FLUIDS AND ELECTROLYTES A. Body Fluids: 1.

Adult : 60% of total bodyweight is water Children: 65% of total bodyweight is water Infants : 75 - 80% of total bodyweight is water . A loss of 10% of body fluid in adult is serious !. A loss of 0% of body fluid in adult is fatal ". #istribution: $! of the %&' ( IC) 1$! of the %&' ( *C) - interstitial+ intra,as-ular ./las0a1 - other: C2)+ intrao-ular water+ bone water+ 3I% se-retions B. Electrolytes 1. *4tra-ellular .*C)1: a. 5a+ Ca: 0ain -ations b. Cl+ 6C7!: anions . Intra-ellular .IC)1: a. 8+ 9g: 0ain -ations b. :hos/hates+ /roteins+ and organi- ions: anions !. )un-tions: a. :ro0ote neuro0us-ular irritability b. 9aintain fluid ,olu0e -. #istribute water between fluid -o0/art0ents d. ;egulate a-id < base balan-e ". 9o,e0ent of )luids and *le-trolytes: a. #iffusion: 0ole-ules 0o,e fro0 an area of higher -on-entration to an area of lower -on-entration b. 7s0osis: water 0o,es fro0 an area of lower -on-entration of /arti-les to an area of higher -on-entration -. )iltration: 0o,e0ent of water and dissol,ed substan-es fro0 an area of greater hydrostati- /ressure to an area of lower hydrostati- /ressure d. 6ydrostati- /ressure: the for-e e4erted by the weight of a solution e. 7s0olality: refers to the nu0ber of os0oti-ally a-ti,e /arti-les /er =ilogra0 of water. f. %he nor0al os0olality of /las0a is 80 < >" 07s0$=g 5. 9e-hanis0s of )luid &alan-e a. 8idneys: -ontrol fluids and ele-trolytes+ se-rete renin b. ?ungs: -ontrol C7 le,els+ water ,a/or -. 2=in: fluid losses d. 6or0onal -ontrol A#6+ Aldosterone

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C. Assessment of Fluid nd Electrolyte B l nce!Im" l nce #. FLUID $OLU%E DEFICIT& %y/es a. Isotoni- dehydration: water and dissol,ed ele-trolytes are lost in e@ual /ro/ortionsA hy/o,ole0ia+ results in de-reased -ir-ulating blood ,olu0e and inade@uate tissue /erfusion. b. 6y/ertoni- dehydration: water loss e4-eeds ele-trolyte loss+ fluid 0o,es fro0 the IC -o0/art0ent into the /las0a and interstitial s/a-es+ -ausing -ellular dehydration and shrin=age. -. 6y/otoni- dehydration: ele-trolyte loss e4-eeds water loss+ fluid 0o,es fro0 the /las0a and interstitial fluid s/a-es into the -ells+ -ausing a /las0a ,olu0e defi-it and -ausing -ells to swell. Causes a. Isotoni- dehydration: Inade@uate inta=e of fluids and solutes )luid shifts between -o0/art0ents *4-essi,e losses of isotoni- fluid b. 6y/ertoni- dehydration: Conditions that in-rease fluid loss < /ers/iration+ hy/er,entilation+ =etoa-idosis+ /rolonged fe,ers+ diarrhea+ early stage renal failure+ and diabetes insi/idus -. 6y/otoni- dehydration: Chroni- illness *4-essi,e fluid re/la-e0ent ;enal failure Chroni- 0alnutrition 9anifestations: - 'eight loss - :oor s=in turgor - #e-reased CB: - In-reased he0ato-rit - In-reased res/irations - In-reased heart rate - #ry 0u-ous 0e0branes - Crine: de-rease in ,olu0e+ dar=+ odorous+ in-. s/. gra,ity I0/le0entations: Corre-t -ause+ /re,ent further loss ;e/la-e fluid < :.7. or IB .?a-tated ;ingerDs+ 0.>% 521 'eigh -lient daily 9onitor inta=e and out/ut+ seru0 ele-trolytes 9easure urine s/. gra,ity '. FLUID $OLU%E E(CESS& %y/es a. Isotoni- o,erhydration: hy/er,ole0ia and results fro0 e4-essi,e fluid in the *C) -o0/art0entA -auses -ir-ulatory o,erload and interstitial ede0a b. 6y/ertoni- o,erhydration: rare+ -aused by e4-essi,e 5a inta=e+ *C) ,olu0e e4/ands and the IC) ,olu0e -ontra-ts -. 6y/otoni- o,erhydration: water into4i-ation+ e4-essi,e fluid 0o,es into the IC s/a-e and all body fluid -o0/art0ents e4/andA ele-trolyte i0balan-es o--ur

