NURS 3150 fluids and lytes narrated

Slide 1:

Fluid Balance Distribution A. intracellular-fluid in the cells (ICF=40% total body weight B. extracellular (ECF=20% TBW) 1) interstitial-lymph-fluid between cells but outside blood vessels 2) intravascular*-plasma (in which blood cells move) 3) transcellular-CSF, pleural, peritoneal, synovial

Slide 2:

Composition Electrolytes-when dissolved in H2O, dissociates into ions a. ions-carry an electrical charge 1. cations -positively charged ions (Na+, K+, Ca++) 2. anions-negatively charged ions ( Cl -, HCO3-, SO4-) b. measured in milli -equivalents/Liter (mEq/L)-# of Gms of the ‘ lyte (solute) dissolved in a liter of plasma (solvent). Together these 2 make up a solution

Slide 3:

Minerals a. ingested as compounds b. constituents found in all body fluids c. important in maintaining all physiologic processes d. acts as catalyst in nerve response, muscle contraction, & metabolism of nutrients in foods e. regulates electrolyte balance & hormone production & strengthens skeletal structures

Slide 4:

Movement of Fluids A. osmosis-movement of a solvent from an area of lesser solute concentration to an area of higher solute concentration (see Figure 41-1 p. 968) 1) osmotic pressure-provides the drawing power for water and is dependent on the # of particles present in solution

Slide 5:

Osmosis (cont) 2) osmolarity-the osmotic pressure of a solution expressed in osmoles or milli- osmoles/Liter. It is the measure used to evaluate blood serum/plasma and urine. Normal serum osmolarity is 280-295 mOsm/L a) pressure is affected by plasma b) proteins (esp. albumin) exert colloid osmotic or oncotic pressure which provides the “pulling power” in blood plasma. This pressure keeps fluid in the intravascular space & exerts the pressure to pull fluids from the interstitial space back into the intravascular space.

Slide 6:

Osmosis (cont) 3. Tonicity-a measure of osmolarity or concentration of fluids. 1) isotonic-same osmolarity as blood plasma/serum ; N/S-expands intravascular volume w/o a fluid shift 2) hypertonic-solution w/ a higher concentration r/t body fluids; fluid shifts from the cells to the blood and cells shrink 3) hypotonic-solution w/ a lower concentration r/t body fluids; fluid shifts from the blood to the cells and the cells expand

Slide 7:

Movement of Fluids (cont.) Diffusion-movement of a solute (solid r gas) from an area of increased concentration to an area of lesser concentration. The difference between the 2 fluids is called a concentration gradient & it provides a difference in pressure that drives the movement of solutes. (see figure 41-2 p. 968)

Slide 8:

Movement of Fluids (cont) C. Filtration -process by which BOTH H2O & diffused substances move together from an area of higher concentration to an area of lower concentration. Impetus to move is provided by differences in pressure exerted by the water (hydrostatic pressure) –more active in capillary beds where capillary walls are very thin & H2O shifts easily into the interstitial space. This is also referred to as “third spacing” since fluid is neither in the intracellular nor intravascular space, but in the interstitial 3 rd space. (see Figure 41-3 , p. 969)

Slide 9:

Movement of Fluids (cont) Active Transport- requires an expenditure of energy to move materials across membranes-allows movement of larger molecules than normally move by other processes. Direction of movement is from lower to higher concentrations. Molecules are bound to a “carrier” and powered by ATP. (see figure 41-4 ; p. 969)

Slide 10:

Regulation of Body Fluids A. Fluid regulation is through fluid intake (oral & otherwise), hormonal controls, & fluid output. Balance is called homeostasis. 1. fluid intake-regulated by osmoreceptors , the hypothalamus, the RAA mechanism/cascade, K+ depletion, psychological factors, & orophyrngeal dryness. 2. hormonal control-please review these from your A&P a) ADH b) renin-aldosterone-angiotensin ( RAA)mechanism c) ANF

Slide 11:

Regulation of Body Fluids (cont) Fluid output a. fluid lost through the kidneys/ lungs/ GI tract/skin b. regulated by the sympathetic nervous system c. loss is either: 1) insensible -undetectable loss of fluid; not perceived by the individual-skin, lungs 2) sensible -detectable loss of fluid- profuse sweating, etc.

