Care of Clients with Problems In Oxygenation, Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Fluids

and Electrolytes (Renal) Alteration II
Topics Discussed Here Are: 1. Basic Concepts of Fluids and Electrolytes 2. Fluid Compartments 3. Major Common Fluid Imbalances

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Basic Concepts on Fluids and Electrolytes

A. Definition of Terms 1. Electrolytes • Are compounds / substances which when placed in a solution would break up / dissociate in 2 electrically charged particles • Can be an: 1. Ion – Electrically charged particles 2. Cation / Anion 2. Fluid / Water • Fluid More ENCOMPASSING Contains WATER and ELECTROLYTES • Water Does not contain ELECTROLYTES FLUID is WATER, but WATER is NOT FLUID Body is made up of 60% - 70% WATER!! B. Factors That Determines the Amount of Water 1. Age (The younger more water! The older the less water) • As we grow older, the LEAN portion of body (muscles), fatty tissues are replaced by ANHYDROUS (Contains no WATER) • Babies have IMMATURE KIDNEYS. Therefore, they are at risk for DEHYDRATION (Kidneys cannot conserve water ) • Body metabolism of newborn is HIGHER compared to an adult (As Age ↑:Body Metabolism ↓) • ↑ Body Metabolism, GREATER CONSUMPTION of WATER ☺ 2. Gender (Sex) • Males: ↑ Water - ↑ Muscle • Females - ↓ Water – Fats (Anhydrous) However, the deposition of muscle on males and fats on females is only a secondary sex characteristic

3.

Body Size • Thinner More WATER! Less FAT! • Obese Less WATER More FAT! (Anhydrous)

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Cl are all inside and outside the cell! Intracellular Fluid (ICF) Fluid inside the cell Composes 2/3 of the TOTAL BODY FLUID of the body Potassium Phosphate (Major ICF Electrolyte) • Potassium (+) INSIDE and OUTSIDE THE CELL~ • Phosphate (–) . Peritoneum = Ascites) Total body fluid is the same!! jcmendiola_Achievers2013 . and synovial fluid 3.600 mL LUNGS and SKIN are INSENSIBLE FLUID LOSS (900 mL) • Fluid loss which are NOT within our control • Fluid loss we CANNOT SEE SWEAT – Sensible fluid loss! Situation: Inside the classroom with a teacher speaking and students listening Who has more insensible fluid loss through the lungs? Who has more sensible fluid loss through the lungs? ☺ FLUID COMPARTMENTS :P 1. the fluid does not go to the other compartment A special compartment wherein the fluid goes in the space. but the fluid is NOT used by the body (Ex. OUTPUT should be the same (2.600 mL) Where do we get the 2.600 mL Whatever we INTAKE. Transcellular Fluid Compartment Consists of body’s secretions and excretions Urine. WBC.Normal Condition of Fluid Intake Normal intake of water is 2.300 mL) • Food (1. Interstitial Fluid Compartment Fluid surrounding the cell or in between the cell Example: Lymph! 11 – 12 L of interstitial fluid b. 2. 3rd Space Fluid If in the event if the ICF/ECF escapes out/inside the cell respectively.600 mL Normal Conditions of Fluid Output Normal output of water is 2. K. Platelets (3 L) c. CSF.6 L of FLUID OUTPUT? • Kidney (1. saliva. GIT secretions.If the amount of concentration is the • Sodium (+) same both inside and outside the cell. Intravascular Fluid Compartment Fluid inside the blood vessel 5 – 6 L of intravascular space Plasma (3 L) RBC.6L of FLUID?? • Water (1. perspiration.000 mL) • Oxidation of Food (300 mL) TOTAL: 2. • Chloride (–) there is no SHIFTING of FLUID Divided into 3 Spaces~ a.600 mL Where do we get the 2.There is a difference of concentration in Extracellular Fluid (ECF) the ICF and ECF Fluid outside the cell .The amount of ion in each compartment 1/3 of total body fluid will account for the osmolality~ Sodium Chloride (Major ECF Electrolyte) . PO4. Na.500 mL) • GIT (200 mL) • Lungs (300 mL) • Skin (600 mL) TOTAL: 2.

