Homeostasis

PNUR 251
Homeostasis

 Physiological balance
Homeostasis: The Balancing Act

 Role of the kidneys?

 ADH?
 Renin and Angiotensin ?
 Aldosterone?
 Atrial Natriuretic peptide ?
 Thirst?
Fluid Distribution
 Intracellular (ICF)  Extracellular (ECF):
 Transcellular, fluid in  Interstitial
– CSF – Between the cells
– GI tract  Intravascular
– Pleural, synovial, – In the plasma
peritoneal spaces
Homeostasis Unbalanced

 A change in % of water volume

 Fluid shifts
– ( ICF ↔ ECF)
 A change in electrolyte balance/ [ ]
 Acid-base imbalance
Movement of Substances
 An ion or molecule can diffuse across the plasma
membrane by:
 Crossing lipid portion of membrane
 Passing through membrane channel
 Larger molecules cannot diffuse through membrane
 Cross membrane by carrier mechanism
 Individual solutes diffuse along their own
concentration gradient (not affected by other solutes)
 Plasma membrane is freely permeable to water
 Diffusion of water is called osmosis
Movement of Substances cont.
Distribution of Fluids and
Electrolytes
 Think Pair Share
If a client takes an oral potassium supplement or
receives potassium in an IV, which physiological
process relocates the potassium within cells?
Fluid Imbalances
 Hypovolemia (low  Hypervolemia (high
volume of extracellular volume of water in
fluid ie: blood volume) intravascular fluid
compartment)
 Fluid Volume Deficit/
Dehydration
 Equal Loss of water  Clinical Manifestations
and lytes in conditions
such as:
FVD: Lab Values

 ↑ serum osmolality
 ↑ Hct
 ↑ Urine specific gravity
 ↕ serum Na depending on cause of FVD
 ↓ serum Potassium
Nursing Implications
 Monitor weight* (most reliable measurement)
and VS (? Postural hypotension present/↑temp will
increase insensible losses)
 Assess breath sounds
 Assess skin turgor (presence of tenting)
 Administer oral fluids as ordered, freq.
mouth care (assess “thirst”)
 Prevent skin break down
 Safety considerations
 ?
 A fluid volume deficit can be caused by
either dehydration or hypovolemia.
What is the distinction between the two?
a. In hypovolemia all fluid compartments
have decreased volumes
b. In dehydration intracellular fluid volume is
depleted
c. In hypovolemia only blood volume is low
d. In dehydration only blood volume is low
Hypervolemia : Fluid Volume
Excess
 Usually results from Na and water
retention
 Conditions that can lead to this retention
include :
Hypervolemia: Manifestations
Hypervolemia: Lab Values

 ↓ serum osmolality
 ↓ Hct
 ↓ urine specific gravity
Hypervolemia:
Medical Management
 Oral and parenteral fluid intake
restriction
 Diuretics
 Na intake restriction
Electrolytes

 Substances whose molecules

dissociate into ions (electrically charged
particles). Positive (cations) or negative
(anions)
 Acids: release hydrogen
 Bases: bind with hydrogen
Specific Electrolytes
 Anions
– Chloride*
– Phosphorus
– Bicarbonate*
 Cations
– Sodium*
– Calcium
– Potassium*
– Magnesium
 Sodium  Potassium
 Major influence in  Regulation of
maintaining water cardiac rhythm
levels  Contraction of
 Required for nerve smooth and skeletal
impulse conduction muscle
 Excreted through  Kidneys conserve
the kidneys Na+ at the expense
 Reference Range: of K+
135 – 145 mEq/L  Reference Range:
3.5 – 5.5 mEq/L
 Calcium  Magnesium
 Stored in bone,  Essential for cardiac
plasma and cells muscle excitability
 Required for bone  Plays a role as a
formation, cardiac coenzyme in
conduction, muscle conversion of ATP
contraction to ADP

 Reference Range:  Reference Range:

– 4 – 5 mEq/L – 1.5 – 2.5 mEq/L
 PHOSPHORUS
 Crucial role in cell
membrane integrity
 Muscle function
 Neurologic function
 Metabolism of fats, carbs,
protein
 Buffering of acids and
bases
 Essential in bones &
teeth
 Found in RBCs
 WBC & Platelet function
CHLORIDE
 Helps maintain serium
osmolality and water
balance
 Secreted by gastric
mucosa as HCL
 Assists in CO2 transport
in RBCs
 Helps maintain acid base
balance
 Sodium Imbalances: Clinical
Manifestations
Hyponatremia Hypernatremia
 Potassium Imbalances: Clinical
Manifestations
Hypokalemia Hyperkalemia
Calcium Imbalances: Clinical
Manifestations
Hypocalemia Hypercalcemia
Chvostek’s Sign /Trousseau’s Sign
Magnesium Imbalances: Clinical
Manifestations
Hypomagnesemia Hypermagnesemia
 Chloride Imbalances: Clinical
Manifestations
 Hypochloremia  Hyperchloremia
Acid-Base Balance
Acid Base Balance