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Causes a. Isotoni- o,erhydration: :oorly -ontrolled IB thera/y ;enal failure ?ong ter0 -orti-osteroid IB thera/y b. 6y/ertoni- o,erhydration: *4-essi,e sodiu0 ingestion ;a/id infusion of hy/ertoni- saline *4-essi,e sodiu0 bi-arbonate thera/y -. 6y/otoni- o,erhydration: *arly renal failure C6)+ 2IA#6 :oorly -ontrolled IB thera/y Irrigation of wounds and body -a,ities with hy/otoni- fluids 9anifestations Cough+ dys/nea+ rales+ ta-hy/nea In-reased &:+ /ulse+ in-reased CB: 5e-= ,ein distention+ /itting ede0a+ weight gain %a-hy-ardia+ de-reased he0ato-rit+ flushed s=in+ heada-he I0/le0entations #iureti-s ;estri-t fluids 9onitor IE7+ weigh daily :ro,ide s=in -are Cse se0i-)owlerDs /osition 9aintain low sodiu0 diet 9onitor seru0 ele-trolytes Electrolyte Im" l nce Disroders #. )ot ssium .8F1: 5B: !.5 < 5 0*@$? . *y+o, lemi & - ../ mE0!L Causes: - diureti-s+ digitalis+ -orti-osteroids - CushingDs syndro0e - Bo0iting+ diarrhea - 'ound drainage+ 53 su-tion - al=alosis+ hy/erinsulinis0 - water into4i-ation - renal dse. i0/airing 8F reabsor/tion Assess0ent: 0us-le -ra0/ing and wea=ness e,entual fla--id /aralysis dys/nea+ lethargy+ -onfusion+ -o0a nausea+ ,o0iting+ -onsti/ation+ abdo0inal distension+ /aralyti- ileus thready wea= /ulse+ ,ariable /ulse rate+ orthostati- hy/otension *C3 -hanges: 2% de/ressionA flat or in,erted % wa,eA /ro0inent C wa,e 5ursing Inter,entions: 8ee/ IE7+ 0onitor seru0 ele-trolytes :otassiu0 su//le0ents: :7 or IB infusion ne,er by bolus+ I9 or 2G

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Che-= renal fun-tion before gi,ing #ilute and 0i4 well before ad0inistration 9a4i0u0 re-o00ended infusion rate is 5-10 0*@$hr+ ne,er to e4-eed 0 0*@$hr :la-e -lient on -ardia- 0onitor while on IB infusion thera/y Can -ause /hlebitisA -he-= IB site e,ery hours Instru-t -lient about foods high in /otassiu0 -ontent - a,o-ado+ raisins+ /or=+ beef+ -antalou/e+ s/ina-h+ bananas+ fish+ oranges+ -arrots+ /otatoes Instru-t -lient about foods that are high in fiber to /re,ent -onsti/ation

". *y+er, lemi & 1 / mE0!l Causes: o,er ingestion of 8F -ontaining foods or 0eds+ ra/id infusion of 8F -ontaining IB solutions 8F s/aring diureti-s+ renal failure AddisonDs disease+ burns+ a-idosis+ hy/eruri-e0ia Assess0ent: Irregular heart rate+ slow+ wea= /ulse rate+ de-reased &: *C3 -hanges: %all % wa,esA widened G;2 -o0/le4esA /rolonged :; inter,alsA flattened or absent : wa,esA heart blo-= #ysrhyth0ias 9us-le -ra0/s+ /aresthesias+ wea=ness+ as-ending /aralysis In-reased 0otility+ hy/era-ti,e bowel sounds+ diarrhea 5ursing Inter,entions: :la-e /atient in a -ardia- 0onitor #is-ontinue IB /otassiu0 and hold oral 8F su//le0ents #iureti-s If renal fun-tion is i0/aired: 8aye4alate < e4-hanges 5aF for 8F #ialysis IB ad0inistration of 1000l of glu-ose with 10 < 0 units of regular insulin 9onitor renal fun-tion A,oid foods high in 8F '. Sodium .5aF1: 5B: 1!5 - 1"5 0*@$? . *y+on tremi & - #./mE0!L Causes: *4-essi,e dia/horesis+ diureti-s+ wound drainage #e-reased se-retion of aldosterone+ renal disease *4-essi,e ingestion of hy/otoni- fluids or irrigation with hy/otoni- fluids Assess0ent: ?ethargy+ hy/otension+ -ra0/s+ ,o0iting+ oliguria :ersonality -hanges+ heada-he+ -on,ulsions 9us-ular wea=ness

