types of fluids
Blood (RBC/WBC/clotting factor)
Serum (plasma) pale yellow liquid
� Albumin (Protein) made by the liver, most abundant
part of serum
Urine Bile Hormones Cerebrospinal fluid
intracellular parts (3)
Solutes
Cations
Anions
extracellular parts (3)
...
extracellular parts (3)
� Interstitial fluid
� Intravascular fluid
� Transcellular and lymph fluids
electrolytes are
charged ions capable of conducting electricity
homestasis depends on
multiple physiological processes
imbalance can result from a variety of conditions (2)
Imbalance can affect chronic and acute
illnesses
Chronic and acute illnesses can create imbalance
normal fluids and electrolytes
60-70% of healthy adult's weight is water
Water necessary for normal cellular function
Medium for metabolic reactions
Transports nutrients, waste products
Acts as lubricant, insulator, shock absorber
Helps to regulate, maintain body temperature
distribution and composition of body fluid (ICF)
� Intracellular fluid (ICF) Found within cells of
the body
~ 2/3 of total body fluid in adults
Vital to normal cell functioning
Contains solutes such as
�Oxygen �Electrolytes �Glucose
distribution and composition of body fluids ECF
Found outside the cells ~ 1/3 of total body fluid
Two main compartments
�Intravascular �Interstitial Third compartment:
lymph and transcelluar fluid
Principal electrolytes: sodium, calcium, bicarbonate
movement of body fluids
� Movement of body fluid across cell and capillary membranes accomplished by:
Osmosis Diffusion Filtration Active transport
tonicity
osmolality of solution
osmosis
low to high
isotonic
same osmolality (solute) (Na+) as body fluids
hypertonic
higher osmolality (Na+) than body fluids
hypotonic
lower osmolality (solute) (Na+) than body fluids
regulating body fluids: fluid intake (3)
2,500 mL/day at moderate activity and temperature
Food contributes
Thirst regulator in hypothalamus
regulating body fluids: fluid output (3)
1,400-1,500 mL/day of urine
Insensible loss through skin and lungs
Feces
maintaining homeostasis (4)
Kidneys primary regulator
Antidiuretic hormone
Renin-angiotesin- aldosterone system
Atrial natriuretic factor
sodium (4)
Normal serum level: 135- 145 mEq/L
Most abundant cation in ECF
Contributes to serum osmolality
Regulating ECF volume and distribution
Potassium (7)
Normal serum level: 3.5-5.3 mEq/L
Major cation in ICF
Maintains ICF osmolality
Transmits nerve and other electrical impulses
Skeletal, cardiac, smooth muscle function
Regulates acid-base balance
Must be ingested daily
potassium most important
skeletal, cardiac, smooth muscle function
Calcium (9_
Normal serum level: 9-11 mg/dL
Most is found in skeletal system
Cation
Skeletal maintenance
Regulates muscle contractions (cardiac)
Neuromuscular function
Cardiac function
Blood clotting
Activates enzymes
calcium two most important
1. found in skeletal system
2. regulates muscle contractions (cardiac)
Magnesium
Normal serum level: 1.5-2.5 mEq/L
Found in skeletal system, ICF
Second most abundant ICF cation
Intracellular metabolism Protein, DNA synthesis Operates sodium-potassium
pump
Regulates cardiac, neuromuscular function
Relaxes muscle contractions
magnesium most important
regulates cardiac and neuromuscular function
Chloride
Normal serum level: 95-105 mEq/L
Major anion of ECF
Regulates serum osmolality
Regulates ECF balance
Regulates acid-base balance
Major component of stomach fluids
Buffer in oxygen- carbon dioxide exchange
chloride two most important
1. regulates acid-base balance
2. bugger in oxygen-carbond dioxide exchange
phosphate
Normal serum level: 2.4-4.5 mg/dL in adults
Much higher in children Major anion of ICF Forms bones and teeth Metabolism of protein, fat,
carbohydrates Cellular metabolism Muscle nerve, RBC function Regulates Acid/Base Balance Regulaes Calcium Level
phosphate two most important
1. forms bones and teeth
2. metabolism of protein, fat and carbs
Bicarbonate (4)
�Found in both ICF, ECF
-MAJOR BODY BUFFER
�Regulates acid-base balance
-Produced through metabolic processes
older adults fluid volume
Thirst response is blunted
Nephrons become less able to conserve water in response to ADH
Dehydration risk increases
Increased sensitivity to salt
gender and body size
Individuals with a higher percentage of body fat have less
body fluid
Women had proportionately more body fat, less body fluid than me
ethnicity
Suggested sodium intake is ?1,500- 2,300 mg/day
Average sodium intake in the United States is >3,400 mg/day
African Americans have greater sensitivity to sodium
concepts related to fluid and electrolyte balance
� Elimination � Cellular Regulation � Cognition � Thermoregulation � Perfusion � Assessment
alterations and manifestations
� Fluid volume deficit (dehydration)
� Fluid volume excess (Overload)
� Elevated electrolyte level (Increase solutes/Na+/K+...)
� Low electrolyte level � Chronic kidney disease � Acute renal failure
compensation (2)
� Body continually attempts to compensate for a fluid and electrolyte imbalance by shifting fluids and electrolytes from one component to another
� Rare for only one type of imbalance to occur
prevalence (2)
� Disorders of diabetes mellitus and hypertension associated with hyponatremia, hypomagnesemia, and hypokalemia
� Use of diuretics ?
electrolyte imbalances
modifiable risk factors for prevention (4)
Stress can increase cellular metabolism, blood glucose concentration, and catecholamine levels (Hormones released from adrenal glands: dopamine, epinephrine, norepinephrine)
Stress can increase production of ADH
Diuretics and antipsychotic agents
Vasocons
heart related illness related to fluid imbalance
� Limit outdoor activity during hottest part of the day
� Take frequent breaks for rest and water
� Drink water before beginning to feel thirsty
� Wear lightweight clothes
� Work or exercise with others when engaging in activity outside
nursing history
Risk
Current, past medical history
Medications
Functional, developmental, socioeconomic factors
Age Lifestyle Intake and output
nursing assessment physical assessment
Skin Oral cavity Mucous membranes Eyes Cardiovascular,
respiratory systems Appearance
clinical measurements
� Daily weights
� Vital signs
� Tachycardia/Bradycardia?
� Blood pressure (Hyper/Hypo)
� Fluid intake and output
fluid intake
Oral fluids Ice chips Liquid foods
Foods that become liquid at room temperature
Tube feedings Parenteral fluids, IV medications Catheter, tube irrigants
fluid output
Urine Vomitus Liquid feces Tube drainage (gastric, intestinal) Wound drainage
diagnostic test
� Serum electrolytes � Complete blood count
Hematocrit affected by changes in plasma volume
� Osmolality
Serum Urine
� Urine specific gravity
independent interventions
Monitor intake and output
Weigh client daily
Engage client in plan of care
Provide client education as indicated
collaborative interventions
Initiating intravenous therapy
Intravenous management
Monitoring fluid balance
Medication administration
Blood transfusion
Interventions and therapies
Collaborative
Pharmacologic therapy
� Electrolyte correction to restore balance
� Hyperkalemia � Hypokalemia � Hypernatremia � Hyponatremia � Colloids � Crystalloids � Diuretics