Body fluid regulation

Body fluid composition

Water: transport, metabolic rxn, body temp regulation, insulation, form, structure, lubricant, enzyme rxn, meuromuscular activity, PROMOTES NORMAL CELL FUNTION

Function of electrolytes

Regulates water balance, regulates acid-base balance, enzyme rxn, neuromuscular activity

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body fluid regulation
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-thirst
-kidneys
-renin angiotension aldosterone system(low bp response)
-atrial natriuretic peptide (fluid overload response)

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fluid volume defecit causes
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-excessive fluid loss
-insufficient fluid intake
-failure of regulatory system
-third spacing (lung disease, liver disease)

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FVD manifestaions
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-thirst
-dry mucous membranes
-altered mental status (anxiety, restlessness)
-fatigue
-pale, cool extremities
-tachycardia
-decreasesd BP
-weight loss

Diagnosing FVD

-low k+
-concentrated serum osmolality
-elevated h&h
-elevated specific gravity
-elevated central venous pressure

Tx for FVD

Rehydration
-water for mild
-sports drink for moderate
-IV fuid for severe (isotonic and k+ sometimes)

Proper fluid intake

1500 ml/day

Nursing dx FVD

-fluid volume defecit
-ineffective tissue perfusion
-risk for injury
-RC hypovolemic shock

Nursing intervention FVD

-assess i/o
-vital signs
-administer fluids
-monitor lab values
-monitor LOC
-safety precautions
-skin care

Fluid volume excess

Fluid overload, water and sodium retained in the body

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manifestations of FVE
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-weight gain
-distended neck vein
-full bounding pulse
-increassed CVP
-dyspnea with cough
-moist crackles
-polyuria
-ascites
-edema

Diagnosing fluid volume excess

-physical exam, edema
-decreased electrolyte and osmolality
-decreased h&h
-renal and livewr funtion tests

Managing FVE

-medications: diuretics
-fluid mansgement
-dietary management (decreased sodium)

Nursing Dx for FVE

-excess fluid volume
-risk for skin integrity
-risk for impaired gas exchange
-RC hypervolemia

Interventions for FVE

-low sodium diet
-assess vital signs
-elevate lower extremeties
-daily weights
-intake and output
-diuretics
-assess skin
-reposition q2h
-monitor o2sat

Normal sodium range

35-145 mEq/L
(We need 500mg daily)

Hyponatremia causes

Sodium loss through kidneys, gi tract, skin;
water gains r/t renal disease, heart failure, liver failure;
excessive hypotonic IV fluids

Hyponatremia lab values

Serum sodium (<135mEq/l)
critical value (<120mEq/L)
serum osmolality (<280mOsm/kg)

Hyponatremea manifestations

-anorexia
-nausea, vomiting
-diarrhea, abdominal cramping
-headache
-altered mental status
-muscle cramps, weakness, tremors
-seizure and coma

Hypernatremia

-serum sodium level greater than 145 mEq/L
-sodium is gained in excess water
-water is lost in excess sodium
-thirst mechanism is stimulated to increase intake of water
-almost never occurs with people with intact thirst mechanism

Causes of hypernatremia

-altered thirst mechanism
-profuse sweating
-diarrhea
-inability to respond to thirst sensation

Manifestations of hypernatremia

-thirst
-dry, sticky mucous membranes
-restless, decreased LOC
-weakness
-muscle twitching
-seizures

Management of hypernatremia

-IV fluid intake
-hypotonic solution 0.45% NaCl
-d5w
-diuretics to increase sodium excretion

Normal K+ value

3.5-5.0 mEq/L

Hypokalemia value

<3.5 mEq/L

Hyperkalemia value

>5.0 mEq/L

Organ of excretion for K+

Kidneys

Causes for hypokalemia

-excess GI loss: vomit, diarrhea, drainage
-renal loss: diuretics, hyperaldosteronism
-inadequate intake

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Hypokalemia management
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Potassium supplements
-KCl, K+protocol around 4.0, IV given slowly 10meq/hr
Dietary intake
-bananas, tomatoea, pork, milk

Hypokalemia nursing dx

-decreased cardiac output
-activity intolerance
-risk for imbalanced fluid volume