FLUID, ELECTROLYTE, AND ACID
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Transcript FLUID, ELECTROLYTE, AND ACID
FLUID, ELECTROLYTE,
AND ACID-BASE BALANCE
NUR 102 - Chapter 14
Body fluids
Extracellular fluids (ECF)
• Interstitial fluid - fills the spaces between most
•
cells of the body
Intravascular fluid - plasma (WBC, RBC and
platelets in this fluid)
Body fluids
Intracellular fluids (ICF)
• Liquids within cell membranes
• 40% of body weight
Components in body fluids
Electrolyte
• an element that when dissolved can carry an
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•
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electrical current
Cations - (+) ; Anions - (-)
neuromuscular function
acid-base balance
Components of body fluids
Minerals
• ingested compounds
• serve as catalysts in nerve response, muscle
contraction, and metabolism of nutrients in
foods, regulate electrolyte balance
Movement of body fluids
Diffusion
• Area of higher concentration to an area of
lower concentration till even distribution
Osmosis
• Movement of a pure solvent, e.g. water
through a semipermeable membrane from a
solution that has a lower solute concentration
to one that has a higher solute concentration
Osmotic pressure
Drawing power of water (dependent on
the number or molecules in solution)
• Isotonic
• Hypotonic
• Hypertonic
Movement of body fluids
Filtration
• Water and diffusible substances move
together in response to fluid pressure
Active transport
• Requires energy
• Able to move larger molecules and go from
less to greater concentration
Fluid Intake
Hypothalamus - thirst control center
Oral fluid intake requires an alert state
Osmoreceptors - monitor osmolality
Fluid Output
Loss through the kidneys and GI tract
Insensible
Sensible
Cations
Sodium (Na+)
• Most abundant in the extracellular fluid
• Maintains water balance, transmits nerve
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impulses, contracts muscles
Values - 135-145 mEq/L
Cation
Potassium (K+)
• Major intracellular cation
• Regulates neuromuscular excitability,
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muscular contraction, and acid-base
Value - 3.5 -5.3 mEq/L
Cation
Calcium (Ca2+)
• Cardiac conduction, blood
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coagulation, bone
growth and formation, & muscular relaxation
Value - 4 - 5 mEq/L
Cation
Magnesium (Mg2+)
• Second most important of intracellular fluids
• Enzyme activities, muscular excitability
• Value - 1.5 - 2.5 mEq/L
Electrolyte Imbalances
Hyponatremia
Hypernatremia
• GI losses, sweating, & diuretics
• S/S: N/V/D, abd cramps, personality change
• Ingestion of large amounts
• S/S: Dry tongue and mucous membranes,
restlessness, convulsions, thirst, dry skin
Electrolyte imbalances
Hypokalemia
Causes: K+ wasting diuretics
N/V/D
polyuria
S/S: weak, irregular pulse
• hypotension
• weakness
Electrolyte imbalances
Hyperkalemia
• Causes: Renal failure
• S/S: irregular slow pulse, weakness, irritability
Electrolyte Imbalances
Hypocalcemia
• Causes: Vitamin D deficiency
• S/S: Numb and tingling fingers and circumoral
region, muscle cramps
Hypercalcemia
• Causes: osteoporosis, prolonged
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immobilization
S/S: decreased muscle tone, weakness,
lethargy, kidney stones
Electrolyte imbalances
Hypomagnesemia
• Causes: malnutrition and alcoholism polyuria
• S/S: muscular tremors, hyperactive deep
tendon reflexes
Hypermagnesemia
• Causes: Renal failure
• S/S: hypoactive deep tendon reflexes, shallow
and slow respirations
Acid - Base Balance
Blood pH - 7.35 - 7.45
paCO2 - 35 - 45
Bicarbonate (HCO3) - 22-26 mEq/L
Respiratory Acidosis
pH < 7.35
paCO2 > 45 mm Hg
Causes: Respiratory failure
Hypoventilation
Resp muscles paralysis
Airway obstruction
Respiratory Alkalosis
pH > 7.45
paCO2 < 35 mm Hg
Causes: excessive exhalation of CO2
(hyperventilation)
Metabolic Acidosis
pH < 7.35
bicarbonate - < 22 mEq/L
Causes: Starvation, DKA, Diarrhea, drug
use
Metabolic Alkalosis
pH > 7.45
bicarbonate > 26 mEq/L
Causes: excessive vomiting, prolonged
gastric suctioning
Fluid & Electrolyte Imbalances
Burns - body fluid loss
Renal D/O - abnormal retention of Na,
Cl, K
GI Disturbances - Loss of fluid,
potassium, and chloride
Exercise
S/S electrolyte imbalance
Head: irritability
Fontanels: depressed, bulging
Eyes: sunken
periorbital edema
Mouth: mucous membranes
CV: neck veins, edema, blood pressure
Resp: Crackles
Imbalances
GI: abdomen, V/D
Renal: Oliguria or anuria (FVD, FE)
Diuresis (FVE)
Increased urine spec. gravity (FVD)
Skin (Temp)
• increased - met acidosis, hypernatremia
• decreased - FVD
Replacement of fluids and
electrolytes
Types of IV fluids
Isotonic
Hypertonic
Hypotonic
IV complications
Infiltration
Phlebitis
Fluid overload
Bleeding
• IVF enter SQ space
• vein inflammation
• S/S: pain, redness, warmth
• Fluids given too rapidly
Discontinuing an IV
Stop infusion
Remove tape
1 - 2 minute pressure
Blood transfusions
Large bore catheter (18 ga or larger)
Give with normal saline
Baseline vital signs
Double check with two RNs
Begin transfusion slowly
Observe closely for first 15 min
Transfusion Reactions
Caused by:
Treatment: stop transfusion, give NS,
save tubing, prepare for emergency
drugs
• blood incompatibility
• allergic sensitivity
• S/S: fever, chills, rash, hypotension, shock