FLUIDS AND ELECTROLYTES In a healthy state, the fluid and electrolytes of our bodies is in balance Illness can disturb

this balance and threaten our existence

DEFINITION OF TERMS: Body Fluid is primarily water with various dissolved substances gases CO2 and O2 Solutes are solid substances that dissolve in body fluids which includes electrolyte and nonelectrolytes. Electrolytes substances that develop an electrical charge when dissolved in water, e.g., Na, K Non-Electrolytes solutes that do not conduct electricity e.g., glucose, urea FUNCTIONS OF BODY FLUIDS: 1. 2. 3. 4. 5. 6. Maintain blood volume Regulate body temperature Transporting material to and from cells Serving as an aqueous medium for cellular metabolism Assisting with digestion of food Serving as a medium for excreting wastes

Fluid 60% of an average adults body weight Obese person has less fluid since fatty tissues contain little or no water as compared to lean build persons which have higher water content BODY FLUID COMPARTMENTS: 1. Intracellular within the cells o 62% of bodys fluid 2. Extracellular surrounding the cells o 30% of bodys fluid 3 Types a. Interstitial fluid Spaces between the body cells Excess fluid within this is called eder b. Intravascular fluid Is the plasma within the blood Fxn is to transport blood cells c. Transcellular fluid Includes specialized fluid such as CSF, pleural, peritoneal, synomial fluid and digestive juices FLUID INPUT AND INTAKE Average adult 1500 ml / day but need 2500 ml / day Added volume 1000 ml / day derived from food Fluid intake is necessary to cound balance fluid loss

Fluid Output Skin Lungs Urine Sweat Feces Urine ultra filtrate of the blood at least 30-50cc/hr Insensible lossess skin (650-900) and lungs (350-400) Sweat 100 cc Feces 100 cc N (68oF) 350 350 1400 100 100 Hot Temp 350 250 1200 1400 100

The composition of body fluids varies between compartments: In the ICF the major cations are K and Mg Major anions are PO4 and 804 In the ECF the major e are Na, Cl and HCO3 Intravascular albumin Transcellular gastric and intestinal secretions

Process of Fluid & Electrolyte Movement 1. Passive transport requires no energy a. Osmosis is the movement of water across a membrane from an area of a less concentrated solution to an area of more concentrated solution Process 1. 2. 3. 4.

Diffusion Active Transport Osmosis Filtration

b. Diffusion is a passive process by which molecules of a solute move through a cell membrane from an area of higher concentration to an area of lower concentration e.g. Pour a cream to a cup of coffee initially the cream is concentrated in the area where you have poured it however later on it is dispersed every throughout the coffee o small molecules move more rapidly than larger molecules o higher temperatures cause molecules to move faster c. Filtration is the movement of both water and smaller particles from an area of high pressure to low pressure 2. Active Transport - Occurs when molecules (electrolyte) move across cell membrances from an area of low concentration to an area of high concentration against a concentation gradient and requires energy expenditure What moves from area to area of molecules (solute) concentration concentration molecules (solute) concentration concentration H2O concentration concentration

H2O & small particles pressure pressure Type of solution based on osmolality or tonicity Concentration of solutes in body fluid 1. 2. 3. Isotomic a fluid that is of the same osmotality as blood Hypotonic solution is of lower osmotality than blood H2O moves from vascular to cells Hypertonic contains a higher concentration of solutes than blood H2O moves from cell to ECF

Total Body Fluid in Relation to Sex and Age Age Full term newborn 1 y/o Young adult Middle adult Older adult Total Body Fluid (Percentage of Body Weight) 70-80% 64% - 60% - 50-55% - 55% - 45-50% - 50% - 45%

Fluid Imbalances - Can have deficit or excess in fluid volume or on alteration in distribution among the fluid compartment I. Fluif Volume Deficit (Hyporolesia) - Occurs when there is a proportional loss of water and electrolyte from the ECF - aka dehydration Etiology a. vomoting b. diarrhea c. prolonged GI sucting d. excessional loss through the skin e. inability to gain ____ to fluid f. bleeding fluid HR but not as powerful Rapid with pulse BP _____________________________________ H2O is pulled from the interstitital spaces and ICF into the vascular system Dry skin and mucous membranes Muscle we knew and fi skin turgor U.O.

 temperature because the bodys unable to cover ____ Weight is a sensitive measure of fluid loss 5% loss of BW significant 8% loss of BW severe 15% loss of BW fatal Nursing Process in Fluid Volume Deficit Assessment: A. PE 1. 2. 3. 4. 5. 6. 7. Weight loss Poor skin turgor Dry mucous membrane Hypotension Tachycardia Flat neck veins CVP