Aldosterone ↑ Fluid intake ↑ Thirst LBM Px 6x Vomiting ↑ Water Reabsorption ↓ Urine Output Posterior Pituitary Gland Fluid Imbalance (FVD) Hypothalamus Pituitary Gland ↑ Na ↑ Reabsorption of Water ↑ Na. Burns.We Are Aware with Fluid Imbalance!! 1.↓ Fluid Intake (People who cannot recognize thirst) . Polyuria. ↓ K ↑ Aldosterone ↑ ADH Anterior Pituitary Gland Adrenal Cortex ↑ ACTH Major Common Fluid Imbalances (Isotonic fluid referred to by body fluid and ECF. ADH b.↑ Fluid loss o Diarrhea.↓ CVP . Bleeding. excessive vomiting (Hyperemesis gravidarum). Blood. Hypovolemia Fluid Volume Deficit (FVD) Isotonic Deficit Dehydration Causes: . Thirst (1st Factor) Hypothalamus tells you if you are thirsty! Hormones a. plasma. Excessive perspiration.↓ Urine Output . perspiration) 1.Urinalysis: Dark yellow urine jcmendiola_Achievers2013 . 2.↓ Weight . drainage (fistulas) Manifestations: . Ex.Sunken fontanels (Newborns) . 3.↓ Blood Pressure . urine.

Hypervolemia Fluid Volume Excess (FVE) Over hydration ↑ Intake: ↓ Output Causes: . Increase Oral Fluid Intake If fluid volume deficit is brought about by diarrhea.Management: a.45 Saline Solution Give when patient is: DEHYDRATED (Poor skin turgor) Hypertonic = Concentration of fluid is ↑ in the blood than the concentration in the ICF Examples: D10W D50W Mannitol Give when patient is/has: EDEMA! OSMOSIS Movement of FLUID from an area of LOW concentration to an area of HIGH concentration DIFFUSION (Gas / Particles) Movement of PARTICLES from a HIGHER CONCENTRATION to a LOWER CONCENTRATION Sea water is HYPERTONIC! SODA is also HYPERTONIC 2. give anti diarrheal drug If vomiting. Intravenous Therapy ICF ECF Isotonic Hypotonic Hypertonic 1.Psychiatric patients (Obsessive Compulsive of Water ) jcmendiola_Achievers2013 . 3. b. give antiemetic Give coagulant if bleeding Blood Transfusion Pack RBC Whole Blood Crystalloid Plasma Expander (Dextran) Burns 2. Isotonic = Concentration of fluid is same as blood.5W 0.9 Saline Solution NSS LRS Give when patient is: BLEEDING Hypotonic = Concentration of fluid is ↓ in the blood than the concentration in the ICF Examples: D2. NO SHIFTING OF FLUID Used to maintain blood volume Examples: D5W 0.

Ascites 5.Urinalysis o Dark Yellow Urine (Can’t EXCRETE) Management: ↓ FLUID INTAKE ↓ Na Diet! SITUATION: (Management for each complication) Right Sided Heart Failure = Digitalis (Lanoxin) Renal Failure = Diuretic Severe Cases of Hypervolemia = Dialysis Liver Impairment Abdominal Paracentesis • Aspiration of FLUID from PERITONEUM • Inserted between the Umbilicus and Symphysis Pubis by 2 – 3 fingers • IMPORTANT: Client MUST EMPTY the BLADDER To prevent damage to the bladder jcmendiola_Achievers2013 . Peripheral Edema (Sausage shaped fingers) 4. ↑ BP Laboratory Findings: . Periorbital Edema 3.Hemoglobin and Hematocrit is Decreased . ↑ K Excretion Increased Na = Increased Water in body ☺ (Hypervolemia) ↓ Urine Output due to: o Renal Failure o Presence of Edema Manifestations: 1.- - - Related to Diet o Increased Na diet o Rapid administration of IV Fluid Overuse of saline solution Associated with Disorders: o Cushing’s Syndrome (↑ Aldosterone) ↑ Na Retention. Weight is INCREASED 2.

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