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5ursing Inter,entions: Cse nor0al saline for irrigation+ a,oid ta/ water ene0as Ad0inister IB fluids with 5aF .!% or 5% saline1 ;estri-t water inta=e+ 0onitor IE7 ". *y+ern tremi & 1 #2/ mE0!L Causes: Corti-osteroids+ -ushingDs syndro0e+ renal failure+ hy/eraldosteronis0 *4-essi,e sodiu0 ingestion+ de-reased water inta=e In-rease rate of 0etabolis0+ fe,er+ hy/er,entilation+ infe-tion+ diarrhea+ dehydration Assess0ent: Altered -erebral fun-tion+ agitation+ -onfusion+ seiHures+ lethargy+ stu/or+ -o0a #ry+ fla=y s=in+ /resen-e or absen-e of ede0a 5ursing Inter,entions: #5 '+ gi,e water between tube feedings #iureti-s+ dialysis and ultrafiltration ;estri-t sodiu0 .. C lcium .CaF1: 5B: 8.5 < 10 0g$dl or ".5 < 5.5 0*@$? . *y+oc lcemi & - 3./ m4!dl Causes: Inade@uate oral inta=e of -al-iu0+ la-tose intoleran-e 9alabsor/tion syndro0e: -elia- s/rue+ CrohnDs disease Inade@uate inta=e of ,it. # *nd stage renal disease 6y/er/hos/hate0ia+ i00obility+ re0o,al or destru-tion of the /arathyroid glands Assess0ent: #e-reased 0yo-ardial -ontra-tility and heart rate+ hy/otension *C3 -hanges: /rolonged 2% inter,alA /rolonged G% inter,al Irritable s=eletal 0us-les: twit-hes+ -ra0/s+ tetany+ seiHures :aresthesias+ .F1 %rousseauDs and Ch,oste=Ds signs 6y/era-ti,e #%;+ in-reased gastri- 0otility+ hy/era-ti,e bowel sounds+ abdo0inal -ra0/s+ diarrhea I0/le0entation: Ad0inister oral -al-iu0 su//le0ents or IB -al-iu0 IB -al-iu0 0ust be war0ed to body te0/erature before ad0inistration+ ad0inister slowlyA 0onitor for *C3 -hangesA obser,e for infiltrationA and 0onitor for hy/er-al-e0ia and hy/o0agnese0ia Initiate seiHure /re-autions 10% Ca glu-onate for treat0ent of a-ute CaF defi-it 9o,e -lient -arefully and 0onitor for signs of fra-ture 7ral CaF su//le0ents 0ust be gi,en 1 < hours after 0eals or at bedti0e Instru-t -lient to -onsu0e foods high in CaF Iogurt+ low-fat 9il=+ -heese+ s/ina-h+ bro--oli+ green beans+ -arrots

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". *y+erc lcemi & 1 #5m4!dl Causes: *4-essi,e oral inta=e of CaF+ ,it. # ;enal failure+ use of thiaHide diureti-s 6y/er/arathyroidis0+ hy/erthyroidis0 9alignan-y+ i00obility+ use of glu-o-orti-oids Assess0ent: *C3 -hanges: shortened 2% seg0entA widened % wa,e 9us-le wea=ness+ di0inished or absent #%; ;enal -al-uli+ de-reased 0otility and hy/oa-ti,e bowel sounds Anore4ia+ nausea+ abdo0inal distension+ -onsti/ation :athologi-al fra-tures 5ursing Inter,entions: In-rease 0obility+ a,oid large doses of ,it. # su//le0entation Ade@uate hydration+ /re/are for dialysis 9o,e -lient -arefully and 0onitor for signs of a fra-trure 9onitor for flan= or abdo0inal /ain and strain urine to -he-= for /resen-e of urinary stones 2. % 4nesium .9gFF1: 5B: 1.6 - .6 0g$dl . *y+om 4nesemi & -#.6 m4!dl Causes: 9alnutrition and star,ation+ i0/aired 3I absor/tion #iureti-s+ -hroni- al-oholis0 6y/ergly-e0ia+ insulin ad0inistration+ se/sis+ al=alosis Assess0ent: *C3 -hanges: tall % wa,es+ de/ressed 2% seg0ents #ysrhyth0ias+ hy/ertension )as-i-ulationA twit-hesA /aresthesias .F1 %rousseauDs and Ch,oste=Ds sign 6y/errefle4ia+ tetany+ seiHures Irritability+ -onfusion+ -on,ulsion 5ursing Inter,entions: Ad0inister 9g27" IB or I9 slowly+ obser,e for urine out/ut and =ee/ antidote .Ca glu-onate1 a,ailable. 9onitor for redu-ed #%; 2eiHure /re-autions 9onitor daily ingestion of 9g /o and /ro0ote diet high in 9g 3reen leafy ,egetables .s/ina-h+ bro--oli1+ a,o-ado+ 0il=+ /eas+ /otatoes

