I. DISTRIBUTION A. Fluid compartments 1. Intracellular: within the cell 2. Extracellular: within the blood vessels 3.

Interstitial: between cells; fluid that surrounds cells  

B. Compartment fluid content clue: TIE Clue 1. BODY FLUID VOLUMES 60: 40 : 20 RULE T I E RULE T I E = Total body water = Intracellular = Extracellular 

FLUID BALANCE PHYSIOLOGY: A. Movement of molecules: 1. DIFFUSION = SOLUTE MOV’T FROM HI-TO-LOW

FLUID BALANCE PHYSIOLOGY: A. Movement of molecules: 2. OSMOSIS = SOLVENT MOV’T FROM LOW-TO-HI

HOMEOSTASIS: CONCEPT OF RENIN ANGIOTENSIN ALDOSTERONE SYSTEM (RAAS)

Renin-Angiotensin-Aldosterone System
Liver produces angiotensinogen 1 Decreased perfusion pressure in the afferent arteriole stimulates secretion of renin by the juxtaglumerular cells 3 Activation of Angiotensin I to Angiotensin II occurs in the pulmonary capillary bed by ACE

2 Renin reacts with angiotensinogen to form Juxtaglumerular cells

Angiotensin I

Angiotensin II

Glomerulus

arteriol e Angiotensin II receptors

Sodium retention
• ADH release and water retention • Increase blood volume

Afferent arteriole 5 Aldosterone causes increased sodium and water reabsorption by the tubules of the kidney 4 Angiotensin II stimulates the angiotensin II receptors to cause release of aldosterone from the adrenal cortex

4 Angiotensin II: a powerful vasoconstrictor

ELECTROLYTES and its VALUES Na K Ca Mg P Cl (SODIUM) (POTASSIUM) (CALCIUM) (MAGNESIUM) (PHOSPHATE) (CHLORIDE) 135 3.5 4.5 1.5 1.5 95 145 5.0 5.5 2.5 2.5 105

MAJOR ELECTROLYTES A. INTRACELL: (PASOK) POTASSIUM-PHOSPHATE B. EXTRACELL: (ECS) SODIUM-CHLORIDE

WHAT IS THE MOST RELIABLE INDICATOR OF FLUID BALANCE? a.Intake and output b.Weight

WEIGHING CLIENT:
 SAME TIME, SAME EQUIPMENT,

SAME CLOTHING  REPORT WEIGHT GAIN MORE THAN 1 LB PER DAY  BEST METHOD OF ASSESSING FLUID STATUS.

CLASSIFICATION OF HUMAN BLOOD

BLOOD TRANSFUSION THERAPY:  Needle 18  Plain NSS  USE FILTER IN IV LINE  STOP ASAP at first sign of transfusion REACTION  TEMPERATURE check before BT  20 DROPS/min FOR FIRST 20 MINUTES or 20-20 METHOD  PREMEDICATE ANTIHISTAMINE if needed!

ABG INTERPRETATION: 1. Start with the pH: 7.35 – 7.45 2. Look at the PaCO2: 35 – 45 mmHg 3. Evaluate the metabolic indicators: HCO3: 22 -26 mEq/L 4. If both values in 2 and 3 are abnormal (PaCO2 and HCO3), with one indicating acidosis and other indicating alkalosis, the body is compensating and attempting to reestablish acid-base balance

5. Establish the amount of hypoxemia present from PaO2 and O2 sat. If these are below normal, some degree of hypoxemia are present If PaO2 is 60 – 80 mmHg : MILD If PaO2 is 40 – 60 mmHg : MODERATE If PaO2 is below 40 mmHg : SEVERE

1. pH = 7.35 – 7.45
a. Below 7.35
b. Above 7.45 c. 7.35 – 7.39 d. 7.41 – 7.45 = = = = acidosis alkalosis Normal But Towards Acidosis Normal But Towards Alkalosis

2. paCO2 = 35 – 45
a. RESPIRATORY CONDITION INDICATOR b. paCO2 below 35 = RESPIRATORY alkalosis c. paCO2 above 45 = RESPIRATORY acidosis

3. HCO3- = 22 – 26
a. METABOLIC CONDITION INDICATOR b. HCO3- below 22 = METABOLIC acidosis c. HCO3- above 26 = METABOLIC alkalosis

THREE (3) steps in ABG interpretation Step 1: Interpret the pH Step 2: What’s THE SAME with pH condition? Step 3: THE REACTION of remaining parameter?  

Fully compensated = if pH is normal limits. (7.35 to 7.45)   b. Partially compensated = if pH is abnormal = if 2 parameters are opposite.   c. Uncompensated = abnormal pH. = 1 parameter is the same with that of the pH condition = another remaining parameter is normal

Example:

pH PCO2 HCO3-

= 7.47 = 33 = 22

ANSWER:

RESPIRATORY ALKALOSIS UNCOMPENSATED!

Example:

pH PaCO2 HCO3 Pa02

: : : :

7.21 31 19 80

Answer:

METABOLIC ACIDOSIS PARTIAL COMPENSATED!

Example:

pH PaCO2 HC03 Pa02

: : : :

7.38 47 28 85

Answer:

RESPIRATORY ACIDOSIS FULLY COMPENSATED!

Example:

pH PaCo2 HCO3 Pa02

: : : :

7.48 38 29 79

Answer:

METABOLIC ALKALOSIS WITH MILD HYPOXEMIA UNCOMPENSATED!

THANK YOU!

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