Terry White, MBA, BSN

Body fluid and electrolyte:

About 46 to 6o % of the average adult weight is water.

Medium of metabolic reaction with cells.Transporter for nutrients, waste products,

and other substance.A lubricant.Shock absorber.Regulate and maintain body temperature.

Water may serve as:

The proportion of water decreases with aging because fat, age and sex effect of total body water. (Infant 70 – 80%).

The body fluid divided in two major compartments:A) Intracellular fluid (ICF): Is found in the cells of the body. its constitute 2/3 of the total body fluid in the adult.

Distribution of body fluids:

b) Extracelluar fluid (ECF): is found out side of cell and account 1/3 of the total body fluid.it’s subdivided into three compartments:1) Intravascular fluid or plasma: is found within vascular system.2) Interstitial fluid: is found surrounding the cell and includes lymph.3) Transcellular: includes cerebrospinal fluid, pleural, peritoneal and synovial fluid.

Composition of Fluids

plasma interstitial intracellularCationsNa 140 146 12K 4 4 150Ca 5 3 10Mg 2 1 7AnionsCl 103 104 3HCO 24 27 10SO4 1 1 -HPO4 2 2 116Protein 16 5 40

Function of ICF & ECF:ICF: is vital to normal cell function, its contain solutes such as oxygen, electrolytes and glucose. It provides a medium to metabolic process.ECF: it is the transport system that carries nutrients and waste product from the cell.

1. Osmosis: Is the movement of water across

cell membranes, from the less concentrated solution to more concentrated solution. In other word water move toward higher concentration.

Movement of body fluid and electrolyte:

•Solutes are substance dissolved in liquid.•Crystalloid: salts that dissolved readily in to true solution.•Colloids: substance such as large protein molecules that do not dissolved in true solution.

Sodium is the major determinant of serum osmolality.

2. Diffusion: Is the continual intermingling of

molecules in liquid, gases by random movement of the molecules.

3. Filtration: Is the process where by fluid and

solutes moved together across a membrane from one compartment to another.

4. Active transport: substance can move across cell

membranes from a less concentrated solution to amore concentrated one by active transport.

Regulating body fluid:

The average adult drinks about 1500ml per day, but need to 2500ml per day, this added volume is acquired by the food.The thirst center is located in the brain, this center trigger by osmotic pressure and angiotensin II .

Hormonal regulation

Regulation of ECF

Urine: normal urine out put 1500ml per 24hrs or at least 30ml per hours.Insensible loss: through the skin as perspiration and through the lung a water vapor in the expired air.Loss through the intestine (feces)

Fluid out put:

Obligatory losses: approximately 500ml of fluid must be exerted through the kidney to eliminate metabolic waste product and feces, respiration and perspiration to maintain body temperature.

The average daily fluid out put for an adult 2500ml/ day.

Post operative client.Client with sever trauma or burn.

Client with chronic disease as congestive heart failure.

Client who are NPO.Client with intravenous infusion.

Client with special drainage.Client who receiving diuretic

Client at risk for fluid and electrolyte imbalance:

Age: infant have greater water need and greater loss due to greater metabolic rate.

Environment: excess heat stimulates the sympathetic nervous system and cause person to sweat.

Factor effecting fluid and electrolyte balance:

Diet: in nutritional deficiency, the body preserved the protein by breaking down the fat and glycogen.Stress: water retention and increase the production antiduritic hormone.Illness: burn, renal disorder

Disturbances in fluid and electrolyte:

Hypovolemia: decrease blood volumeHypovolemic shock when intravascular fluid is depleted.Hypervolimia: increase blood volume.

Edema: is collection of fluids in the tissue. Type of edema:Dependent edma: found in the lowest part body.Pitting edma: edema that leaves a depression or pit after finger pressure is applied on the swollen area.

Pitting odema

Sodium (Na):Is the most abundant cation in the extracelluar fluid and major contributor to serum osmolality.Function of sodium:controlling and regulating water balance.Maintaining blood volume Transmitted nerve impulses.

Normal level is 135 – 145 mg/dl.Hyponatremia: sodium deficit in the blood.Hypernatremia: sodium excess in the blood. Sodium is found in many foods, such as processed cheese, table salt.

Potassium:Is the major cation in intracellular fluid.Function of potassium:Maintain ICF osmolality.Transmitting nerve impulses.Regulate cardiac impulses.Skeletal and smooth muscle function.Regulate acid base balance

•Potassium is found in many fruits and vegetables, meat, fish, milk.•Normal level of potassium is 3.5 – 5.3meq/l.•Hypokalemia: potassium deficit in the blood.•Hyperkalemia: potassium excess in the blood.

Hypocalcemia: calcium deficit in the blood.Hypercalcemia: calcium excess in the blood.

Vomiting.Diarrhea.

Excessive sweating.Ployuria.

Fever.Nasogastric suction.Abnormal drainage.

Anorexia.Nausea

Impaired swallowing.

Loss of water and electrolyte:

Skin: dry pale, cool skin, reduce skin Turgor. Oral cavity: dry mucous membrane, absence of salivation.Weak rapid pulse.Decreased blood pressure.Decreased central venous pressure

Finding associated with fluid and electrolyte imbalance:

Decreased urine out put.Increased hematocrit.Thirst.Flat neck vein.

Excess intake of sodium – containing intravenous fluid.Excess of ingestion of sodium in diet.Heart failure.Renal failure.Liver cirrhosis.

Fluid volume excess:

Weight gain.Fluid intake greater than out put.

Moist mucous membrane.Tachycardia.

Increased blood pressure.Distended neck vein.

Dyspnea and crackles.Mental confusion.

Clinical manifestation:

Acid – Base Balance

Assessment:•Nursing history:Date include fluid and food intake, output.Recent fluid losses.Sign of fluid deficit.Common sign of electrolyte disturbance.Medication.

Nursing care plan

Clinical measurement:

• Daily weights, vital sign, fluid intake and output (I&O), serum electrolyte, complete blood count (CBC). Serum osmolality, urine specific gravity.

Fluid volume deficit related to dehydration.Fluid volume excess related to heart failure.Altered oral mucous membrane related to fluid volume defects.Impaired skin integrity related to dehydrationDecreased cardiac output related to hypovolemia.Altered tissue perfusion related to decreased cardiac output.

Nursing diagnosis:

Assess clinical manifestation of hypo or Hypervolimia. Provide fluid and electrolyte orally.Foods.Intravenous therapy can prescribed for those reason Provide salts if needed.Provide glucose for metabolism.Provide water soluble vitamins

Implementation:

Monitor intake & output.Monitor lapratory finding.Provide frequent oral care.Monitor weight.Assess for edma.Place patient in fowler position.Assess breathing sound, inspiration and expiration (crackles).Provide safety for client