Electrolyte
An ionic compound whose aqueous solution conducts an electric current and are found in all body fluids.
Conditions with fluid and electrolyte imbalance
Dehydration, renal failure, acute and chronic illness
Water makes up what percentage of the body?
60%
Water is important to health and cellular functioning by
1 a medium for metabolic reactions within cells, 2 a transporter for nutrients, waste products, and other substances, 3 a lubricant, 4 an insulator and shock absorb-er, 5 one means of regulating and maintaining body temperature.
Cations
ions with a positive charge
Anions
ions with a negative charge
Cations examples
sodium (Na+) , potassium ( K+) , calcium ( Ca2+), magnesium (Mg2+)
Anions examples
chloride (Cl-), bicarbonate (HCO3-), Phosphate (HPO4 2-), and sulfate (SO4 2-)
intracellular fluid
makes up 2/3 of total body fluid in adults and contains solutes and provides a medium in which metabolic processes of the cell take place.
Solutes
substances dissolved in a liquide such as oxygen, electrolytes, glucose, proteins called crystalloids or colloids
crystalloids
salts that readily dissolve in solution
colloids
protein molecules and other substances that do not readily dissolve in solution
Composition of intracellular fluid
Primary cations are Potassium (K+) and magnesium (Mg2+) . The major anions are phosphate (HPO4 2-) and sulfate (SO4 2-).
extracellular fluid
fluid outside the cell, 1/3 of fluid, has two compartments Intravascular and Interstitial.
Intravascular fluid or plasma
makes up 20% of extracellular fluid
interstitial fluid
fluid between cells make up 75% or ECF
composition of extracellular fluid
Largest quanities Sodium (Na+) , chloride (Cl-) , bicarbonate (HCO3-).
Difference between Intravascular fluid and Interstitial fluid
Protein in the Intravascular fluid lots of albumin.
Osmosis
Diffusion of water through a selectively permeable membrane from area of low concentrated solution to area of high concentrated solution
isotonic solution
A solution in which the concentration of solutes is essentially equal to body fluid. example normal saline- 0.9% sodium chloride.
hypertonic solution
A solution in which the concentration of solutes is greater than normal body fluid example is 3% sodium chloride.
hypotonic solution
A solution in which the concentration of solutes is less than that of the normal body fluid example is 0.45% sodium chloride or half normal saline
Diffusion
the natural movement of molecules due to their random motion, can occur across the capillary membranes.
rates of diffusion depend on
1. Size of molecules: Larger molecules diffuse more slowly than small ones.
2. Concentration of solution: Solutes move from a solution of higher concentration to one of lower concentration via diffusion.
3. Temperature of solution: Diffusion occurs more q
Filtration
A process that separates materials based on the size of their particles. movement from area of high pressure to lower pressure
active transport
Energy-requiring process that moves material across a cell membrane against a concentration difference. its especially important in maintaining sodium and potassium ion concentrations of the extracellular and intracellular fluid compartments.
Normal sodium levels
135-145 mEq/L
sodium largely
controls and regulates water balance
Normal serum potassium level
3.5-5.0 mEq/L
Potassium important for
maintaining correct ratio of potassium in icf vs ecf for neuromuscular response to stimuli. vital for skeletal, cardiac, and smooth muscle activity. must eat it everyday not stored. fruits, veggies, meats, fish
Calcium importance
1) MUSCLE CONTRACTION and relaxation 2) BLOOD CLOTTING 3) COFACTOR FOR ENZYMES
Normal total serum calcium level
9-11 mg/dL
Normal Serum Magnesium Level
1.5-2.5 mEq/L
Magnisum
in skeleton and icf. important for intracellular metabolism especially with adenosine triphosphate- ATP, necessary for protein and DNA synthesis, regulates neuromuscular and cardiac function. foods with this cereal grains, nuts, dried fruit, legumes, gree
Normal serum chloride level
95-105 mEq/L
Chloride
functions with sodium to regulate serum osmoalality and blood volume. kidney absorbs sodium chloride follows, in gastric juices in hydrochloric acid, involved in regulating acid base balance. buffer in oxygen and carbon dioxide exchange in RBC. same foods
Phosphate
children higher levels than adults and newborns 2x that of adults. involved in chemical actions of cells and essential for muscle, nerves, and rbc. involved in metabolism of protein, fat, and carbohydrate. absorbed from intestine and found in meat, fish,
Bicarbonate
Primary function is regulating acid-base balance as an essential component of carbonic acid-bicarbonate buffering system. Extracellular levels regulated by the kidneys. excreted if to much is present. doesn't need to be ate is produced through metabolic p
Sodium is regulated by
1 Renal re absorption or excretion and
2 aldosterone increases sodium re absorption in collecting duct of nephrons
Sodium Function is
1 regulating ECF volume and distribution
, 2 maintaining blood volume, and
3 transmitting nerve impulses an contracting muscles
Potassium is regulated by
1 renal excretion and conservation,
2 aldosterone increases potassium excretion,
3 movement into and out of cells,
