fluid volume

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