Slide 12:

Regulation of Electrolytes Cations - 1. Na+-most abundant cation in the ECF; regulated by dietary intake and aldosterone secretion; normal serum Na+- 135-145 mEq/L 2. K+-major cation in ICF; small amount in ECF; normal plasma/serum levels-3.5- 5.0 mEq/L; regulated primarily by nutritional intake & renal output— easily lost and is not conserved by the body

Slide 13:

Regulation of Electrolytes (cont.) Ca++- stored primarily in bone; only 1% located in the blood—of that amount, 50% is bound to proteins & 40% is in ionized state. Normal ionized serum Ca++-4.5-5.5; normal total Ca++- 8.5-10.5; regulated by thyroid gland Mg++- found primarily in ICF; regulated by dietary intake & parathyroid gland

Slide 14:

Regulation of Electrolytes (cont.) Anions 1. Cl - major anion in ECF; usually follows Na+, so if one is abnormal, the other will be also. Regulated by dietary intake & kidneys; normal serum Cl - is 90-110 mEq/L 2. HCO3 - major body pH buffer; essential component of the acid-base body system; helps maintain normal blood pH; usual measure is drawn from an artery & ranges from 22-26 mEq/L. if a venous sample is drawn, the value is reflected as blood CO2; normal ranges are 24-30 mEq/L

Slide 15:

Regulation of Electrolytes (cont.) 3. PO4 -3 ; phosphates-a buffer anion primarily found in ICF w/ a small amount in the ECF. Assists in acid- base system to maintain body pH. Ca ++ & PO4 -3 usually move together; however , proportions are inverse; that is when one is up, the other is down and vice-versa. Regulated by nutritional intake, intestinal absorption , renal excretion, & PTH from the parathyroid gland.

Slide 16:

Regulation of Acid-Base Balance You MUST read and understand how the body regulates acid-base levels and what the roles are for chemical, biological, and physiological regulation activities.You will need to know and understand: a. what is the relationship of H+ ions to acid-base levels b. what is a buffer and what is its role c. what are the mechanisms of action for biologic buffering c. what are the roles of the kidneys and lungs in maintaining acid-base balance

Slide 17:

Fluid, electrolyte & acid-base Imbalances Please look at the boxes on pps . 973-977 in your book and be familiar with the conditions that are listed. You will encounter them all at some time during your clinicals . You MUST know & understand: a) what disease conditions tend to predispose patients to each imbalance b ) what the lab values are for each (esp. PANIC values-see your lab manual); c) what health related actions are taken to correct each; d) what medications may contribute to &/or help to correct the imbalance; e) what is the nurse’s role in patient care.

Slide 18:

Patient care It is important to approach patient care keeping in mind the use of the nursing process as the basis for care. Assessment Look at the sections discussed in your book paying special attention to the boxes on pps.980-982 and the lab values on p.984 for areas that need to be assessed for patients who may have a medical diagnosis consistent with actual or risk for fluid, electrolyte, or acid-base imbalances

Slide 19:

Nursing diagnosis When formulating diagnoses for patients w/ these problems, you must look at the data that you have collected, cluster it, and formulate a nursing diagnosis that fits the cluster of assessment factors you have collected. Your book gives a representative list of possible diagnoses for these patients on p. 987. This is not an exhaustive list, but only a representative one. There may be others you may need to use that are not listed. Refer to your nursing diagnosis book for other possible diagnoses.

Slide 20:

Planning care On p. 987, the diagram shows the next step in the process. As the nurse, you will be involved in all those activities listed in the center box when designing your plan of care . Your plan should be prioritized based on your assessment data. You will then establish an expected outcome taking into account priorities and continuity of care. Next, you should list actions or strategies to accomplish this stated outcome and implement them. Your book lists some suggested strategies for care that may be helpful. Again, this is not all there is.

Slide 21:

Implementation of care The next phase is to carry out the plan as established. Your book covers a lot of ground discussing insertion, maintenance and troubleshooting if IV lines, the administration of fluids and blood/blood products, and IV line dressings. Please be familiar with the list of IVFs on p. 992. Please pay careful attention to the box on p. 1023 re: blood reactions. You will see this information again and may be called upon to monitor blood administration in the clinical area. Other interventions are also listed—again not an exhaustive list.

Slide 22:

Evaluation and Revision of care It is especially important to continue to monitor and carry out interventions on patients who are being treated for fluid/electrolyte & acid-base imbalances. Since your care is ongoing, you will be monitoring and making changes/adjustments to your interventions continuously while again evaluating the responses you assess taking place during care & treatment.

Slide 23:

Activities Please look at the case scenario in your book on p. 1026-27 . Answer the questions with this scenario. Additionally list a) assessment factors, b) a nursing diagnosis, c) an expected outcome and d) strategies or interventions for this Also, look at the questions on pp. 1027 and answer each.