4 insulin helps move potassium into cells; tissue damage and acidosis shift potassium out of cells into ECF
Potassium functions
1 Maintaining ICF osmolality,
2 transmitting nerve and other electrical impulses,
3 regulating cardiac impulse transmission and muscle contraction,
4 skeletal and smooth muscle function,
5 regulating acid-base balance
calcium regulated by
1 redistribution between bones and ECF and
2 parathyroid hormone and calcitriol increase serum calcium levels;calcitonin decreases serum levels
Calcium functions
1 Blood clotting,
2 nerve impulse transmission,
3 forming bones and teeth,
4 regulating muscle contractions,
5 maintaining cardiac pacemaker automatically,
6 activating enzymes such as pancreatic lipase and phospholipase
Magnesium regulated by:
1 conservation and excretion by kidneys and
2 intestinal absorption increased by vitamin D and parathyroid hormone
Magnesium functions
1 intracellular metabolism,
2 operating sodium-potassium pump,
3 relaxing muscle contractions,
4 transmitting nerve impulses, and
5 regulating cardiac function
Chloride regulated by:
1 excreted and reabsorbed along with sodium in the kidneys and
2 Aldosterone increases chloride reabsorption with sodium
Chloride functions
1 hydrochoric acid (HCl) production,
2 regulating ECF balance and vascular volume,
3 regulating acid-base balance,
4 buffer in oxygen-carbon dioxide exchange in RBCs
Phosphate regulated by:
1 Excretion and reabsorption by kidneys,
2 parathyroid hormone decreases serum levels by increasing renal excretion,
3 reciprocal relationship with calcium: increasing serum calcium levels when decreasing phosphate levels; decreasing serum calcium increas
Phosphate function
1 Forming bones and teeth
2 Metabolizing carbohydrate, protein, and fat
3 Cellular metabolism; producing ATP and DNA
4 Muscle, nerve, and RBC function
5 Regulating acid-base balance
6 Regulating calcium levels
normal serum levels phosphate
2.5-4.5 mg/dL
Bicarbonate regulation
1 Excretion and reabsorption by the kidneys
2 Regeneration by kidneys
Bicarbonate function
Major body buffer involved in acid-base regulation
normal serum levels bicarbonate
24-28 mEq/L
What affects total body water?
age, sex, and body fat
Infants body water content
65%- loose more fluid through the kidney as they are less able to conserve water than adults due to immaturity. Respiration are more rapid and body surface area is greater causing . dehydratequicker and fontanels , weight loss or gain are indicators of fl
60 and older total body water content
50%-normal aging process affect fluid balance by decreased thirst response, antidiuretic hormone level normal or elevated, nephrons less able to conserve water. skin turgor not valid assessment for fluid balance. cardiovascular problems contribute to flui
women total body water content
is lower than men due to more fat and less muscle
newborn total body water
75%
Child total body water
50%- need fluid replacement during vigorous exercise, need to comsume a varity of fluids and limit intake of caffeine
ethnicity and water content
African Americans greater sensitivity which increases the salt content.
diarrhea leads to fluid and electrolyte loss watch for
sodium and chloride loss, evaluate degree of dehydration, educate and respond quickly especially with kids.
Acute hemorrhage leads to fluid imbalance manifested by hypovolemia watch for
fatigue, tachycardia, low hemoglobin and hematocrit. anticipate need for fluid replacement, admin whole blood, packed cells or colloids
Electrolyte loss or excess can lead to change in cognition watch for
confusion and Loss of consciousness. Assess mentation and rule out head trauma.
most common condition of fluid imbalance is
dehydration, in which the body loses more water than it takes in
dehydration or fluid volume deficit manifestations
Dry to tenting skin
Dry mucous membranes
Increased hemoglobin and
hematocrit
Thirst
Decreased urine output
Weight loss
dehydration or fluid volume deficit definition
Fluids are lost secondary to
diarrhea, vomiting, inability to
take in fl uids, excessive
perspiration, or increased
basal metabolic rate due to
fever, hyperthyroidism, or
medications
dehydration or fluid volume deficit interventions
Administer fluids via either the
oral or intravenous route and
treat the underlying cause.
Fluid intake for the average healthy adult should be around
2,500 mL/day, about 1,500 of which comes from drinking fluids; the rest comes from food
The primary regulator of fluid intake is
thirst center in the hypothalamus, which is triggered by decreased volume of ECF or increased osmolality of ECF. After drinking fluid, it takes 30-60 minutes for water to be absorbed into the body, increasing the fluid volume and decreasing the osmolality
The body loses fluid through four routes, which are:
1. Urine: major route of fluid output; volume increases as fluid intake increases, decreases if loss through perspiration is large
2. Insensible fluid loss: not noticeable or measurable, occurs through skin (diffusion and unmeasurable perspiration) and lu
Fluid loss can lead to alterations in thermoregulation due to body losing ability to regulate its loss due to hypovolemia. interventions include.
replace fluids, move to air, shade and possible fluid replacements.
