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Total Body Fluids
40 Liters

        cell fluid 25L

        plasma  3L

        extracellular 15L

        Interstitial & Transcellular 12L
Movement of Body Fluids & Electrolytes
  • Diffusion
  • Osmosis
  • Filtration
  • Active Transport
Diffusion
  • The movement of particles through a semipermeable membrane from an area of high concentration to an area of lower concentration
Osmosis
  • water molecules move from the less concentrated area to the more concentrated area in an attempt to equalize the concentration of solutions on two sides of a membrane 
filtration
  • pressure changes within a capillary bed. On the arterial side, arterial blood pressure exceeds colloid osmotic pressure, so that water and dissolved substances move out of the capillary into the interstitial space. On the venous side, venous blood pressure is less than colloid osmotic pressure, so that water and dissolved substances move into the capillary
Active Transport
Energy (ATP) is used to move sodium and potassium molecules acrossa semipermeable membrane against sodium's and potassium's concentration gradients
Regulating Body Fluids
  • Fluid intake: thirst
  • Fluid Output: Urine, feces, insensible loss (skin/lungs)
Regulating Body Fluids

     Maintaining Body Fluids 
  • kidneys
  • hormones
  • ADH
  • Renin-angiotensin-aldosterone system
  • Atrial natriuretic system
Regulating Electrolytes
  • Sodium
  • Potassium
  • Calcium
  • Magnesium
  • Chloride
  • Phosphate
  • Bicarbonate
Body Fluids are normally slightly alkaline
  • 7.35 - 7.45 pH
  •    - buffers, respiratory regulation, renal regulation