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". *y+erm 4nesemi & 1 '.6 m4!dl Causes: 9g -ontaining anta-ids and la4ati,es+ IB 9g re/la-e0ent ;enal insuffi-ien-y Assess0ent: &rady-ardia+ hy/otension+ dysrhyth0ias *C3 -hanges: /rolonged :; inter,alA widened G;2 -o0/le4es #i0inished or absent #%;+ s=eletal 0us-le wea=ness #rowsiness and lethargy that /rogresses to -o0a 5ursing Inter,entions: #iureti-s+ Ca su//le0ents to re,erse the -ardia- effe-ts #ietary restri-tions A,oidan-e of la4ati,es and anta-ids -ontaining 9gFF /. )7os+7orus: 5B: .7 < ".5 0g$dl . *y+o+7os+7 temi & - '.8 m4!dl - a--o0/anied by hy/er-al-e0ia Causes: 9alnutrition+ star,ation 6y/er/arathyroidis0+ renal failure+ 0alignan-y 6y/ergly-e0ia+ hy/erali0entation Assess0ent: 'ea=ness+ de-reased #%;+ fra-tures Irritability+ -onfusion+ seiHures 5ursing Inter,entions: 7ral /hos/orus with a ,it. # su//le0entation Assess renal syste0 before ad0inistering /hos/horus 9o,e -lient -arefully and 0onitor for signs of fra-ture ". *y+er+7os+7 temi & 1 2./ m4!dl *le,ated le,els tolerated by 0ost body syste0s A--o0/anied with hy/o-al-e0ia :roble0s that o--ur in hy/er/hos/hate0ia -enter on the hy/o-al-e0ia that results Causes: ;enal insuffi-ien-y #ietary inta=e or o,eruse of /hos/hate -ontaining la4ati,es

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ACID 9 BASE BALANCE I. *YDRO:EN IONS; ACIDS AND BASES

A. 6ydrogen ions .6F1 1. Bital to life . *4/ressed as /6 !. Cir-ulate in the body in for0s: a. ,olatile hydrogen of -arboni- a-id .6 C7!1 b. non,olatile for0 of hydrogen and organi- a-ids &. A-ids 1. :rodu-ed as end /rodu-ts of 0etabolis0 . Contain hydrogen ions !. 6ydrogen ion donors+ whi-h 0eans that a-ids gi,e u/ 6F to neutraliHe or de-rease the strength of an a-id or to for0 a wea=er base C. &ases 1. Contain no 6FA hydrogen ion a--e/tors . A--e/t 6F fro0 a-ids to neutraliHe or de-rease the strength of a base or to for0 a wea=er a-id II. RE:ULATORY SYSTE%S FOR *YDRO:EN ION CONCENTRATION IN T*E BLOOD A. Buffers 1. %he fastest a-ting regulatory syste0 . :ro,ide i00ediate /rote-tion against -hanges in 6F -on-entration in the *C) !. Absorb or release 6F as needed ". 2er,e as trans/ort 0e-hanis0 that -arries e4-ess 6F to the lungs &. )rim ry "uffer systems in ECF 1. 6e0oglobin .6gb1 syste0 a. In the ;&Cs b. 9aintains a-id-base balan-e by a /ro-ess -alled -hloride shift -. )or ea-h -hloride ion that lea,es an ;&C+ a 6C7! ion enters .,i-e ,ersa1 . :las0a /rotein syste0 a. )un-tions in -onJun-tion with the li,er to ,ary the a0ount of 6F in the -he0i-al stru-ture of /rotein b. /las0a /roteins ha,e the ability to attra-t or release 6F !. Carboni- a-id $ bi-arbonate syste0 a. 9aintains a /6 of 7." with a ratio of 0 /arts 6C7! to 1 /art 6 C7! . 0:11 b. Carboni- a-id -on-entration is -ontrolled by the e4-retion of C7 by the lungsA the rate and de/th of res/iration -hange in res/onse to -hanges in C7 . -. &i-arbonate -on-entration is -ontrolled by the =idneys+ whi-h sele-ti,ely retain or se-rete bi-arbonates in res/onse to the body needs. C. Lun4s 1. &odyDs se-ond defense that intera-ts with the buffer syste0 to 0aintain a-id-base balan-e . In a-idosis+ the /6 goes down and the ;; and de/th go u/ in an atte0/t to blow off a-idsA the -arboni- a-id -reated by the neutraliHing a-tion of bi-arbonate -an be -arried to the lungs+ where it is redu-ed to C7 and 6 7 and e4haledA thus 6F are ina-ti,ated and e4-reted.