Several mechanisms regulate the volume and composition of body fluids, those being:
Kidneys:
Antidiuretic hormone (ADH):
Renin-angiotensin-aldosterone system:
Atrial natriuretic factor (ANF):
Kidneys:
primary regulator of body fluids and electrolytes; act through selective absorption and excretion of water and electrolytes in urine
Antidiuretic hormone (ADH):
synthesized by the hypothalamus and secreted by the posterior pituitary, regulates water absorption by the collecting ducts of the kidneys and influences urine volume
Renin-angiotensin-aldosterone system:
an enzyme pathway that acts on the blood vessels and nephrons of the kidneys; net effect is restoration of blood volume through sodium and water retention
Atrial natriuretic factor (ANF):
a hormone released by cells in the atrium of the heart; causes water loss and inhibits thirst, reducing vascular volume.
Fluid loss leads to decreased perfusion watch for
pulses equal and present, nail beds, color, body position for comfort, orientation. Admin oxygen as needed and anticipate need for pharmacotherapy to improve cardiac output.
assessment for fluid imblance to identify underlying source of imbalance and address potential complications check for
vital signs, intake and output, daily weights, skin turgor, mentation
Modifiable risk factors for fluid imbalance
Stress, medications, heat related illnesses
Stress and fluid imbalance
increased cellular metabolism, blood glucose concentration, catecholamine levels, increases production of ADH which decreases urine production
Medications and fluid imbalances
diuretics, antipsychotic agents affect thirst mechanism, vasoconstrictors, beta-blockers, stimulants increase risk for fluid imbalance affects thermoregulation
prevention of heat related illness begins with education. educate client on
1 limit outdoor activity during hottest part of the day
2 take frequent breaks for rest and water
3 drink water before they begin to feel thirsty
4 wear lightweight clothes
5 work or exercise with others when engaging in activity outside
questions
Qs
An emergency room nurse is assessing a client who overhydrated during a marathon. Which assessment is essential for the nurse to perform during the physical? examination? (Select all that? apply.)
A. Lung sounds
B. Eye accommodation
C. Teeth
D. Level of c
A, D, E
The student nurse is assisting the nurse in administering intravenous normal saline to a dehydrated client. The nurse explains to the student that active transport is essential in maintaining sodium and potassium ion concentrations in the? body's fluid co
D. ?"Unlike diffusion, active transport moves solutes from a solution with a lower concentration of solutes to a more concentrated? solution."
Rationale
Unlike? diffusion, active transport moves solutes against their concentration gradients from a solutio
The nurse is performing an assessment on a client who has had nothing by mouth since the previous evening. Which manifestation related to the? client's fluid restriction would be of concern to the? nurse? (Select all that? apply.)
A. Dry mucous membranes
A. Dry mucous membranes
B. Tenting skin
C. Increased hematocrit
Rationale
Oral fluid restriction can cause dehydration. The nurse should monitor for manifestations of dehydration such as dry mucous? membranes, increased? hematocrit, and tenting skin. Edem
The nurse is caring for a client with hyponatremia. What are independent interventions that the nurse can perform to help manage the? client's electrolyte? imbalance? (Select all that? apply.)
A. Involve client in meal planning
B. Administer oral sodium s
A. Involve client in meal planning
D. Monitor intake and output
E. Weigh client daily
Rationale
Monitoring intake and? output, weighing the client? daily, and involving the client in meal planning are all independent interventions that the nurse can perfo
The nurse is caring for a client with a fluid volume deficit. Which nursing intervention addresses the? client's potential for poor? perfusion?
A. Monitoring for signs of blood loss
B. Checking client?'s temperature
C. Administering whole blood
D. Assessi
D. Assessing? client's nail beds
Rationale
Fluid and electrolyte balance is related to several nursing? concepts, including? perfusion, cellular? regulation, and cognition. Fluid volume loss can lead to decreased? perfusion, so the nurse should assess? pu
A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for what therapy to help drive potassium back into the cells prior to? dialysis?
A. Insulin
B. Antidiuretic hormone
C. Potassium supplements
D. Blood transfusion
A. Insulin
Rationale
Glucose and insulin are administered to the client with hyperkalemia to help drive potassium back into the intracellular? fluid, reducing the amount of potassium in the blood. Potassium supplements would only increase the? client's po
The nurse is administering a blood transfusion to a client who is hemorrhaging. The nurse identifies that the client is experiencing a deficit in which body fluid? compartment?
A. Interstitial fluid
B. Intracellular fluid
C. Transcellular fluid
D. Intrava
D. Intravascular fluid
Rationale
Blood loss causes a deficit in the intravascular fluid? compartment, which is a subcompartment of extracellular fluid? (ECF). Transcellular and interstitial? fluids, along with? lymph, make up the other compartments of ECF
An emergency room nurse is assessing a client who overhydrated during a marathon. Which assessment is essential for the nurse to perform during the physical? examination? (Select all that? apply.)
Lung sounds
Eye accommodation
Teeth
Level of consciousness
...
The community health nurse is performing health screenings at a homeless shelter. When assessing for fluid and electrolyte? imbalances, which question is most important for the nurse to? ask?
?A. "Are you currently being treated for joint? problems?"
?B.
?D. "Describe what you eat and drink on a typical? day
Rationale
It is important for the nurse to consider socioeconomic factors affecting food and fluid intake when assessing a? client's risk for fluid and electrolyte? imbalances, especially with a vulne