nur 102 - chapter 14 fluid and electrolytes
TRANSCRIPT
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FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
NUR 102 - Chapter 14
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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)
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Body fluids
Intracellular fluids (ICF)• Liquids within cell membranes
• 40% of body weight
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Components in body fluids
Electrolyte• an element that when dissolved can carry an
electrical current
• Cations - (+) ; Anions - (-)
• neuromuscular function
• acid-base balance
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Components of body fluids
Minerals• ingested compounds
• serve as catalysts in nerve response, muscle contraction, and metabolism of nutrients in foods, regulate electrolyte balance
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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
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Osmotic pressure
Drawing power of water (dependent on the number or molecules in solution)• Isotonic
• Hypotonic
• Hypertonic
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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
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Fluid Intake
Hypothalamus - thirst control center Oral fluid intake requires an alert state Osmoreceptors - monitor osmolality
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Fluid Output
Loss through the kidneys and GI tract Insensible Sensible
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Cations
Sodium (Na+)• Most abundant in the extracellular fluid
• Maintains water balance, transmits nerve impulses, contracts muscles
• Values - 135-145 mEq/L
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Cation
Potassium (K+)• Major intracellular cation
• Regulates neuromuscular excitability, muscular contraction, and acid-base
• Value - 3.5 -5.3 mEq/L
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Cation
Calcium (Ca2+)• Cardiac conduction, blood coagulation, bone
growth and formation, & muscular relaxation
• Value - 4 - 5 mEq/L
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Cation
Magnesium (Mg2+)• Second most important of intracellular fluids
• Enzyme activities, muscular excitability
• Value - 1.5 - 2.5 mEq/L
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Electrolyte Imbalances
Hyponatremia • GI losses, sweating, & diuretics
• S/S: N/V/D, abd cramps, personality change
Hypernatremia• Ingestion of large amounts
• S/S: Dry tongue and mucous membranes, restlessness, convulsions, thirst, dry skin
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Electrolyte imbalances
Hypokalemia Causes: K+ wasting diuretics N/V/D polyuria S/S: weak, irregular pulse
• hypotension
• weakness
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Electrolyte imbalances
Hyperkalemia• Causes: Renal failure
• S/S: irregular slow pulse, weakness, irritability
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Electrolyte Imbalances
Hypocalcemia• Causes: Vitamin D deficiency
• S/S: Numb and tingling fingers and circumoral region, muscle cramps
Hypercalcemia• Causes: osteoporosis, prolonged
immobilization
• S/S: decreased muscle tone, weakness, lethargy, kidney stones
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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
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Acid - Base Balance
Blood pH - 7.35 - 7.45 paCO2 - 35 - 45 Bicarbonate (HCO3) - 22-26 mEq/L
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Respiratory Acidosis
pH < 7.35 paCO2 > 45 mm Hg Causes: Respiratory failure Hypoventilation Resp muscles paralysis Airway obstruction
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Respiratory Alkalosis
pH > 7.45 paCO2 < 35 mm Hg Causes: excessive exhalation of CO2
(hyperventilation)
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Metabolic Acidosis
pH < 7.35 bicarbonate - < 22 mEq/L Causes: Starvation, DKA, Diarrhea, drug
use
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Metabolic Alkalosis
pH > 7.45 bicarbonate > 26 mEq/L Causes: excessive vomiting, prolonged
gastric suctioning
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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
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S/S electrolyte imbalance
Head: irritability Fontanels: depressed, bulging Eyes: sunken
periorbital edema
Mouth: mucous membranes CV: neck veins, edema, blood pressure Resp: Crackles
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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
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Replacement of fluids and electrolytes
Types of IV fluids Isotonic Hypertonic Hypotonic
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IV complications
Infiltration • IVF enter SQ space
Phlebitis• vein inflammation
• S/S: pain, redness, warmth
Fluid overload• Fluids given too rapidly
Bleeding
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Discontinuing an IV
Stop infusion Remove tape 1 - 2 minute pressure
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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
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Transfusion Reactions
Caused by: • blood incompatibility
• allergic sensitivity
• S/S: fever, chills, rash, hypotension, shock
Treatment: stop transfusion, give NS, save tubing, prepare for emergency drugs