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 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