CARE OF PATIENT WITH FLUIDS AND ELECTROLUYTES Acidosis : Increase in H inside the blood . Alkalosis : Excess of bicarbonate ion inside the blood . Anaphylactic Reaction : it is a life threatening condition characterized by a severe respiratory and cardiovascular collapse , severe GI disturbance. Blood transfusion : It is the procedure of administering blood or its components to a client Dehydration : Loss of water/fluid from extra cellular space . Fluid : Liquid available in body .
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CARE OF PATIENT WITH FLUIDS AND ELECTROLUYTES
Acidosis : Increase in H inside the blood .
Alkalosis : Excess of bicarbonate ion inside the blood .
Anaphylactic Reaction : it is a life threatening condition characterized by a severe respiratory and cardiovascular collapse , severe GI disturbance.
Blood transfusion : It is the procedure of administering blood or its components to a client
Dehydration : Loss of water/fluid from extra cellular space .
Fluid : Liquid available in body .
BODY FFLUIDSApproximately 60% of a typical adult’s weight consists of fluid
( Water and Electrolyte ) .
Factors that influence the amount of body fluid are
Age
Gender
Body fat
In general ,younger people have a higher percentage of body fluid than older people .
Men have proportionately more body fluids than women .
People who are obese have less fluid than those who are thin ,because fat cells contain little water.
The skeleton also has low water content .
Muscle skin and blood contain the higher amount of water .
DISTRIBUTION OF BODY FLUIDSBody fluid is located in two fluid compartment :
intracellular space ( fluid in the cells )
Extra cellular space ( fluid outside the cells )
Approximately two thirds of body fluid is in the ICF compartment and is located primarily in the skeletal muscle mass.
Approximately one third is in the extra cellular fluid ECF compartment.
ECF FLUID COMPARTMENT The ECF compartment is further divided into the
Intra vascular
Interstitial
transcellular
The intravascular space ( the fluid within the blood vessels) contains plasma , the effective circulating volume. Approximately 3 L of the average 6 L of blood volume in adults is made up of plasma . The remaining 3 L is made up of erythrocytes, leukocytes , And thrombocytes
The interstitial space contains the fluid that surrounds the cell and totals about 11 to 12 L in an adult . Lymph is an interstitial fluid.
The transcellular space is the smallest division of the ECF compartment and contains approximately 1 L . Example –synovial fluids , CSF, pericardial fluids.
67%
33%
Sales
1st Qtr
2nd Qtr
Source of Body Water Gains and losses
Intake (mL) Output (mL)
Oral intake As water 1,000 Urine 1,500
In food 1,300 Stool 200
Water of oxidation 200 Insensible Lungs 300Skin 500
Total gain 2,500 Total loss 2,500
FUNCTION OF BODY FLUIDS Regulation of body temperature.
Protects and cushions vital organs.
Transportation of nutrients to the cells.
Helps convert food into energy .
Transportation of Waste products away from cells.
Transportation of hormones to activity site .
Lubrication of joint spaces.
Flushes the kidneys of the waste products of metabolism .
Improves intestine health and helps prevent constipation
ELECTROLYTES Electrolytes in body fluids are active chemicals (
cations that carry positive charge and anoin that carry negative charge .
The major cations in body fluids are sodium , potassium , calcium , magnesium ,
The major anions are chloride , bicarbonate , phosphate , sulphate .
Electrolytes mEq/l
Extracellular fluids ( plasma )
Cations Sodium Potassium Calciummagnesium
142552
Anion Chloride BicarbonatePhosphateSulphate
1032621
Intracellular fluid
CationPotassiumMagnesiumSodium
Anion Phosphate and sulphateBicarbonateChloride
1504010
1501010
Factor affecting fluid and electrolyte balance
Age : At different ages , the body weight , body surface area , renal filtration capacity and metabolic rate is different , that influences the fluid intake.
Climate : Climate changes affect the fluid intake and fluid loss . High heat and low environmental humidity increases the sweating and fluid loss . Exercise , dry atmospheric condition , heavy sweating imbalances the fluid and electrolyte balance
Illness : Nausea ,vomiting diarrhea ,increase metabolism ,wound and burns affect the fluid and electrolyte balance
Medication : Excessive use of cathartics , enemas , diuretics , and steroids stimulate bowel evacuation by irritating the smooth muscles intestine . This can result in fluid volume deficit from excessive water and electrolyte loss .
Medical treatment
ALTERATION IN FLUID AND ELECTROLYTE BALANCEFLUID OLUME ALTERATION: It includes the following
1. Fluid volume deficit: It is also known as dehydration and is defined as loss of water and or electrolyte from ECF . Extra Cellular Fluid Deficit applies either proportionate or disproportionate losses.
