Fluid and Electrolyes Day 1

D. Wilhite, RN, MSN NUR 105

Objectives for Fluid and Electrolytes

Be able to describe the normal control of fluids, electrolytes, and acid-base balance Be able to discuss etiologies that disrupt homeostasis and resultant manifestations Be knowledgeable about actions that can be taken to prevent or restore fluid, electrolyte, and acid-base balance

Homeostasis
Equilibrium in the body Maintenance is necessary. Many diseases and treatments can affect fluid and electrolyte balance.

Scientific Knowledge
Water is the largest single component of the body. Several factors influence the amount of water.

Distribution of body fluids

Intracellular Extracellular (ECF)

Water Composition and Age

Functions of Body Fluids

Transport nutrients, electrolytes, and oxygen to cells Carry waste products away from cells Lubricates joints and membranes Medium for food digestion

Electrolytes
Electrolyte
An element or compound that separates when wet or mixed with another solvent

Ions
Cations
Positively charged electrolytes Major cations:

Anions
Negatively charged electrolytes Major anions:

Mechanisms that control movement

Electrolytes move
according to their concentration gradient
toward areas with the opposite charge

METHODS OF FLUID & ELECTROLYTE MOVEMENT

Diffusion Osmosis Active Transport Filtration

Diffusion
The process in which a solute moves from an area of higher to lower concentration
The membrane must be permeable. Example: exchange of oxygen and carbon dioxide between the pulmonary capillaries and alveoli Diffusion goes with the flow!!!

Osmosis
The movement of water across a semipermeable membrane from lower to higher concentration of solute What influences osmosis?
Fluid/Water moves with osmosis.

Osmosis

Concentration of Solute
Expressed in mEq/L, mmol/L, and mOsm/L mOsm/L: expressed as either
1. Osmolarity: number of mOsm/L normal osmolarity of plasma: 270-300

2. Osmolality: number of milliosmoles in a kilogram of solution

Movement of Body Fluidscontd

Osmolarity
Hypertonic

Isotonic
Hypotonic

ACTIVE TRANSPORT SYSTEM

Moves molecules or ions uphill against concentration & osmotic pressure Hydrolysis of adenosine triphosphate (ATP) provides energy needed Requires specific carrier molecule as well as specific enzyme (ATPase) Sodium, potassium, calcium, magnesium, plus some sugars, & amino acids use it

Filtration
Process by which solutes and solution move together in response to fluid pressure to create an equilibrium Example: tissue perfusion

 If more concentrated solution on one side of selectively permeable membrane and a less concentrated solution on the other side, there is a pull called osmotic pressure that draws the water to the more concentrated side Osmotic pressure determined by relative number of particles in the concentrated solution Unit of measure: osmole Osmolarity: osmotic pressure of a solution

Hydrostatic Pressure
The force of fluid pressing outward against a surface (vessel wall) Aided by pressure of weight of blood and the force of the pumping of heart Hydrostatic pressure resulting from the process of filtration moves water and diffusible solutes from an area of higher pressure to an area of lower pressure Causes fluids and solutes to be pushed out at the arterial end of the capillary

Osmotic Pressure
Affects the movement of fluid between the interstitial and intravascular compartments Osmotic pressure caused by plasma colloid: colloid osmotic pressure or oncotic pressure

Regulation of Body Fluids

Fluid intake
Primarily regulated by the thirst mechanism located in hypothalamus

Hormonal regulation
ADH Aldosterone Renin Natriuretic peptides

Antidiuretic Hormone
AKA Vasopressin Made in hypothalamus Stored and released by posterior pituitary gland Restores blood volume by reducing diuresis and increasing water retention

ADH

Renin-angiotensin-aldosterone system
Renin: amount secreted depends on blood flow and level of sodium in the bloodstream Angiotensin: a vasoconstrictive substance formed when renin is released in the kidney

Aldosterone
Secreted by adrenal cortex Promotes retention of sodium Promotes excretion of potassium

Aldosterone

ADH and Aldosterone

Natriuretic Peptides
Hormones secreted by special cells that line the atria of the heart and ventricles of the heart Secreted in response to increased blood volume and blood pressure Creates effects that oppose the reninangiotensin system

Regulation of Body Fluidscontd

Fluid output regulation
Kidneys Skin Lungs Gastrointestinal Insensible water loss Sensible water loss

Homeostatic Mechanisms
Kidney functions Heart and blood vessel functions Lung functions Pituitary functions Adrenal functions Parathyroid functions

Electrolytes
Sodium Potassium Calcium Phosphorus Magnesium Chloride

Sodium (Na)
Range:

Responsibilities: governs osmolality Foods:

Potassium (K+)
Ranges: Functions: regulates cell excitability Foods:

Calcium (Ca2+)
Range Function: stabilizes cell memrane, blood clotting, muscle contraction

Foods

Phosphorous (P)
Range Function: controls energy metabolism Foods

Magnesium (Mg2+)
Range Functions: influences enzyme reactions Foods

Nursing Assessment
Patients age Chronic disease Surgery, head, or chest trauma Environmental factors Lifestyle factors Medication use

Measuring Intake and Output

Intake
By mouth NG or jejunostomy IV infusion IV piggyback Blood

Output
Urine Diarrhea Gastric suction Wound drainage Other tubes

Laboratory Studies
CBC Creatinine Urine specific gravity ABG

Venipuncture

Venipuncture

References
Ostendorf, W. (2011). Fluid, Electrolyte, and Acid-Base Balances. In P. Potter and A. Perry. Basic Nursing (7th ed., pp. 466- 521). St. Louis, MO: Elsevier Saunders Workman, M. (2010). Assessment and Care of Patients with Fluid and Electrolyte Imbalances. in D. Ignatavicius and L. Workman (Eds). Medical surgical nursing: Patient centered collaborate care (6th ed., pp. 170-197). St. Louis, MO: Elsevier Saunders