 Ratio of 20 parts HCO3 to 1 part

H2CO3 maintains normal plasma pH
 Buffer systems can temporarily store
Hydrogen ions and thereby provide
short term stability
 Compensatory mechanisms (respiratory
and kidney)
Acid-Base Balance
 Carbonic acid H2CO3
 Bicarbonate HCO3
 pH refers to amount of hydrogen ions in a
solution
 Body maintains the normal plasma pH by
two mechanisms:
– Chemical (buffers) regulation
– Organ (physiological) regulation
Bicarbonate Buffer System
Organ Regulation

 Lungs and kidneys facilitate the ratio of

HCO3 to H2CO3
 The lungs regulate by releasing or
conserving CO2 (↑ or↓ respiratory rate,
volume of both)
 Kidneys assist by retaining or secreting
bicarbonate ions
Diagnostics
RESPIRATORY ACIDOSIS
 Caused by excess carbonic acid
 Causes the blood pH to drop below 7.35
 (think respiratory insufficiency)
 Common Causes Table 19-12
 Clinical Manifestations of
Acidosis
Table 19-13
-Disorientation
-Cyanosis
-Shallowed or labored breathing
-Pale extremities
-Seizures
-Cardiac dysrhythmias
-Poor capillary refill
 Collaborative Treatment
 Focus on improving ventilation and
lowering PaCO2 level
– Bronchodilation
– Mechanical ventilation
 If stems from non-respiratory condition,
focus on correcting underlying cause
– Ie. Drug overdose
 Nursing Implications
 ABC’s
 Safety
 VS, cardiac rhythms, respiratory patterns
 Meds (bronchodilators)
 Oxygen therapy
 DB& C
 I&O
 IV access (fluids)
 Reassurance
 Teaching
Nursing Interventions
Respiratory Alkalosis

 Results from alveolar hyperventilation

and hypocapnia (carbonic acid
deficiency that occurs when rapid
breathing releases more CO2)
 May be acute or chronic
 May be difficult to id because of renal
compensation
How it Happens
 Clinical condition that increases the
respiratory rate or depth so as to cause
an increase in pH
Table 19-12
 Clinical Manifestations of
Alkalosis
 Table 19-14
 Lethargy
 Tetany, numbness, tingling of
extremities
 Seizures, tremors
 Treatment

 Focuses on correcting underlying

disorder, removal of causative agent
such as salicylate or other drug or
measures to reduce fever and eliminate
the source of sepsis
 Oxygen therapy, antianxiety, or
sediatives
 METABOLIC ACIDOSIS
 Underlying mechanism is loss of HCO3 from
ECF (urine or feces) OR
 Buildup of metabolic acids (ie. Overproduction
of ketone bodies when glucose supplies have
been used up and body breaks down fat
stores), impaired H+ exertion by kidneys
 An accumulation of metabolic acids or a
combination of both
Gain acids, lose bases
 Overproduction of ketone bodies when
glucose supplies have been used up
and body breaks down fat stores
– Table 19-12
What to look for

 Table 19-13
 Interventions
 Respiratory therapy is usually first line of
therapy including mechanical ventilation if
needed
 Manage K levels (will shift rapidly)
 Give insulin (diabetic ketoacidosis)
 Replace bicarbonate (IV route)
 Dialysis may be indicated for patients with
renal insufficiency or toxicity etiology
Interventions
 ABC’s
 Safety
 VS, cardiac rhythms, respiratory patterns,
neurological
 Meds (vasopressors, antibiotics, insulin, sodium
bicarbonate)
 Prepare for dialysis or ventilation
 I&O
 Positioning (depending on neurological status)
 Lab monitoring
METABOLIC ALKALOSIS
 Underlying mechanism includes loss of
H+, a gain in Bicarbonate, or both
 Table 19-12
What to look for
 Table 19-14
Treatment
Interventions
Interpreting ABG Results

 Tic Tac Toe

 ROME (Table 19-17)