     
Regulation of Acid-Base Balance
  • Low pH = acidic
  • High pH = alkalinic 
Buffers
  • Prevent excessive changes in pH
  • Major buffer in ECF is HCO3- and H2CO3
  • Other buffers include:
  •      Plasma proteins, hemoglobin, phospates
Lungs
  • regulate acid-base balance by eliminating or retaining carbon dioxide
  • does this by latering rate/depth of respirations
  •      Faster rate/more depth = get rid of more CO2 and pH rises
  • Slower rate/less depth = retain CO2 and pH lowers
Kidneys
  • Regulate by selectively excreting or conserving bicarbonate and hydrogen ions
  • Slower to respond to change
Factors Affecting Body Fluid, Electrolyte, & Acid-Base Balance
  • Age
  • Gender
  • Body Size
  • Environmental Temperature
  • Lifestyle
Fluid Imbalances
  • Fluid volume deficit-isotonic loss of water and electrolytes (Third Space Syndrome)
  • Fluid volume excess-isotonic gain of water & electrolytes (Edema)
  • Dehydration (hyperosmolar loss of only water leaving the client with excess sodium)
  • Overhydration (Hypo-osmolar gain of only water leaving low osmolatity and low serum sodium levels 
Electrolyte Imbalances
  • Sodium Na+ (hyponatremia, hypernatremia)
  • Potassium K+ (hypokalemia, hyperkalemia)
  • Calcium Ca+ (hypocalcemia, hypercalcemia) 
Hyponatremia
  • Loss of Na+ (GI losses: N/V, diarrhea, GI suction), Renal loss (kidney disease, diuretics), Skin loss (excessive perspiration, burns)
  • Inappropriate  ADH (Head injury, AIDS, malignant lumps)
  • Gain of water (hypotonic tube feeding, excessive H2O intake, excessive IV administration of D5W
Hyponatremia: Clinical Manisfestations
  • think neurological changes
  • Personality change
  • lethargy, confusion, apprehension
  • muscle twitching
  • abdominal cramps
  • anorexia, nausea, vomiting
  • headache
  • seizures, coma
  • Na+ <135 mEq/L
  • Urine specific gravity < 1.010
Hyponatremia: Nursing Interventions
  • Assess clinical manifestations
  • Monitor I & O
  • Monitor lab data (Na+, sp. gravity)
  • Encourage food increase in Na+
  • Limit water intake as indicated
Sodium Imbalances: Hypernatremia
  • Loss of water (hyperventilation or fever, diarrhea, water deprivation)
  • Gain of sodium (IV saline solutions, hypertonic tube feedings, excessive table salt)
  • Other conditions (diabetes insipidus, heat stroke)
Hypernatremia: Clinical Manifestations
  • Thirst
  • Dry, sticky mucous membranes
  • Red, dry, swollen tongue
  • Na+ > 145mEq/L
  • Urine specific gravity >1.030
Hypernatremia: Nursing Interventions
  • Assess clinical manisfestations
  • Monitor behavioral changes
  • Monitor I & O
  • Monitor lab data (Na+, sp. gravity)
  • Encourage fluids
  • Monitor diet as ordered (decrease Na)
Potassium Imbalances: Hypokalemia
  • Loss of potassium
  • vomiting and gastric suction
  • diarrhea
  • heavy perspiration
  • use of K+ wasting drugs (diuretics)
  • poor intake of K+
  • hyperalsosteronism
Hypokalemia: Clinical Manifestations
  • think heart
  • cardiac dysrhythmias
  • weak irregular pulses
  • muscle weakness, leg cramps
  • fatigue, lethargy
  • anorexia, N/V
  • decrease bowel sounds
  • decrease deeo tendon reflexes
  • K+ < mEq/L
Hypokalemia: Nursing Interventions
  • monitor HR & rhythm
  • administer oral K+ with food
  • administer IV K+ slowly
  • teach client about food increase K+
  • teach preventative measures
Potassium Imbalances: Hyperkalemia
  • Decreased K+ excretion (renal faillure, hypoaldosteronism, K+ conserving diuretics)
  • High K+ intake (excessive use of salt substitutes, rapid/excessive IV K+ infusion, K+ shift out of cells into plasma) 
Hyperkalemia: Clinical Manifestations
  • think heart again
  • cardiac dysrhythmias or arrest
  • decrease HR, irregular pulse
  • ECG changes
  • GI hyperactivity
  • irritability, apathy, confusion
  • paresthesis, numbness in extremities
  • K+ > 5mEq/L
Hyperkalemia: Nursing Interventions
  • monitor serum K+ levels carefully
  • Teach client to avoid food increase in K+
Calcium Imbalances: Hypocalcemia
  • Surgical removal of parathyroid glands
  • certain conditions (hypoparathyroidism, acute pancreatitis, hyperphosphatemia, thyroid carcinoma)
  • Inadequate Vitamin D intake (malabsorption, hypomagnesemia, alkalosis, sepsis, ETOH abuse)
Hypocalcemia: Clinical Manifestations
  • Think neuromuscular
  • nurmbness, tingling
  • muscle tremors, severe cramps, tetany, & convulsions
  • cardiac dysrhythmias, decreased CO, abnormal ECG patterns
  • plus Trousseau's &Chvosteks
  • confusion, anxiety, psychoses
  • hyperactive deep tendon reflexes
  • Ca+ < 4.5 (ionized) or < 8.5 (total)
Hypocalcemia: Nursing Interventions
  • protect confused patient and monitor respirations & cardiac status
  • administer oral and IV Ca+ as ordered
  • teach clients about the risk for osteoporosis and measures to take
Calcium Imbalances: Hypercalcemia
  • Prolonged immobilization
  • Hyperparathyroidism
  • Malignancy of the bone
  • Paget's disease
Hypercalcemia: Clinical Manifestations
  • lethargy, weakness
  • decrease deep-tendon reflexes
  • bone pain
  • anorexia, N/V
  • constipation
  • polyuria, hypercalciuria
  • flank pain
  • dysrhythmias
  • Ca+ > 5.5 (ionized), >10.5 (total)
Hypercalcemia: Nursing Interventions
  • Increase movement & exercise
  • Increase oral intake
  • Limit food/fluids increase in Ca+
  • increase fiber foods
  • protect confused patient
  • encourage intake of cranberry or prune juice
Acid-Base Imbalances
  • Respiratory acidosis
  • Respiratory alkalosis
  • Metabolic acidosis
  • Metabolic alkalosis
ROME
R = Respiratory

