FLUID, ELECTROLYTE, AND ACID-BASE BALANCE : FLUID, ELECTROLYTE, AND ACID-BASE BALANCE NUR 102 - Chapter 14
Body fluids : 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 : Body fluids Intracellular fluids (ICF)
Liquids within cell membranes
40% of body weight
Components in body fluids : Components in body fluids Electrolyte
an element that when dissolved can carry an electrical current
Cations - (+) ; Anions - (-)
neuromuscular function
acid-base balance
Components of body fluids : 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 : 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 : Osmotic pressure Drawing power of water (dependent on the number or molecules in solution)
Isotonic
Hypotonic
Hypertonic
Movement of body fluids : 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 : Fluid Intake Hypothalamus - thirst control center
Oral fluid intake requires an alert state
Osmoreceptors - monitor osmolality
Fluid Output : Fluid Output Loss through the kidneys and GI tract
Insensible
Sensible
Cations : Cations Sodium (Na+)
Most abundant in the extracellular fluid
Maintains water balance, transmits nerve impulses, contracts muscles
Values - 135-145 mEq/L
Cation : Cation Potassium (K+)
Major intracellular cation
Regulates neuromuscular excitability, muscular contraction, and acid-base
Value - 3.5 -5.3 mEq/L
Cation : Cation Calcium (Ca2+)
Cardiac conduction, blood coagulation, bone growth and formation, & muscular relaxation
Value - 4 - 5 mEq/L
Cation : Cation Magnesium (Mg2+)
Second most important of intracellular fluids
Enzyme activities, muscular excitability
Value - 1.5 - 2.5 mEq/L
Electrolyte Imbalances : 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
Electrolyte imbalances : Electrolyte imbalances Hypokalemia
Causes: K+ wasting diuretics
N/V/D
polyuria
S/S: weak, irregular pulse
hypotension
weakness
Electrolyte imbalances : Electrolyte imbalances Hyperkalemia
Causes: Renal failure
S/S: irregular slow pulse, weakness, irritability
Electrolyte Imbalances : 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
Electrolyte imbalances : 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 : Acid - Base Balance Blood pH - 7.35 - 7.45
paCO2 - 35 - 45
Bicarbonate (HCO3) - 22-26 mEq/L
Respiratory Acidosis : Respiratory Acidosis pH < 7.35
paCO2 > 45 mm Hg
Causes: Respiratory failure
Hypoventilation
Resp muscles paralysis
Airway obstruction
Respiratory Alkalosis : Respiratory Alkalosis pH > 7.45
paCO2 < 35 mm Hg
Causes: excessive exhalation of CO2 (hyperventilation)
Metabolic Acidosis : Metabolic Acidosis pH < 7.35
bicarbonate - < 22 mEq/L
Causes: Starvation, DKA, Diarrhea, drug use
Metabolic Alkalosis : Metabolic Alkalosis pH > 7.45
bicarbonate > 26 mEq/L
Causes: excessive vomiting, prolonged gastric suctioning
Fluid & Electrolyte Imbalances : 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 : 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 : 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 : Replacement of fluids and electrolytes Types of IV fluids
Isotonic
Hypertonic
Hypotonic
IV complications : IV complications Infiltration
IVF enter SQ space
Phlebitis
vein inflammation
S/S: pain, redness, warmth
Fluid overload
Fluids given too rapidly
Bleeding
Discontinuing an IV : Discontinuing an IV Stop infusion
Remove tape
1 - 2 minute pressure
Blood transfusions : 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 : 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