NUR 102 Chapter 14 Fluid and Electrolytes webpage

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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 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 Calcium (Ca2+) Cardiac conduction, blood 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: 

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 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

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