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6F F 6C7! 6 C7! 2yste0i- -ir-ulation

6 7 F C7 lungs

!. In al=alosis+ the /6 goes u/ and the ;; and de/th go downA the C7 is retained+ and the -arboni- a-id builds to neutraliHe and de-rease the strength of e4-ess bi-arbonate. ". %he /ro-ess of -orre-ting a defi-it or e4-ess ta=es 10 to !0 se-onds to -o0/lete. 5. %he lungs are -a/able of ina-ti,ating only 6F -arried by 6 C7!A e4-ess 6F -reated by other /roble0s 0ust be e4-reted by the =idneys. #. <idneys 1. %he ulti0ate -orre-tion of a-id-base disturban-es is de/endent on the =idneys+ e,en though the renal e4-retion of a-ids o--ur 0ore slowly . Co0/ensation re@uires a few hours to se,eral days !. In a-idosis+ the /6 goes down+ and e4-ess 6F are se-reted into the tubules and -o0bine with buffers for e4-retion in the urine ". In al=alosis+ the /6 goes u/+ and bi-arbonate ions 0o,e into the tubules+ -o0bine with sodiu0 and are e4-reted in the urine 5. ;egulation of bi-arbonate in the =idneys a. %he =idneys restore bi-arbonate by the release of 6F and by holding bi-arbonate ions b. *4tra 6F are e4-reted in the urine in the for0 of /hos/hori- a-id 6F F :7" 6:7" -. %he alteration of -ertain a0ino a-ids in the renal tubules results in a diffusion of a00onia into the =idneys+ and the a00onia -o0bines with e4tra 6F and is e4-reted in the urine *. )ot ssium 1. :lays an e4-hange role in 0aintaining a-id-base balan-e . %he body -hanges the 8F le,el by drawing 6F into the -ell or by /ushing the0 out of the -ell. a. In a-idosis: e4-ess 6F 8F 0o,es out .hy/er=ale0ia1

H+ K+

b. In al=alosis:

release 6F

H+ K+

8F 0o,es into the -ells .hy/o=ale0ia1

ACID9 BASE I%BALANCE A. %et "olic cidosis &ase bi-arbonate defi-itA in-rease in hydrogen ion -on-entration Causes: - 2tar,ation+ 0alnutrition - =etogeni- diet .high fat1 - 2yste0i- infe-tions - diarrhea - ;enal failure - e4-essi,e e4er-ise - #iabeti- a-idosis 9anifestations: - heada-he+ -onfusion+ stu/or - loss of -ons-iousness - =etone breath+ hy/er=ale0ia - hy/er/nea or 8uss0aulDs res/irations - /6: K 7.!5 - 6C7!: K - urine /6: K 6