B. Subjective ____ 1. Thirst 2. Nausea 3. Annorexia 4. Muscle ventricle and crape 5. Change in mental state C. Laboratory Findings 1. Bun and Crea due to depletion of fluid or decreased renal perfusion 2. urine specific gravity ability of kidney to conserve water resulting in more concentrated urine > 1.020 3. Electrolyte ___ at once D. Diagnosis Risk for fluid volume deficit Fluid volume deficit Impaired oral mucous membrane R/t deficit fluid volume inpaired skin integrity RH ____ CO R/t hypenolin Activity intolerance R/t fluid look through dissolve

E. Planning - To restore body fluid balance Implementation - Assist in medical intervention - Provide IVF or ordered - Provide fluid as ordered - VS, I&O monitoring remove if UO < 30a - Monitor daily weight approximate weight loss 1 ly = 1L - Monitor VS, skin and tongue turgor, urine concentration, mental fxn and peripheral circulation - Provide frequent oral care - Prevent fluid deficit from occuring by identifying risk patient - Maintain skin integrity - Teach patient to change position slowly to avoid sudden postural hypotension Evaluation

Fluid balance is monitored as evidenced by balance 24 hours intake and output, good skin turgor, eyeballs form, BP n Improvement of alertness and cognitive orientation Drinks at least 2500ml in 24 hours Urine sc within n limits

II. Fluid Volume Excess Hyperolemia - Involves excessive retention of Na and water in the ECF - aka as overhydration excess water in the ECF but does not desolve or change Etiology 1. Excessive salt intake 2. Excessive fluid intake 3. Disease affecting kidney function 4. Consumption of excessive IV fluid Pathophysiology fluid Expansion of blood volume Edema, neck vein dislocation Tachycardia HPN NA Osmotic pressure in the ECF Fluid pull from the cells into the ECF Accumulate in tissue Edema Nursing Process in Fluid Volume excess Assessment 1. PE - weight gain UO diluted kidney unable to concentrate urine because of henodilution Weight gain Discended neck vein ____ in the lungs Subjectives: 1. Shortness of breath 2. Change of _____ Laboratory - Bun & Coc because of dilution - Urine secretion - because of dilution - CXN conjection

Nursing Diagnosis: - Fluid volume excess - Risk for fluid volume excess - Activity intolerance R/f fluid accumulation in lungs - Impaired gas exchange - Risk for impaired skin integrity Implementation - Assist in medical intervention - Administer diueritics as prescribed - Provide dietary restriction of Na and water - Assess the patients condition continually VS, I&O, weight, edema assessment a breath sound - Provide frequent rest removed - Semi Fowlers position - Closely monitor IV fluid - Instruct patient to avoid OTC which nursing intervention needed Nursing Teachings to prevent Fluid Imbalances 1. Drink at leat 8-10 8ounce glasses of water / day 2. Use thirds as a guide to fluid intake indicates an abnormality in plasma osmolarity since the thirst center which leads to the UR to ____ 3. Limit consumption of fluids q in salt, caffeine or ROH 4. Drink water before, during and after strevenous exercises 5. Avoid routine use of laxative, antacids, weight loss products of enemas 6. Weight daily of fluid balance is critical or if you are experiencing excessive loss 7. Contact a health professional if there is a sudden change of weight, and UO, edema, shortness of breath, vomiting, diarrhea, etc Modifying Oral Fluid intake facilitating fluid intake Clients with actual or potential fluid volume deficit may need to increase their fluid intake Whenever possible should take fluids by mouth, NAT or ___ tube

Order: Force fluid 2500 ml / 24o 7AM 3PM - 1200mL 3PM 11PM - 900 mL 11PM 7AM - 300mL _____ to increase fluid ____ include the following: 1. Offer a variety of fluids throughout the day. Vary hot and cold liquids, and offer a choice of juices and other drinks 2. Each time you are at the bedside, remind the patient to drink 3. Break daily goals into slowly increments e.g. 8 hours time 150cc/hr 4. Provide a glass with ml marking on it so that the patient will know how much he is drinking 5. Always have fluid readily available to the client. E.g. keep a pitches of water at bedtime 6. Encourage the family members to participate in teaching fluid intake Facilitating Fluid Restriction - Indicated for patient with CV, renal or liver impairment Order: limit TFI to 1500ml/24o Includes both IV and oral e.g. oral 700ml on the day shift

1. 2. 3. 4. 5. 6.

400ml on the evening shift 100ml at night Do not offer liquids each meal because food may quench thirst. Reserve liquids for between meals Limit intake of dry, salty or spicy foods; these foods increase thirst Offer ice chips to help quench thirst Provide frequent oral hygiene Keep liquids away from the bedside Provide diversional activities