem.


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TOTAL INTAKE OF FLUID IS 2600ml

INTAKE OF WATER IN FOOD - 1000ml

Water produced by metabolism -400ml

NORMAL INTAKE OF FLUIDS

INTAKE OF ORAL FLUIDS 1200ml


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NORMALOUTPUT

URINE 1500ml

Stool150ml

Lungs500ml

Skin450ml

Total Normalout put

26ooml


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FLUID VOLUME DEFICIT 1)Hypovolemia;

DEFINITION; Hypovolemia occurs when loss of extracellular fluid

exceeds the Intake of fluids.

ETIOLOGY:Abnormal fluid loss Vomiting Diarrhoea GI suctioning Sweating

Decreased intake of fluids. Inability to gain access of f luids.


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PATHOPHYSIOLOGY;

Due to the above etiological factors

Fluid intake is decreased

Imbalance in body function

Fluid & electrolyte imbalance

Hypovolemia;


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CLINICAL MANIFESTATIONS; Weight loss skin turgor Oligurea Weak & rapid heart rate Increased temperature Cool skin Anorexia

Nausea Muscle weakness. DIAGNOSTIC EVALUATION. History taking Physical examination

Haematocrit level Na level K + level BUN(blood urea nitrogen) Serum sodium Serum potassium.


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Medical management

IF the fluid loss is not severe then management wil be

oral fluids IF the fluid loss is severe than management wil be IV

FLUIDS ISTONIC ELECTROLYTE SOLUTION LIKE RL.

ASSESS Intake-output chart.

VITAL SIGNS.

PHARMACOLOGICAL management

DIURETICS thiazid & loop diuretics.

SOLUTIONS COLLIOD

POTASSIUM SUPPLIMENTS.

HYPERYONIC SOLUTIONS.

Nutritional management.

Sodium diet & Potassium diet.


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NURSING MANAGEMENT: Provide bed rest. Monitor intake & output chart every hourly.

Check body weight. Monitor vital signs closely.

Mental function is being tested regularly. Monitor urine output.

PREVENTION:

The nurse should identify the patient at risk.Take measures to minimize the fluid loss.

Oral fluid administration.

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Meeting the Needs of the Patient