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5ursing Inter,entions: - treat underlying -ause - /ro0ote good air e4-hange - gi,e sodiu0 bi-arbonate - 0onitor 8F le,el B. %et "olic l, losis &ase bi-arbonate e4-essA de-reased hydrogen ion -on-entration Causes: - ,o0iting .e4-essi,e loss of Cl1 - al=ali ingestion - gastri- su-tion - long ter0 diureti- thera/y 9anifestations: - C52 sy0/to0s: -onfusion+ irritability+ agitation+ -o0a - shallow res/irations - /6 : L 7."5 - hy/ertoni- 0us-les - 6 C7!: L 6 - hy/o=ale0ia+ hy/o-al-e0ia 5ursing Inter,entions: - restore fluid ,olu0e+ 0onitor seru0 8F and CaFF le,els+ institute safety /re-autions C. Res+ir tory cidosis *4-ess /C7 and hydrogen Causes: - A-ute: res/iratory su//ression or obstru-tion due to /ul0onary ede0a+ o,ersedation+ /neu0onia - Chroni-: -hroni- airflow li0itation or C7:# 9anifestations: A-ute: - -onfusion+ -o0a - wea=ness+ restlessness Chroni-: - /C7 : L "5 006g - ta-hy/nea+ dys/nea+ weight loss 5ursing Inter,entions: - ad0inister 5a 6 C7! - good res/iratory e4-hange - se0i-fowlerDs /osition - bron-hodilators - /6 : K 7.!5 - heada-he

- 0onitor A&3+ 7 - en-ourage hydration - turn to sides+ dee/ breathing

D. Res+ir tory l, losis /C7 defi-itA de-rease in 6F -on-entration Causes: - hy/er,entilation .se-ondary to /ain+ an4iety1 - de-reased 7 ./neu0onia+ /ul0onary ede0a1 - ele,ated body te0/erature - 2ali-ylate into4i-ation 9anifestations: - heada-he+ lightheadedness - un-ons-ioussness - -ir-u0oral nu0bness - /C7 : K !5006g

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5ursing Inter,entions: - breathe into a /a/er bag+ -u//ed hands - 7 if hy/o4i- :ro,ide e0otional su//ort - 0onitor ele-trolyte le,els Blood : ses& 1. Arterial &lood 3as a. 9ost a--urate 0eans of assessing res/iratory fun-tion b. 9ust be sterile+ anaerobi-. #rawn into he/ariniHed syringe d. 8ee/ on i-e and trans/ort to lab i00ediately e. #o-u0ent whether re-ei,ing 7 + te0/erature f. A//ly /ressure to site for 5 < 10 0ins Co0/onents: /6: 0easure of a-idity or al=alinity of blood 5B ( 7.!5 < 7."5 /C7 : /artial /ressure of C7 A res/iratory /ara0eter influen-ed by lungs only 5B ( !5 < "5 006g M hy/o,entilation results in hy/er-a/niaA hy/er,entilation results in hy/o-a/nia /7 : /artial /ressure of o4ygen+ 0easure of a0ount of o4ygen deli,ered to the lungs 5B ( 80 < 100 6 C7!: bi-arbonate+ 0etaboli- /ara0eter influen-ed only by 0etaboli- fa-tors 5B ( < 6 006g

M /C7 : in,ersely asso-iated to /6 M 6 C7!: dire-tly asso-iated with the /6

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Com+ens tory mec7 nisms %et "olic Acidosis &lowing off of C7 through the lungs %he lungs are the fastest 0e-hanis0 used to -o0/ensate %et "olic Al, losis %he lungs atte0/t to hold on to the -arboni- a-id in an effort to neutraliHe the base state 'hen the lungs are -o0/ensating+ the :C7 will in-rease L "5 0*@$? Co0/ensation /6 O L 7."5 7."5 6C7! O L 6 /C7 nor0 O L "5 Res+ir tory Acidosis %he =idneys -o0/ensate will ta=e hours to days. 8idneys will retain 6C7! and return it to *C) %he 6C7! le,el will be ele,ated with /artial or -o0/lete -o0/ensation Co0/ensation /6 N K 7.!5 7.!5 6C7! nor0 O 6 /C7 O L "5 Res+ir tory l, losis %he =idneys -o0/ensate by e4-reting 0ore bi-arbonate ions and retaining hydrogen ions %his /ro-ess returns the a-id-base to nor0al ratio

Co0/ensation /6 N K 7.!5 7."0 6C7! N K /C7 nor0 N K !5

Co0/ensation /6 O L 7."5 7."5 6C7! nor0 K /C7 N !5

An ly=in4 AB: 1. ?oo= at /6: a-idosis ( /6 is down .K 7.!51 al=alosis ( /6 is u/ . L 7."51 . ?oo= at /C7 : ;es/iratory /ara0eter ;es/iratory a-idosis : /6 N+ /C7 O ;es/iratory al=alosis : /6 O+ /C7 N !. ?oo= at 6C7!: 9etaboli- /ara0eter 9etaboli- a-idosis : /6 N+ 6C7! N 9etaboli- al=alosis : /6 O+ 6C7! O ". Co0/ensation: If /6 is within nor0al range: -o0/lete -o0/ensation If /6 is not within nor0al: ;es/iratory I0balan-es: ?oo= at the 6C7! to deter0ine -o0/ensation 6C7! nor0al : un-o0/ensated 6C7! abnor0al : /artial -o0/ensation 9etaboli- i0balan-es: ?oo= at the /C7 to deter0ine -o0/ensation /C7 nor0al : un-o0/ensated /C7 abnor0al : /artial -o0/ensation

