NCM Lab Fluid

• Functions of Water in the Body:

  • Transporting nutrients to cells and wastes from cells
  • Transporting hormones, enzymes, blood platelets, and red and white blood cells
  • Facilitating cellular metabolism and proper cellular chemical functioning
  • Facilitating digestion and promoting elimination
  • Acting as a solvent for electrolytes and non-electrolytes
  • Acting as a tissue lubricant and cushion
  • Helping maintain normal body temperature
• Two compartments of fluid in the body:

  • Intracellular Fluid (ICF): found within the cells of the body, vital to normal cell functioning, contains solutes such as oxygen, electrolytes, and glucose
  • Extracellular Fluid (ECF): found outside the cells and accounts for about one-third of the total body fluid, subdivided into intravascular fluid or plasma and interstitial fluid
• Electrolytes:

  • Are charged ions capable of conducting electricity, present in all body fluids and fluid compartments
  • Maintain fluid balance, contribute to acid-base regulation, facilitate enzyme reactions, transmit neuromuscular reactions
• Major Electrolytes/Chief Function:

  • Sodium: controls and regulates volume of body fluids
  • Potassium: chief regulator of cellular enzyme activity and water content
  • Calcium: nerve impulse, blood clotting, muscle contraction, B12 absorption
  • Magnesium: metabolism of carbohydrates and proteins, vital actions involving enzymes
  • Chloride: maintains osmotic pressure in blood, produces hydrochloric acid
  • Phosphate: involved in important chemical reactions in body, cell division and hereditary traits
  • Bicarbonate: body's primary buffer system
• Acid-Base Balance:

  • Acid is a substance that releases hydrogen ions (H+) in solution
  • Bases or Alkalis have a low hydrogen ion concentrate and can accept hydrogen ions in solution
  • pH measures the acidity or alkalinity of a solution
• Regulation of Acid-Base Balance:

  • Buffers
  • Acidosis
  • Alkalosis
• Factors Affecting Body Fluid, Electrolytes, and Acid-Base Balance:

  • Age
  • Sex and Body Size
  • Environmental Temperature
  • Lifestyle
  • Fluid Imbalances
• Disturbances in Fluid Volume, Electrolyte, and Acid-Base Balance:

  • Four categories of fluid imbalances:

  1. An isotonic loss of water and electrolytes - Fluid volume deficit

  2. An isotonic gain of water and electrolytes - Fluid volume excess

  3. A hyperosmolar loss of only water - Dehydration

  4. A hypo-osmolar gain of only water - Overhydration
• Electrolyte Imbalances:

  • Sodium (Na+): functions include maintaining osmolality, participating in active transport, regulating body fluids, and participating in the action potential
  • Hypernatremia: serum sodium is more than 150 mEq/L, causes include loss of water such as insensible water loss, diarrhea, and water deprivation
  • Potassium: functions include maintaining osmolality, participating in active transport, regulating body fluids, and participating in the action potential
• • Hypokalemia: causes include vomiting, diarrhea, heavy perspiration, and use of potassium-wasting drugs like diuretics
• Potassium electrolyte imbalances:
• Hypokalemia (low potassium):

  • Causes: Vomiting, diarrhea, heavy perspiration, use of potassium-wasting drugs like diuretics
• Hyperkalemia (high potassium):

  • Causes: Decreased potassium excretion, can lead to cardiac arrest, serum potassium level greater than 5.0 mEq/L, renal failure
• Calcium electrolyte imbalances:
• Functions: Formation of bone and teeth, muscle contraction, blood coagulation, blocks sodium transport into the cell, transmission of nervous impulses
• Hypocalcemia (low calcium):

  • Symptoms: Paraesthesia, tetany, laryngeal spasms, congestive heart failure, decreased cardiac output, cardiac dysrhythmias
• Hypercalcemia (high calcium):

  • Symptoms: Lethargy, confusion, coma, deep bone pain, fractures, stones in the kidneys, constipation, anorexia, nausea, vomiting, shortened QT interval, bradycardia, cardiac arrest
• Magnesium electrolyte imbalances:
• Hypomagnesemia (low magnesium):

  • Causes: Chronic alcoholism, pancreatitis, burns
• Hypermagnesemia (high magnesium):

  • Causes: Renal failure, adrenal insufficiency
• Chloride electrolyte imbalances:
• Hypochloremia (low chloride):

  • Causes: Excess loss of chloride through the GI tract, kidneys, or sweating, symptoms include muscle twitching, tremors, or tetany
• Hyperchloremia (high chloride):

  • Causes: Acidosis, weakness, lethargy, may risk dysrhythmias or coma
• Phosphate electrolyte imbalances:
• Hypophosphatemia (low phosphate):

  • Causes: Alcohol withdrawal, use of antacids that bind in the GI tract, symptoms include paresthesia, muscle weakness and pain, mental changes, possible seizures
• Hyperphosphatemia (high phosphate):

  • Causes: Tissue trauma, infants fed cow’s milk, symptoms include numbness and tingling around the mouth and in fingertips, muscle spasm, tetany
• Acid-Base Imbalances:
• Respiratory Acidosis:

  • Causes carbon dioxide retention, pH level falls below 7.35
• Respiratory Alkalosis:

  • Causes excess exhalation of carbon dioxide, pH rises above 7.45
• Metabolic Acidosis:

  • Bicarbonate levels are low, pH level falls
• Metabolic Alkalosis:

  • Excess bicarbonate in the body, respiratory center is depressed
• Nursing Management:
• Assessment includes nursing history, physical assessment, clinical measurements, and laboratory tests like serum electrolytes and CBC
• Diagnosing includes fluid volume deficits, excess, risk for imbalanced fluid volume, impaired gas exchange, oral mucous membrane, skin integrity, ineffective tissue perfusion
• Planning goals include maintaining or restoring normal fluid balance, electrolyte balance, pulmonary ventilation, oxygenation, and preventing associated risks
• Implementation involves promoting wellness, fluid and electrolyte replacement, dietary changes, and oral electrolyte supplements
• Intravenous Solutions:

  • Isotonic: 0.9% NaCl, Lactated Ringer’s, 5% dextrose water
  • Hypotonic: 0.45% NaCl, 0.33% NaCl
  • Hypertonic: D5NS, D5 1/2NS, D5LR
• Intravenous Infusion Equipment:

  • IV catheters, catheter stabilization devices, solution containers, infusion administration sets, IV filters, IV poles
• Regulating and Monitoring Intravenous Infusions:

  • Calculating flow rate, monitoring client responses, checking infusions regularly
• Devices to Control Infusions:

  • Manual flow regulator, electronic infusion devices