Fluid, electrolyte, and acid base balance.drjma

Dr. James Malce Alo, MAN, MAP, PhD

The most important practical lesson that can

be given to nurses is to teach them what to

observe—how to observe—what are of

importance.

—Nightingale (in Skretkowicz, 1992)

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1. Review the physiological processes and core concepts relative to body fluid and acid-base balance and imbalances.

2. Identify the function, distribution, composition and types of body fluid & electrolyte movement.

3. Describe the regulation of ECF, fluid output, causes of electrolyte imbalances and client at risk of f/e imbalances.

4. Relate the common disturbances in body fluid and acid-base balance to their clinical manifestations and nursing interventions.

5. Describe the common nursing interventions for clients with alterations in body fluid and acid-base balance in the scope of nursing process.

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About 46% to 60% of the average adult weight

is water.

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Medium of metabolic reaction with cells.

Transporter for nutrients, waste products and

other substances.

A lubricant.

Shock absorber.

Regulate and maintain body temperature.

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The proportion of water decreases with aging

because of fats, age and sex effect of the

total body water.

Infant (70-80%).

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The body fluids divided into 2 major

compartments:

A. Intracellular fluid (ICF)

Is found in the cells of the body. It constitute 2/3 of

the total body fluid in adult.

B. Extracellular fluid (ECF)

Is found outside the cell and account 1/3 of hkthe

total body fluid.

It is subdivided in 3 compartments

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1. Intravascular fluid or plasma - is found

within the vascular system.

2. Interstitial fluid- is found surrounding the

cells an includes lymph.

3. Transcellular – includes cerebrospinal

fluid, fleural, peritoneal and synovial fluid.

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Plasma osmolar concentration, interstitial and intracellular fluid. Note that the main cation in the

plasma and in the interstitial fluid is sodium, while in the intracellular fluid the main cation is

potassium. Adaptad from West JBE (10), 1985.

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Cation- a positively charged ion, i.e. one that would be attracted to the cathode in

electrolysis.

Anion - a negatively charged ion, i.e. one that would be attracted to the anode in

electrolysis.

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ICF

Vital to normal cell function.

Contains solute such as oxygen, electrolytes and

glucose.

Medium to metabolic purposes.

ECF

Transport system that caries nutrients and waste

product from the cell.

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1. Osmosis

It is the movement of water across cell

membranes from the less concentrated solution

to more concentrated solution.

Water move toward higher concentration.

Solutes are substance dissolved in liquid.

Crystalloids are salts dissolved readily into true

solution.

Colloids are substance such as large protein

molecules that do not dissolve in true solution.

Sodium is the major determinant of serum

osmolality.

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2. Diffusion

Is the continual intermingling of molecules in

liquid, gases by random movement of the

molecules.

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3. Filtration

Is the process whereby fluid and solute move

together across a membrane from one

compartment to another.

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4. Active transport

Substance can move across cell membrane from

a less concentrated solution to a more

concentrated one by active transport.

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The average adult drinks about 1500ml/day,

this added volume is acquired by the food.

The thirst center is located in the brain, this

center is triggered by osmotic pressure and

angiotensin II.

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1. Urine : normal urine output 1500ml/ 24

hrs or at least 30ml/hr

2. Insensible loss: through the skin as

perspiration and through the lung as water

vapor in the expired air.

3. Loss through the intestine (feces)

4. Obligatory losses: approx. 500ml ‘of fluid

must be exerted through the kidney to

eliminate metabolic waste product and

feces, respiration and perspiration to

maintain body temperature.

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The average daily fluid output for adult is

2500ml / day

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Post-operative client.

Client with severe trauma or burn.

Client with chronic disease as congestive

heart failure.

Client who are NPO.

Client with intravenous infusion.

Client with special drainage.

Client receiving diuretic.

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1. Age : infant have greater water need and

greater loss due to greater metabolic rate.

2. Environment: excess heat stimulates the

sympathetic nervous system and cause

person to sweat.

3. Diet : in nutritional deficiency, the body

preserved the protein, by breaking down the

fat and glycogen.

4. Stress : water retention & increase the

production of antidiuretic hormone.

5. illness : burn & renal disorder.

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1. Hypovolemia – decrease blood volume

2. Hypovolemic – when intravascular fluid is

depleted

3. Hypervolemia – increase blood volume

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4. Edema: is collection of fluid in the tissue.

Types of edema

1. Dependent edema – found in the lowest part of the

body.

2. Pitting edema – edema that leaves a depression or

pit after finger pressure is applied on the swollen

area.

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occurs when fluid collects in the tissue. By pressing a thumb or finger firmly against

the tissue for a few seconds, a dent can be produced.

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Is the most abundant cation in ECF & major

contributor to serum osmolality.

Functions:

1. controlling & regulating water balance

2. maintaining blood vol

3. transmit nerve impulses

Normal level : 135-145mg/dl

Hyponatremia- Na deficit in the blood

Hypernatemia – Na excess in the blood

Na is found in many foods, such as

;processed cheese & table salt.

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Is the major cation in ICF

Functions: Maintain ICF osmolality

Transmitting nerve impulses

Regulate cardiac impulses

Skeletal & smooth muscle function

Regulate acid-base balance

K is found ;in many fruits & vegetables, meat, fish & milk

Normal level of K is 3.5-5.3 meq/L

Hypokalemia : K deficit in the blood

Hyperkalemia : K excess in the blood

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Normal Ca level in the blood: 9-10.5 mg/dl

Hypocalcemia: Ca deficit in the blood

Hypercalcemia : Ca excess in the blood

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Loss of h2o & electrolyte due to:

Vomittting

Diarhea

Excessive sweating

Polyuria

Fever

Nasogastric suction

Abnormal drainage

Anorexia

Nausea

Impaired swallowing

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1. Skin : dry, pale, cool skin, reduce skin turgor

2. Oral cavity ; dry mucous membrane, absence of salivation.

3. Weak rapid pulse

4. Decreased blood pressure.

5. Decreased central venous pressure.

6. Decreased urine output.

7. Increased hematocrit.

8. Thirst

9. Flat neck vein

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Excess intake of Na containing intraveous

fluid.

Excess ingestion of Na in a diet.

Heart failure.

Renal failure.

Liver cirrhosis.

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metabolic acidosis

= acidosis and bicarbonate concentration in the body fluids resulting either from the

accumulation of acids or the abnormal loss of bases from the body (as in diarrhea or renal

disease)

metabolic alkalosis

= alkalosis resulting from hydrogen-ion loss or excessive intake of alkaline substances

respiratory acidosis

= acidosis resulting from reduced gas exchange in the lungs (as in emphysema or pneumonia);

excess carbon dioxide combines with water to form carbonic acid which increases the acidity

of the blood

respiratory alkalosis

= alkalosis resulting from increased gas exchange in the lungs (as in hyperventilation

associated with extreme anxiety or aspirin intoxication or metabolic acidosis)

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