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I. CO%%UNICABLE DISEASES A. Tu"erculosis > a highly infe-tious -hroni- diseases -aused by the %& ba-illi. It is /ri0arily a res/iratory disease -o00on a0ong 0alnourished indi,iduals li,ing in -rowded areas. It often o--urs a0ong -hildren in underde,elo/ed and de,elo/ing -ountries. T7e Stren4t7ened N tion l Tu"erculosis Control )ro4r m :ener l O"?ecti@e > %o -ontrol tuber-ulosis+ whi-h is a /ubli- health /roble0+ by the year through the redu-tion of: Annual ;is= of Infe-tion fro0 .5% to 1.0% :re,alen-e ;ate fro0 6.6 to 1.> /er 1000 /o/ulation 9ortality ;ate due to %uber-ulosis fro0 !>." to 1>. /er 100+000 /o/ulation S+ecific O"?ecti@es& 1. %o ,a--inate with &C3 the eligible /o/ulation under the *4/anded :rogra0 for I00uniHation s-he0e in towns+ s-hools+ -lini-s and hos/itals with at least >0% -o,erage. . %o identify at least "5%+ the /re,alen-e of infe-tious -ases annually. !. %o treat effe-ti,ely and ade@uately all s/utu0 /ositi,e -ases in-luding those with 0oderate and far ad,an-ed radiogra/hi- abnor0alities with -a,itary lung lesion for a /eriod of 6 0onths with the use of the short -ourse -he0othera/y. Nursin4 Res+onsi"ilities& 1. &C3 ,a--ination of newborn+ infants and grade I$s-hool entrants. . *du-ate the /ubli- in 0ode of s/read and 0ethods of -ontrol and the i0/ortan-e of early diagnosis. !. I0/ro,e so-ial -onditions+ whi-h in-rease the ris= of be-o0ing infe-ted+ su-h as o,er-rowding. ". 9a=e a,ailable 0edi-al+ laboratory and 4-ray fa-ilities for e4a0ination of /atients+ -onta-ts and sus/e-ts and fa-ilities for early treat0ent of -ases and /ersons at high ris= of infe-tion and beds for those needing hos/italiHation. 5. :ro,ide /ubli- health nursing and outrea-h ser,i-es for ho0e su/er,ision of /atients to su/er,ise thera/y dire-tly and to arrange for e4a0ination and /re,enti,e treat0ent of -onta-ts. B. )neumoni s > an a-ute infe-tious disease of the lings usually -aused by the /neu0o-o--us resulting in the -onsolidation of one or 0ore lobes of either one or both lungs. Control of Acute Res+ir tory Infections ACARIB A-ute ;es/iratory Infe-tions .A;I1 es/e-ially /neu0onia re0ains to be the leading -ause of illness and death a0ong )ili/ino -hildren. In 1>8>+ whi-h was the laun-hing year of the :rogra0 for the 000

