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Fluid and Electrolyes Day 1

D. Wilhite, RN, MSN

NUR 105

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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

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Homeostasis

Equilibrium in the

body

Maintenance is

necessary.

Many diseases and

treatments can

affect fluid and

electrolyte balance.

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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)

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Water Composition and Age

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Functions of Body Fluids

Transport nutrients,

electrolytes, and oxygen

to cells

Carry waste productsaway from cells

Lubricates joints and

membranes

Medium for food

digestion

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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:

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Mechanisms that control movement

Electrolytes move

according to their concentration gradient

toward areas with the opposite charge

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METHODS OF FLUID & ELECTROLYTE

MOVEMENT

Diffusion

Osmosis

Active Transport Filtration

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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!!!

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Osmosis

The movement ofwater across a

semipermeable membrane from lower tohigher concentration ofsolute

What influences osmosis?

Fluid/Water moves with osmosis.

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Osmosis

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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

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Movement of Body Fluidscontd

Osmolarity

Hypertonic

Isotonic

Hypotonic

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ACTIVE TRANSPORT SYSTEM

Moves molecules or ions uphill against

concentration & osmotic pressure

Hydrolysis ofadenosine 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

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Filtration

Process by which solutes and solution move

together in response to fluid pressure to

create an equilibrium

Example: tissue perfusion

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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 tothe 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

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Hydrostatic Pressure

The force of fluid pressing outward against a surface (vessel

wall)

Aided by pressure of weight of blood and the force of thepumping 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

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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

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Regulation of Body Fluids

Fluid intake

Primarily regulated by the thirst mechanism

located in hypothalamus

Hormonal regulation

ADH

Aldosterone

Renin

Natriuretic peptides

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Antidiuretic Hormone

AKA Vasopressin

Made in hypothalamus

Stored and released by posterior pituitarygland

Restores blood volume by reducing diuresis

and increasing water retention

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ADH

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Renin-angiotensin-aldosterone system

Renin: amount secreted depends on blood flow and

level of sodium in the bloodstream

Angiotensin: a vasoconstrictive substance formedwhen renin is released in the kidney

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Aldosterone

Secreted by adrenal cortex

Promotes retention of sodium

Promotes excretion of potassium

Ald

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Aldosterone

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ADH and Aldosterone

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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 renin-

angiotensin system

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Regulation of Body Fluidscontd

Fluid output regulation

Kidneys

Skin

Lungs

Gastrointestinal

Insensible water loss

Sensible water loss

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Homeostatic Mechanisms

Kidney functions

Heart and blood vessel functions

Lung functions

Pituitary functions

Adrenal functions

Parathyroid functions

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Electrolytes

Sodium

Potassium

Calcium

Phosphorus

Magnesium

Chloride

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Sodium (Na)

Range:

Responsibilities:

governs osmolality

Foods:

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Potassium (K+)

Ranges:

Functions: regulates cell excitability

Foods:

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Calcium (Ca2+)

Range

Function: stabilizes cell memrane, blood

clotting, muscle

contraction

Foods

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Phosphorous (P)

Range

Function: controls energy metabolism

Foods

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Magnesium (Mg2+)

Range

Functions: influences enzyme reactions

Foods

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Nursing Assessment

Patients age

Chronic disease

Surgery, head, or chest trauma

Environmental factors

Lifestyle factors

Medication use

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Measuring Intake and Output

Intake Output

By mouth Urine

NG or jejunostomy Diarrhea

IV infusion Gastric suction

IV piggyback Wound drainage

Blood Other tubes

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Laboratory Studies

CBC

Creatinine

Urine specific gravity

ABG

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Venipuncture

Venipuncture

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Venipuncture

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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 Careof Patients with Fluid and ElectrolyteImbalances. in D. Ignatavicius and L.

Workman (Eds). Medical surgical nursing:Patient centered collaborate care (6th ed., pp.170-197). St. Louis, MO: Elsevier Saunders

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