Disproportion losses In this two condition exist
Hypotonic dehydration Electrolyte loss is proportionately greater than loss of water . Its causes include diabetes insipidus
Hypertonic dehydration Water loss is proportionately greater than electrolyte loss
EFFECT S:-
Hypovolemia : Loss of blood volume either through Haemorrhage or through severe depletion of the ECF by another causes lead to circulatory failure.
Other effect include : Brain cells are more sensitive . Tachycardia , restlessness dry mucus membrane , poor skin turgor ,decrease urine output
Fluid volume excess When water and solutes are gained in proportionate amounts
of extra cellular fluid ,it is known as Extra cellular fluid excess or over hydration.
Causes
a) Rapid administration of iv fluids.
b) Cardiac and renal failure.
c) Liver disease.
Symptoms:a) Generalized edema.
b) Wide spread accumulation of fluid in the intestial spaces.
c) Weight gain ,jugular vain engorgement.
Nursing measures to prompt optimum fluid and electrolyte balance
1. PREVENTIVE CAREIn this the cause of fluid and electrolyte imbalance are provided to the clients so that they can take preventive measure .
A. Life style analysis : Factors like age , stress , diet of a client are analysed to prevent the occurrence of fluid and electrolyte imbalance.
B. Life style counselling.
C. Health education : Health education regarding stress relieving factors , dietary pattern and medical symptom i.e.
Hyperirritability
Bradicardia
Shallow respirations.
paresthesia
Laboratory tests for evaluating fluid status Osmolality is the concentration of fluids that affects
the movement of water between fluids compartment by osmosis .osmolality measures the solute concentration per kilogram in blood and urine .it is also a measure of a solution’s ability to create osmotic pressure and affect the movement of water.
Serum osmolality primarily reflects the concentration of sodium , although blood urea nitrogen (BUN) and glucose also play a measure role in determining serum osmolality.
Urine osmolality is determined by urea , creatinine and uric acid . When measured with serum osmolality , urine osmolality is the most reliable indicator of urine concentration . Osmolality is reported as miliosmole per kilo gram of water.
In healthy adults , normal serum osmolality is 270 to 300 mOsm/kg .sodium predominates in ECF osmolality and hold water in this compartment .
Urine specific gravity measures the kidneys’ ability to create or conserve water . The specific gravity of urine is compared to the weight of distilled water , which has a specific gravity of 1.000 . The normal range of urine specific gravity is 1.010 to 1.025 .
Specific gravity varies inversely with urine volume ; normally , the larger the volume of urine the lower the specific gravity .
Specific gravity is less reliable indicator of concentration than urine osmolality .
Increase glucose or protein in urine can cause a falsely elevated specific gravity .
BUN is made up of urea , which is an end product of the metabolism of protein ( from muscle and dietary intake ) by the liver.
Amino acid breakdown produces large amount of ammonia molecules , which are absorbed into the blood stream . Ammonia molecule converted to urea and excreted in the urine. The normal BUN is 10 to 20 mg/dl . The BUN level varies with urine output . Factor that increase BUN include decreased renal function, GI bleeding , Dehydration ,increase protein intake fever and sepsis . Those that decrease BUN include end stage liver disease , low protein diet , starvation , and any condition that result in expanded fluid volume.
Creatinine is the end product of muscle metabolism . It is a better indicator of renal function than BUN because it does not vary with protein intake and metabolic state . The normal serum creatinine is approximately 0.7 to 1.4 mg/dl; however , its concentration depends on lean body mass and varies from person to person.
Serum creatinine level increase when renal function decrease.
Hematocrit measures the volume percentage of red blood cells in whole blood and normally ranges from 42% to 52% for male and 35% to 47% for females . Conditions that increase the hematocrit are over hydration and anaemia.
Urine sodium values change with sodium intake and the status of fluid volume ; as sodium intake increase , excretion increases ;as the circulating fluid volume decrease , sodium is conserved .normal urine sodium levels range from 75 to 200 mEq/24 hours .
Urine sodium levels are used to assess volume status are useful in the diagnosis of hyponatremia and acute renal failure
COMMON LABORATORY TEST TO ASSESS FLUID, ELECTROLYTE AND ACID BASE BALANCE
Fluid Balance Test Normal findings
Serum osmolarity : Measures total concentration of dissolved particles in serum ; determined largely by sodium concentration.
Urine osmolarity : measures concentration or number of solute particles ,regardless of size in urine .
Urine specific gravity : measures density of water compared to distilled water not as precise a measurement as urine osmolarity
Child =70-290 mosm/kgAdult = 280-300mosm/kg
New born = 100-600mosm /kgChild =50-1200 mosm/kgAverage =200-800mosm/kg
1.003-1.040
Fluid balance test Normal finding
Hematocrit (Hct) : Measures percentage by volume of Red blood cells in whole blood provides a relative indication of fluid volume alteration.
Haemoglobin (Hgb or Hg):-Measures oxygen carrying capacity of blood ; also an indicator of fluid balance
Blood Urea Nitrogen (BUN):-Measures level of nitrogenous
