Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Download
Standard view
Full view
of .
Look up keyword
Like this
2Activity
0 of .
Results for:
No results containing your search query
P. 1
Fluid Electrolytes Acid-base and Shock

Fluid Electrolytes Acid-base and Shock

Ratings:
(0)
|Views: 31|Likes:
Published by josephabram051590

More info:

Published by: josephabram051590 on May 08, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

08/02/2013

pdf

text

original

 
 
FLUID, ELECTROLYTES, ACID-BASE AND SHOCKObjectives:
1.
 
Discuss the importance of fluids, electrolytes and acid-base elements inensuring/maintaining proper body function.2.
 
Describe the movement of fluids, electrolytes and other substances throughout thebody by the following: diffusion, osmosis, pressure differential, and other essentialmechanisms.3.
 
Relate common fluid, electrolyte, and acid-base laboratory values and diagnosticteststo normal physiology and pathological disease processes.4.
 
Discuss common causes of fluid, electrolyte and acid-base imbalances5.
 
Discuss nursing responsibilities for assessment, identification, treatment andfollow-
 
up of fluid, electrolyte and acid-base imbalances6.
 
Discuss nursing responsibilities for hypovolemic, cardiogenic, neurogenic,anaphylacticand septic shock .
Readings:
1. Lewis, Medical-Surgical Nursing: 7
th
edition, chapter 17 and 67; 6
th
edition,chapters 16 and 65.2. "Emergency: Hyperkalemia," AJN, Jan 2000, article following content
 
3. “Management of Hyponatremia,” Kian Peng Goh, American Family Physician, May15, 2004,http://www.findarticles.com/p/articles/mi_m3225/is_10_69/ai_n6048503 
Please utilize the readings to supplement and further elaborate the topics below, to fulfill theobjectives of the course.
 
FLUIDS, ELECTROLYTES and ACID-BASE STATUSI.
 
GENERAL CONSIDERATIONS:
A.
 
The body likes to remain in balance and employs various mechanisms tohelp maintain homeostasisB.
 
Acute rapid changes in fluids and/or electrolytes are more ominous thanslow gradual changesC.
 
Water, electrolytes and other substances are present in many differentareas of the body, yet serum laboratory values only measure conditions in
1
 
the intravascular space so cellular and other changes often must beinferredD.
 
Treatment of imbalances always includes correcting the underlying cause,when possible. In addition, when other treatments are employed, must becareful not to over treat; body is employing its own mechanisms tocounteract and serum changes often lag slightly behind treatment sotreatment is aimed at approaching, not reaching normal in order toprevent ending up with exact opposite problem that was being treated(e.g., treatment for hyponatremia causing hypernatremia); frequentlaboratory and clinical checks are essential
BODY FLUIDS
I.
 
FUNCTION:
vital to life; help maintain body temperature and cell shape;involved in transporting nutrients, gases, and wastes; principle fluid in body iswater; skin, lungs and kidneys work together to maintain the proper fluidbalance
 
II.
 
FLUID
 
COMPARTMENTS
: 2 main; separated by capillary walls & cellmembranes:A.
 
intracellular fluid (ICF): within cells; 40% of body weight and 70% of totalbody waterB.
 
extracellular fluid (ECF): outside cells; 20% of total body weight and 30 %of total body water; comprised of:1.
 
interstitial fluid (ISF): between cells; ~2/3 ECF2.
 
intravascular fluid (IVF): plasma; ~1/3 ECF; high proteinconcentration3.
 
transcellular (TCF): GI tract, peritoneal, cerebrospinal, pleural, andsynovial fluid; small ~1L of ECF
 
III.
 
BODY WATER DISTRIBUTION & SPACING:
A.
 
Distribution varies with age, sex and body composition. Percentage ofbody weight that is water is about 80% in a full-term infant, 60% in atypical lean, adult male, and 45-50% of obese and elderly. This putsinfants, elderly, and obese individuals at greater risk for fluid relatedproblems.B.
 
Fluid spacing is a term used to classify the distribution of water in thebody:1.
 
First Spacing 
: describes normal distribution of fluid in the bodyin both the intracellular and extracellular fluid compartments.2.
 
Second Spacing:
describes the excess accumulation of fluid in theinterstitial spaces, which we also call edema.
2
 
3.
 
Third Spacing:
occurs when fluid accumulates in areas thatnormally have no fluid or minimal amount of fluid, such aswith ascites, and edema associated with burns. In extreme casesthird spacing can cause a relative hypovolemia.4.
 
Fluid Status:
1 liter of water weighs 2.2 pounds. A sudden weightgain or loss is the best indicator of fluid status. Patients that needto have their fluid status monitored should have not only theirIntake and Output measured, but also daily bedside weights.
IV.
 
FLUID, ELECTROLYTE & PARTICLE MOVEMENT
A.
 
Electrolytes move between ICF & ECF via concentration (toward lowerconcentration) & electric gradients (toward opposite charge)1.
 
Diffusion:
movement of molecules from an area of higherconcentration to one of lower concentration.2.
 
Facilitated Diffusion:
addition of specific carrier molecule toaid/accelerate diffusion (e.g., glucose transport into cell facilitatedby insulin)3.
 
Active transport:
molecules moved from area of low to higherconcentration; external energy (ATP) allows movement againstconcentration gradient (e.g., “Sodium Pump”, where potassium ismoved into cell and sodium pumped out)B.
 
Water moves according to pressure forces1.
 
Hydrostatic pressure:
pressure of blood fluid against capillarywall; if greater than pressure in interstitial space, fluids and solutesforced out of blood; if less, come back into blood2.
 
Osmosis:
water movement from area of higher to lowerconcentration (“diffusion of water”) through membrane permeableto water, but not to solute; no energy needed; stops when solutionconcentrations equalizea)
 
Osmotic pressure:
movement of water by osmosis;measured by osmolarity (mOsm/L) and osmolality(mOsm/kg); kidneys are mainly responsible for maintainingconcentration of body fluids within normal range ofosmolality through changes in antidiuretic hormone (ADH)secretion; normal osmolality is 275-295 mOsm/kgb)
 
Tonicity & IV solutions:
a solution’s solute concentration(e.g., I.V. fluid) compared to another solution (e.g., blood);its “effective osmolality”; IV solutions are categorized into:(1)
 
Isotonic:
same effective osmolality as body fluids(e.g., 0.9% NaCl, D5W (prior to infusion), LactatedRingers); causes intravascular expansion and possiblysome interstitial edema but no water shifts into or outof cells.
3

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->