O = Opposite
      pH increase PCO decrease Alkalosis

      pH decrease PCO increase Acidosis 
M = Metabolic

E = Equal 

      pH increase HCO increase Alkalosis

      pH decrease HCO decrease Acidosis
Risk Factors: Acid Base Imbalances
  • Acute lung conditions that imapir alveolar gas exchange (pneumonia, acute pulmonary gas edema, aspiration of foreign body, near drowning)
  • Chronic Lung Disease (asthma, cystic fibrosis, emphysema)
  • Narcotic/sedatives overdose that depress respiratory rate/depth
  • Brain injury that affects the respiratory center
  • Airway obstruction
Acid-Base Imbalances:  Respiratory Alkalosis
Hyperventilation due to:

    Extreme anxiety, elevated temp, overventilation with a mechanical ventilator, hypoxia, salicylate overdose  
Acid-base Imbalances: Clinical Manifestations
  • increased pulse/respiratory rates
  • headache, dizziness
  • confusion, decreased level of consciousness
  • convulsions
  • warm, flushed skin
Acid-base Imbalances: Nursing Interventions
  • Frequently assess respiratory status & lung sounds
  • monitor airway & ventilation
  • administer pulmonary therapy measures such as inhalation therapy, percussion & postural drainage, brochodilators, antibiotics
  • monitor fluidI/O, vital signs & arterial blood gases
  • administer narcotic antagonist
  • Maintain adequate fluid hydration
  • Monitor ABGs
  • Assist client to breathe more slowly
  • help client breathe into paper bag or apply a rebreather make to inhale CO2
Respiratory Acidosis
  • Hypoventilation into hypoxia
  • Rapid, shallow respirations
  • decrease BP with vasodialtion
  • Dyspnea
  • Headache
  • Hyperkalemia
  • Dysrhythmias
  • Drowsiness, dizziness, disorientation
  • Muscle weakness, hyperreflexia
Respiratory Acidosis: Causes
  • Decrease respiratory stimuli (anesthesia, drug overdose)
  • COPD
  • Pneumonia
  • Atelectasis
Respiratory Alkalosis
  • Seizures
  • Deep, rapid breathing
  • hyperventilation
  • tachycardia
  • decrease or normal BP
  • hypokalemia
  • numbeness & tingling of extremities
  • Lethargy & confusion
  • light headedness
  • nausea, vomiting
Respiratory Alkalosis: causes
  • hyperventilation (anxiety, PE, fear)
  • mechanical ventilation
Metabolic Acidosis
  • Headache
  • Decreased BP
  • Hyperkalemia
  • Muscle Twitching
  • Warm, flushed skin
  • Nausea, vomiting, diarrhea
  • changes in LOC
  • kussmaul respirations (compensatory hyperventilation)
Metabolic Acidosis: Causes
  • DKA
  • Severe Diarrhea
  • Renal Failure
  • Shock
Metabolic Alkalosis
  • Restlessness followed by lethargy
  • Dysrhythmias (tachycardia)
  • Compensatory hypoventilation
  • Confusion (decreased LOC, Dizzy, Irritable)
  • Nausea, vomiting, diarrhea
  • tremors, muscle cramps, tingling of fingers & toes
  • Hypokalemia
Metabloic Alkalosis: Cause
  • Severe Vomiting
  • Excessive GI Suctioning
  • Diuretics
  • Excessive NaHCO3
Assessment
  • Nursing History
  • Physical Assessment
  • Clinical Measurement
  • Review of laboratory test results   
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