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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:

LOOKY HERE ☺
LOOKY
HERE ☺
  • 1. Basic Concepts of Fluids and Electrolytes

Basic Concepts on Fluids and Electrolytes

  • 2. Fluid Compartments

  • 3. Major Common Fluid Imbalances

A. Definition of Terms 1. Electrolytes • • Are compounds / substances which when placed in
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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Normal Condition of Fluid Intake

Normal intake of water is 2,600 mL

 

Whatever we INTAKE, OUTPUT should be the same (2,600 mL)

Where do we get the 2.6L of FLUID??

 

Water (1,300 mL)

 

Food (1,000 mL)

Oxidation of Food (300 mL)

 

TOTAL: 2,600 mL

Normal Conditions of Fluid Output

Normal output of water is 2,600 mL

 
 

Where do we get the 2.6 L of FLUID OUTPUT?

 

Kidney (1,500 mL)

GIT (200 mL)

Lungs (300 mL)

Skin (600 mL)

 

TOTAL: 2,600 mL

 

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. Intracellular Fluid (ICF)

    • Fluid inside the cell

K, PO 4 , Na, Cl are all inside and outside the cell!

  • Composes 2/3 of the TOTAL BODY FLUID of the body

  • Potassium Phosphate (Major ICF Electrolyte)

Potassium (+)

Phosphate (–)

  • 2. Extracellular Fluid (ECF)

    • Fluid outside the cell

    • 1/3 of total body fluid

    • Sodium Chloride (Major ECF Electrolyte)

Sodium (+)

Chloride (–)

  • Divided into 3 Spaces~

    • a. Interstitial Fluid Compartment

INSIDE and OUTSIDE THE CELL~

  • - There is a difference of concentration in the ICF and ECF

  • - The amount of ion in each compartment will account for the osmolality~

  • - If the amount of concentration is the same both inside and outside the cell, there is no SHIFTING of FLUID

Fluid surrounding the cell or in between the cell

Example: Lymph!

11 – 12 L of interstitial fluid

  • b. Intravascular Fluid Compartment

Fluid inside the blood vessel

5 – 6 L of intravascular space

Plasma (3 L)

RBC, WBC, Platelets (3 L)

  • c. Transcellular Fluid Compartment

Consists of body’s secretions and excretions

  • 3. 3 rd Space Fluid

Urine, perspiration, saliva, GIT secretions, CSF, and synovial fluid

  • If in the event if the ICF/ECF escapes out/inside the cell respectively, 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. Peritoneum = Ascites)

  • Total body fluid is the same!!

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We Are Aware with Fluid Imbalance!!

  • 1. Thirst (1 st Factor)

  • 2. Hypothalamus tells you if you are thirsty!

  • 3. Hormones

    • a. ADH

    • b. Aldosterone

↑ Fluid intake ↑ Thirst Fluid Hypothalamus Imbalance
↑ Fluid intake
↑ Thirst
Fluid
Hypothalamus
Imbalance

(FVD)

We Are Aware with Fluid Imbalance!! 1. Thirst (1 Factor) 2. Hypothalamus tells you if you

LBM

We Are Aware with Fluid Imbalance!! 1. Thirst (1 Factor) 2. Hypothalamus tells you if you

Px 6x

We Are Aware with Fluid Imbalance!! 1. Thirst (1 Factor) 2. Hypothalamus tells you if you

Pituitary Gland

We Are Aware with Fluid Imbalance!! 1. Thirst (1 Factor) 2. Hypothalamus tells you if you
We Are Aware with Fluid Imbalance!! 1. Thirst (1 Factor) 2. Hypothalamus tells you if you

Anterior

Pituitary Gland

↓ Urine Output
↓ Urine
Output

Vomiting

↑ Water

Reabsorption

Posterior

Pituitary Gland

↑ Na ↑ Na, ↓ K
↑ Na
↑ Na, ↓ K
↑ ADH
↑ ADH

Reabsorption

of Water

↑ ACTH
↑ ACTH

Aldosterone

  • Adrenal Cortex

Major Common Fluid Imbalances

(Isotonic fluid referred to by body fluid and ECF, Ex. Blood, plasma, urine, perspiration)

  • 1. Hypovolemia

Fluid Volume Deficit (FVD)

Isotonic Deficit

Dehydration

Causes:

 
 

-

Fluid Intake (People who cannot recognize thirst)

-

Fluid loss

 

o

Diarrhea, Polyuria, Bleeding, Burns, Excessive perspiration, excessive vomiting (Hyperemesis gravidarum), drainage (fistulas)

Manifestations:

 

-

Sunken fontanels (Newborns)

-

Urine Output

-

Weight

-

Blood Pressure

-

CVP

-

Urinalysis: Dark yellow urine

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Management:

  • a. Intravenous Therapy

ICF

 

ECF

 
Isotonic
 
  • Isotonic

ICF ECF Isotonic Hypotonic Hypertonic
   
   

Hypotonic

ICF ECF Isotonic Hypotonic Hypertonic
   
   
  • Hypertonic

  • 1. Isotonic = Concentration of fluid is same as blood; NO SHIFTING OF FLUID Used to maintain blood volume Examples:

D 5 W

0.9 Saline Solution

NSS

LRS

Give when patient is: BLEEDING

  • 2. Hypotonic = Concentration of fluid is in the blood than the concentration in the ICF Examples:

D 2.5 W

0.45 Saline Solution

Give when patient is: DEHYDRATED (Poor skin turgor)

  • 3. Hypertonic = Concentration of fluid is in the blood than the concentration in the ICF Examples:

D

10

W

D

50

W

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

  • b. Increase Oral Fluid Intake

 

If fluid volume deficit is brought about by diarrhea, give anti diarrheal drug

If vomiting, give antiemetic

Give coagulant if bleeding

Blood Transfusion

 

Pack RBC Whole Blood

Crystalloid Plasma Expander (Dextran) Burns

2.

Hypervolemia

 
 

Fluid Volume Excess (FVE)

Over hydration

Intake: Output

Causes:

  • - Psychiatric patients (Obsessive Compulsive of Water )

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  • - Related to Diet Increased Na diet Rapid administration of IV Fluid

o

o

  • - Overuse of saline solution

  • - Associated with Disorders:

o Cushing’s Syndrome (Aldosterone) Na Retention, K Excretion

  • - Increased Na = Increased Water in body (Hypervolemia)

  • - Urine Output due to:

 

o

Renal Failure

o

Presence of Edema

Manifestations:

1.

Weight is INCREASED

2.

Periorbital Edema

3.

Peripheral Edema (Sausage shaped fingers)

4.

Ascites

5.

BP

Laboratory Findings:

-

Hemoglobin and Hematocrit is Decreased

-

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

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