FLUID AND ELECTROLYTES

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FLUID AND ELECTROLYTES

• NPN 205

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FLUIDS

• 50-60 of the human body is water (decreases with
  age)
• Body fluids are classified according to their
  location with most of the bodys fluids found
  within the cell
• Intracellular
• Extracellular (mainly responsible for transport
  of nutrients and wastes)
• Fluid compartments are separated by selectively
  permeable membranes that control movement of
  water and solutes
• The process of homeostasis involves delivery of
  oxygen and nutrients to the cells and removal of
  waste

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Transport of Water and Fluids

• Osmolality concentration of a solution
  determined by the number of dissolved particles
  per kilogram of water. Osmolality controls water
  movement and distribution in body fluid
  compartments
• Diffusion the random movement of particles in
  all directions through a solution
• Active transport movement of solutes across
  membranes requires expenditure of energy
• Filtration transfer of water and solutes through
  a membrane from a region of high pressure to a
  region of low pressure
• Osmosis movement of water across a membrane from
  a less concentrated solution to a more
  concentrated solution

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Fluid Pressures (Starlings Law)

• ECF and ICF fluid shifts occur related to changes
  in pressure within the compartments
• Fluid flows only when there is a difference in
  pressure
• 3 types of body fluids
• Isotonic
• Hypotonic
• Hypertonic

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Hydrostatic Pressure and Colloid Osmotic Pressure

• Tissue fluids and plasma in the capillaries have
  hydrostatic and colloid osmotic pressure
• Hydrostatic pressure forces fluid and solutes
  through the capillary walls
• When the hydrostatic pressure inside the
  capillary is greater than the pressure in the
  surrounding interstitial space, fluids and
  solutes inside the capillary they are forced out
  into the interstitial space
• This also happens in the reverse

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Albumins Role in F/E Balance

• Reabsorption prevents too much fluid from leaving
  the capillaries
• Albumin is a large molecule and will not pass
  through the capillary membrane
• When fluid filters through the capillary, the
  protein albumin remains behind
• When the concentration of albumin increases,
  fluid begins to move back into the capillary wall
  by osmosis
• The pulling force of albumin in the intravascular
  space is called plasma colloid oncotic pressure

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Plasma Colloid Osmotic Pressure
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Regulation of Fluid Volume

• Kidneys
• Capillary pressure forces fluid through the walls
  and into the tubule
• At this point H2O or electrolytes are then either
  retained or excreted
• The urine becomes more dilute or more
  concentrated based on the needs of the body

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Regulation of Fluid Volume, cont.

• Antidiuretic hormone (ADH)
• Produced by the hypothalamus
• Stored in the pituitary gland
• Restores blood volume by increasing or decreasing
  excretion of water
• Increased osmolality or decreased blood volume
  stimulates the release of ADH
• Then the kidneys reabsorb water
• Also may be released by stress, pain, surgery,
  and some meds

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Regulation of Fluid Volume, cont.

• Renin-angiotensin-aldosterone system
• Renin secreted in kidney
• Amount of renin produced depends on blood flow
  and amount of Na in the blood
• Produces angiotensin II (vasoconstrictor)
• Angiotensin causes peripheral vasoconstriction
• Angiotensin II stimulates the production of
  aldosterone

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Regulation of Fluid Volume, cont.

• Aldosterone
• Secreted by the adrenal gland response to
  angiotensin II
• The adrenal gland may also be stimulated by the
  amount of Na and K in the blood
• Causes the kidneys to retain Na and H2O
• Leads to increases in fluid volume and Na levels
• Decreases the reabsorption of K
• Maintains B/P and fluid balance

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Regulation of Fluid Volume, cont

• Atrial natriuretic peptide or factor (ANP) (ANF)
• Cardiac hormone
• Released in response to increased pressure in the
  atria (increased blood volume)
• Opposes the renin-angiotensin-aldosterone system
• Stimulates excretion of Na and H2O
• Suppresses renin level
• Decreases the release of aldosterone
• Decreases ADH release
• Reduces vascular resistance by causing
  vasodilation

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Fluid shifting

• 1st space shifting- normal distribution of fluid
  in both the ECF compartment and ICF compartment.
• 2nd space shifting- excess accumulation of
  interstitial fluid (edema)
• 3rd space shifting- fluid accumulation in areas
  that are normally have no or little amounts of
  fluids (ascites)

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REGULATION OF FLUID VOLUME
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Diagnostic Tests for F/E

• Urine studies
• Urine pH Urine specific gravity
• Urine osmolarity
• Urine creatinine clearance
• Urine sodium
• Urine potassium

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Blood Studies

• Serum Hematocrit 40-54/men, 38-47 for women
• Serum Creatinine 0.6 1.5 mg/dl
• BUN 8-20 mg/dL
• Serum osmolality
• Serum Albumin 3.5-5.5 g/dL
• Serum Electrolytes

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ASSESSMENT FOR F/E BALANCE

• History of potential factors which place patient
  at risk
• Vital signs
• I/O
• Body weight
• Skin
• Mucus membranes
• Vascular system

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FLUID VOLUME DEFICITE

• Hypovolemia isotonic extracellular fluid
  deficit
• Deficiency of both water electrolytes
• Caused by decreased intake, vomiting, diarrhea,
  fluid shift

• Dehydration hypertonic extracellular fluid
  deficit
• Deficiency of water
• Caused by water loss related to high blood
  glucose, inadequate ADH production, high fever,
  excess sweating

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Assessment of Fluid Deficit

• Hypotension
• Weak rapid pulse
• Temperature decreased if hypovolemic, and
  increased in dehydration
• Weight loss
• Skin turgor poor in dehydration and possible
  edema in hypovolemic
• Concentrated urine and blood

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Treatment of Deficit

• Correct cause
• IV fluids
• I and O
• Skin care
• Assist with ADLs

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FLUID VOLUME EXCESS

• Extracellular isotonic fluid excess
• Excess of both water and electrolytes
• Caused by retention of water and electrolytes
  related to kidney disease overload with isotonic
  IV fluids

• Intracellular water excess
• Excess of body water without excess electrolytes
• Caused by over-hydration in the presence of renal
  failure administration of D5W

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FLUID VOLUME EXCESS/Assessment

• Isotonic
• Hypertension
• Bounding pulse
• Crackles, dyspnea
• Weight gain
• Edema in extremities
• JVD
• Irritable, confused

• Hypotonic
• Systolic B/P
• Decreased pulse
• Increased respirations
• Weight gain
• Cerebral edema
• Irritable, confused

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FLUID VOLUME EXCESS/ Treatment

• Isotonic
• Correct cause
• Restrict H2O and Na
• Diuretics
• Digitalis
• Possible dialysis

• Hypotonic
• Correct cause
• Restrict H2O intake
• IV fluids with E-lytes

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FLUID VOLUME EXCESS/Nursing Care

• Isotonic
• Monitor for excess excretion of H2O R/T diuretics
• Maintain fluid restriction
• Consult dietary for salt restrictions
• Watch for skin problems
• HOB 30 degrees

• Hypotonic
• IVs and meds as ordered
• I/O
• Oral care and ice chips
• Safety precautions
• Seizure precautions

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