fluid, electrolyte, and acid- base imbalances chapter 17 overview copyright © 2011, 2007 by mosby,...
TRANSCRIPT
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Fluid, Electrolyte, and Acid-Base Imbalances
Chapter 17 Overview
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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Water Content of Body
•Body Fluid Compartments
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Water Content of Body
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Fig. 17-2. Relative volumes of three body fluids. Values represent fluid distribution in a young male adult.
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Electrolytes
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Fig. 17-3. Electrolyte content of fluid compartments.
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Mechanisms Controlling Fluid and Electrolyte
Movement•Diffusion
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Mechanisms Controlling Fluid and Electrolyte
Movement
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Fig. 17-4. Diffusion is the movement of molecules from an area of high concentration to an area of lowconcentration. Eventually the sugar molecules are evenly distributed.
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Mechanisms Controlling Fluid and Electrolyte
Movement•Facilitated Diffusion•Active Transport
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Mechanisms Controlling Fluid and Electrolyte
Movement
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Fig. 17-5. Sodium-potassium pump. As sodium (Na+) diffuses into the cell and potassium (K+) diffuses out of thecell, an active transport system supplied with energy delivers Na+ back to the extracellular compartment and K+ tothe intracellular compartment. ATP, Adenosine triphosphate.
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Mechanisms Controlling Fluid and Electrolyte
Movement•Osmosis
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Mechanisms Controlling Fluid and Electrolyte
Movement
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Fig. 17-6. Osmosis is the process of water movement through a semipermeable membrane from an area of lowsolute concentration to an area of high solute concentration.
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Mechanisms Controlling Fluid and Electrolyte
Movement•Osmosis, continued
Measurement of osmolality Osmotic movement of fluids
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Mechanisms Controlling Fluid and Electrolyte
Movement
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Fig. 17-7. Effects of water status on red blood cells. A, Hypotonic solution (H2O excess) results in cellularswelling. B, Isotonic solution (normal H2O balance) results in no change. C, Hypertonic solution (H2O deficit)results in cellular shrinking.
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Mechanisms Controlling Fluid and Electrolyte
Movement• Hydrostatic Pressure• Oncotic Pressure
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Fluid Movement in Capillaries
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Fig. 17-8. Dynamics of fluid exchange between a capillary and tissue. An equilibrium exists between forces filteringfluid out of the capillary and forces absorbing fluid back into the capillary. Note that the hydrostatic pressure isgreater at the arterial end of the capillary than at the venous end. The net effect of pressures at the arterial end ofthe capillary causes a movement of fluid into the tissue. At the venous end of the capillary, there is net movementof fluid back into the capillary.
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Fluid Movement in Capillaries
•Fluid Shifts Shifts of plasma to interstitial fluid
•Elevation of venous hydrostatic pressure
•Decrease in plasma oncotic pressure•Elevation of interstitial oncotic pressure
Shifts of interstitial fluid to plasma
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Regulation of Water Balance
•Hypothalamic Regulation•Pituitary Regulation•Adrenal Cortical Regulation
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Regulation of Water Balance
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Fig. 17-9. Factors affecting aldosterone secretion. ACTH, Adrenocorticotropic hormone.
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Regulation of Water Balance
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Fig. 17-10. Effects of stress on fluid and electrolyte balance. ACTH, Adrenocorticotropic hormone; ADH,antidiuretic hormone; CRH, corticotropin-releasing hormone.
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Regulation of Water Balance
•Renal Regulation•Cardiac Regulation•Gastrointestinal Regulation
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Regulation of Water Balance
• Insensible Water Loss
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Gerontologic Considerations
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Fluid and Electrolyte Imbalances
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Calcium Imbalances
•Hypercalcemia
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Calcium Imbalances
•Hypocalcemia
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Magnesium Imbalances
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Fig. 17-10. Effects of stress on fluid and electrolyte balance. ACTH, Adrenocorticotropic hormone; ADH,antidiuretic hormone; CRH, corticotropin-releasing hormone.
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Acid-Base Imbalances
•pH and Hydrogen Ion Concentration
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Acid-Base Imbalances
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Table 17-11. Terminology Related to Acid-Base Physiology.
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Acid-Base Imbalances
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Fig. 17-6. Osmosis is the process of water movement through a semipermeable membrane from an area of lowsolute concentration to an area of high solute concentration.
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Acid-Base Imbalances
•Acid-Base Regulation Buffer system Respiratory system Renal system
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Acid-Base Imbalances
•Alterations in Acid-Base Balance Respiratory acidosis
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Acid-Base Imbalances
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Fig. 17-17. Kinds of acid-base imbalances. A, Respiratory imbalances caused by carbonic acid (CA) excess andcarbonic acid deficit. B, Metabolic imbalances caused by base bicarbonate (BB) deficit and base bicarbonateexcess.
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Acid-Base Imbalances
•Alterations in Acid-Base Balance, continued Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Mixed acid-base disorders
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Acid-Base Imbalances
•Clinical Manifestations Blood gas values
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Acid-Base Imbalances
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Table 17-15. Normal Arterial Blood Gas Values *
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Acid-Base Imbalances
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Table 17-16. Arterial Blood Gas (ABG) Analysis.
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Assessment of Fluid, Electrolyte, and Acid-Base
Imbalances•Subjective Data
Important health information•Past health history•Medications•Surgery or other treatments
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Assessment of Fluid, Electrolyte, and Acid-Base
Imbalances•Subjective Data, continued
Functional health patterns•Health perception–health management pattern
•Nutritional-metabolic pattern•Elimination pattern•Activity-exercise pattern•Cognitive-perceptual pattern
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Assessment of Fluid, Electrolyte, and Acid-Base
Imbalances•Objective Data
Physical examination Laboratory values
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Oral Fluid and Electrolyte Replacement
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Intravenous Fluid and Electrolyte Replacement
•Solutions Hypotonic Isotonic Hypertonic Intravenous additives Plasma expanders
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