Fluids…

• Body Fluids


  Consist of water, electrolytes, blood plasma and component cells, proteins, and other soluble particles called solutes
• Types of Body Fluids

  • Blood (plasma, RBC, WBC, platelets)
  • Lymph
• Intracellular Fluids


  Fluids inside the cells
• Extracellular Fluids


  Fluids outside the cells
• Oncotic Pressure


  Pressure exerted by the protein content of the blood (albumin) that holds water inside of a compartment
• Hydrostatic Pressure


  Pressure exerted by blood against the capillaries
• Filtration


  Hydrostatic pressure pushes fluids and solutes through a permeable membrane so they can be excreted
• Osmosis


  Water movement through a semipermeable membrane, from an area of lesser solute concentration to an area of greater solute concentration
• Passive Transport


  Fluid to travel due to a concentration gradient and no energy is expended during the process
• Active Transport


  Movement of molecules from an area of higher concentration to an area of lower concentration to equalize the concentration of solutes throughout an area against a concentration gradient (SODIUM-POTASSIUM PUMP)
• Diffusion


  Movement of molecules from an area of higher concentration to an area of lower concentration to equalize the concentration of solutes throughout an area
• Atrial Natriuretic Factor


  Released from the cells in the atrium of the heart in response to excess blood volume and stretching of the atrial walls, acts on the nephrons, promotes sodium wasting, potent diuretic and inhibits thirst

  
• Routes of Fluid Output

  • Urine (1-2L daily)
  • Insensible loss (skin perspiration and lungs 300-400mL/day–water vapor around 600mL/day)
  • Noticeable loss through the skin (0-1000mL/hour)
  • Feces (100-200mL/day)

  
• Factors Affecting Body Fluid, Electrolytes and Acid-Base Balance

  • Age
  • Gender and Body Size
  • Environment/Temperature
  • Lifestyle
• Fluid Volume Deficit (FVD)

  Body loses both water and electrolytes from the ECF, fluid loss in intravascular compartments, results from abnormal losses, decreased fluid intake, bleeding, or third space fluid shifts
• Fluid Volume Excess


  Body retains both water and sodium in similar proportions to normal ECF, hypervolemia (increased blood volume), always secondary to an increase in total body sodium content
• Edema


  Excess interstitial fluid, caused by increased capillary hydrostatic pressure, decreased plasma oncotic pressure, or increased capillary permeability
• Dehydration


  Hyperosmolar imbalance, occurs when water is lost from the body leaving the client with excess sodium, serum osmolality and serum sodium increases
• Overhydration


  Also known as hypo-osmolar imbalance or water excess, low serum osmolality and serum sodium levels, can lead to cerebral edema and impair neurologic function
• Nursing History


  • Current and past medical history, medications, functional, developmental, and socio-economic status, older people and very young children/infants, bedridden patients, those who depend on others to meet their needs, and those who are unable to access food and water
• Physical Assessment


  • Daily weights, vital signs (temperature, pulse, blood pressure, respiratory rate)
• Intake and Output Monitoring


  Measure oral fluids, tube feedings, parenteral fluids, urine output, vomitus, tube drainage, wound drainage
• Laboratory Tests


  • Serum electrolytes, complete blood count, serum osmolality, urine osmolality, urine pH, urine specific gravity, urine Na and Cl, arterial blood gases
• Arterial Blood Gas


  Assesses acid-base balance and oxygenation, measures pH, PaO2, PaCO2, bicarbonate, oxygen saturation
• Nursing Diagnoses


  • Deficient Fluid Volume
  • Excess Fluid Volume
  • Risk for Imbalance Fluid Volume
  • Risk for Deficient Fluid Volume
  • Impaired Gas Exchange
• pH


  Normal values - 7.35-7.45
• PaO2


  The pressure exerted by oxygen dissolves in the plasma or arterial blood, an indirect measure of blood oxygen content (70-100mmHg)
• PaCO2


  Partial pressure of Carbon Dioxide in arterial plasma (35-45mmHg)
• Bicarbonate HCO3


  Measure of metabolic component of acid-base balance (22-26mEq/L)
• Oxygen saturation (SpO2)


  The percentage of hemoglobin saturated with oxygen (97% and up)
• Nursing Diagnoses


  • Deficient Fluid Volume (intravascular, interstitial, and/or intracellular)
  • Excess Fluid Volume
  • Risk for Imbalance Fluid Volume
  • Risk for Deficient
  • Impaired Gas Exchange
• Other Nursing Diagnosis


  • Impaired Oral Mucous Membrane
  • Impaired Skin Integrity
  • Decreased Cardiac Output
  • Ineffective Tissue Perfusion
  • Activity Intolerance
  • Risk for Injury
  • Acute Confusion
• Planning


  • Maintain or restore normal fluid balance
  • Maintain or restore normal balance of electrolytes in the intracellular and extracellular compartments
  • Maintain or restore pulmonary ventilation and oxygenation
  • Prevent associated risks (tissue breakdown, decreased cardiac output, confusion, and other neurologic signs)
• Nursing Management for Volume Deficit

  1. Maintain normal fluid balance

  2. Provide ongoing assessment (Physical assessment)

  3. Maintain skin integrity

  4. Provide frequent oral care

  5. Change position slowly to minimize postural hypotension
• Nursing Management for Volume Excess

  1. Maintain normal fluid balance

  2. Prevent or minimize edema

  3. Provide client and family teachings
• Electrolytes


  A substance that conducts electricity when dissolved in water
• Main Electrolytes in the Body

  • Sodium [Na+]
  • Chlorine [Cl-]
  • Magnesium [Mg2+]
  • Calcium [Ca2+]
  • Potassium [K+]
• Functions of Electrolytes


  • Balance Fluids in Your Body
  • Maintain Your Blood's Proper pH
  • Carry Electrical Signals from Nerves to Muscles
• Electrolytes, Normal Values, Sources

  • Sodium (ECF) - 135 - 145 mEq/L - dill pickles, tomato juices, sauces, and soups, table salt
  • Potassium (ICF) - 3.5 - 5 mEq/L - Sweet potatoes with their skin, plain yogurt, bananas, avocados
  • Calcium - 9 - 11 mEq/L - Yogurt, milk, ricotta, collard greens, spinach kale, sardines
  • Magnesium (ICF) - 1.5 -3 mEq/L - Halibut, pumpkin seeds, nuts and seed, spinach, bananas, avocado
  • Chloride (ECF) - 98 - 106 mEq/L - tomato juices, sauces, and soups, lettuce, olives, table salt
  • Phosphorous - 1.8 -2.3 mEq/L - dairy products, meats and poultry, fish, eggs, nuts, legumes, vegetables, and grains
• Electrolyte Imbalances


  • Hyponatremia
  • Hypernatremia
  • Hypokalemia
  • Hyperkalemia
  • Hypocalcemia
  • Hypercalcemia
  • Hypomagnesemia
  • Hypermagnesemia
  • Hypophosphatemia
  • Hyperphosphatemia