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FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
NUR 102 - Chapter 14
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
Intracellular fluids (ICF)• Liquids within cell membranes
• 40% of body weight
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
Minerals• ingested compounds
• serve as catalysts in nerve response, muscle contraction, and metabolism of nutrients in foods, regulate electrolyte balance
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
Drawing power of water (dependent on the number or molecules in solution)• Isotonic
• Hypotonic
• Hypertonic
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
Hypothalamus - thirst control center Oral fluid intake requires an alert state Osmoreceptors - monitor osmolality
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
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
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
Hypokalemia Causes: K+ wasting diuretics N/V/D polyuria S/S: weak, irregular pulse
• hypotension
• weakness
Electrolyte imbalances
Hyperkalemia• Causes: Renal failure
• S/S: irregular slow pulse, weakness, irritability
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
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
Blood pH - 7.35 - 7.45 paCO2 - 35 - 45 Bicarbonate (HCO3) - 22-26 mEq/L
Respiratory Acidosis
pH < 7.35 paCO2 > 45 mm Hg Causes: Respiratory failure Hypoventilation Resp muscles paralysis Airway obstruction
Respiratory Alkalosis
pH > 7.45 paCO2 < 35 mm Hg Causes: excessive exhalation of CO2
(hyperventilation)
Metabolic Acidosis
pH < 7.35 bicarbonate - < 22 mEq/L Causes: Starvation, DKA, Diarrhea, drug
use
Metabolic Alkalosis
pH > 7.45 bicarbonate > 26 mEq/L Causes: excessive vomiting, prolonged
gastric suctioning
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
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
Types of IV fluids Isotonic Hypertonic Hypotonic
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
Stop infusion Remove tape 1 - 2 minute pressure
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
Caused by: • blood incompatibility
• allergic sensitivity
• S/S: fever, chills, rash, hypotension, shock
Treatment: stop transfusion, give NS, save tubing, prepare for emergency drugs