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Control of A-ute ;es/iratory Infe-tions .CA;I1+ al0ost 5+000 -hildren aged under fi,e died de to /neu0onia alone. :ener l O"?ecti@e > %he CA;I /rogra0 is 0andated to redu-e 0ortality due to /neu0onia a0ong under fi,es by 5% fro0 baseline le,els by year 000. It ho/es to a--o0/lish this through the following strategies: 1. %raining go,ern0ent and /ri,ate health wor=ers in the standard 0anage0ent of A;I. . *nabling &6's to identify /neu0onia -ases+ refer -ases for treat0ent and edu-ating /atients and -areta=ers. !. Assuring the ade@uate su//ly of antibioti-s and other essential drugs. ". %ea-hing /arents and -o00unities on how to re-ogniHe sy0/to0s of /neu0onia and other A;I. 5. 9obiliHing non-go,ern0ent organiHations and field wor=ers to -o00uni-ate with /arents and -o00unities. 6. Ad,o-a-y and so-ial 0obiliHation to gain the su//ort of lo-al go,ern0ent offi-ials+ 537s+ /ri,ate and edu-ational institutions. Nursin4 Res+onsi"ilities 1. &edrest . Ade@uate salt+ -alorie and ,ita0in inta=e. 'ater re@uire0ent in-reases be-ause of fe,er+ sweating and in-reased res/iratory rate. :las0a -hlorides tend to fall in /neu0onia+ hen-e sodiu0 -hloride should be gi,en by 0outh or by ,ein if ne-essary. !. Ade@uate urine out/ut is essential for e4-retions of to4ins and for a,oidan-e of serious urinary -o0/li-ations due to 0edi-ations. ". Ade@uate -alori- and ,ita0in .Bita0in C1. 5. %e/id s/onge for fe,er 6. )re@uent turning fro0 side to side 7. Antibioti-s based on CA;I of #76. C. Di rr7e l Dise ses 9 a 0aJor -ause of 0ortality in the :hili//ines. 7,er the /ast 0 years+ it has ran=ed 1st to "th leading -ause of 0orbidity and 0ortality. A0ong -hildren under the age of fi,e+ it is a 0aJor -ause of illness and death. Control of Di rr7e l Dise ses ACDDB #iarrheal disease in general and in /arti-ular a0ong -hildren under fi,e is a serious /ublihealth and de,elo/0ent /roble0. In ,iew of this+ the #76 laun-hed a national /rogra0 to -ontrol diarrheal disease .C##1 in 1>80. O"?ecti@es& %o redu-e 0ortality fro0 diarrhea /arti-ularly a0ong -hildren under fi,e through e4tensi,e -ase 0anage0ent utiliHing oral rehydration thera/y .7;%1+ en,iron0ental sanitation+ 0aternal and -hild health+ nutrition and health edu-ation a-ti,ities.

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Nursin4 Res+onsi"ilities 1. . !. ". 5. 6. 7. 8. Assist 0others in breastfeeding I0/ro,ed weaning /ra-ti-es Cse /lenty of -lean water )a-ilitate :ro/er 6andwashing Cse of latrines :ro/er dis/osal of babiesD stools 9easles i00uniHation Con,in-e and hel/ -o00unity 0e0bers to ado/t the /ra-ti-es and to -ontinue the /ra-ti-e the0 on an on-going basis.

D. % l ri > -ontinues to be a 0aJor health /roble0 in the -ountry ha,ing an annual /arasite in-iden-e of 5.1$1000 /o/ulation+ In 1>>"+ it was ai0ed that there be a 0% redu-tion in 0orbidity annually. %he nature of 0alaria as a /ubli- health /roble0 re@uires sustained and syste0ati- efforts towards two 0aJor strategies+ na0ely /re,ention and trans0ission through ,e-tor -ontrol and the dete-tion and early treat0ent of -ases to redu-e 0orbidity and /re,ent 0ortality. % l ri Control Ser@ice > Sust in "le )re@enti@e nd $ector Control %e sures refer to the ado/tion of 0easures for the /re,ention and -ontrol against the 0alaria /arasite and the 0os@uito ,e-tor. 2u-h 0easures being affordable+ a//li-able and a//ro/riate under our lo-al -onditions so that these 0easures -an be sustained throughout the duration of 0alaria -ontrol o/erations. O"?ecti@e& %o redu-e the sour-e of infe-tion in the hu0an /o/ulations-,e-tor -onta-t and the density of the 0os@uito ,e-tor /o/ulation. Nursin4 Res+onsi"ilities& 1. 'earing of -lothing that -o,ers ar0s and legs in the e,ening. . A,oiding outdoor night a-ti,ities+ /arti-ularly during ,e-torDs /ea= biting hours fro0 > /0 to ! a0. !. Csing 0os@uito re/ellents su-h as 0os@uito -oils+ soa/ lotion+ or other /ersonal a//li-ation 0easures ad,o-ated by #76$9C2 ". :lanting of 5ee0 tree whi-h are 0os@uito re/ellents. 5. Poo/ro/hyla4is-ty/ing of do0esti- ani0als near hu0an dwellings to de,iate 0os@uito bites fro0 0an to these ani0als. 6. All -ases should be gi,en drug treat0ent and followed-u/ until -lini-ally found negati,e. 7. Continuous sur,eillan-e 0easures should be i0/le0ented.

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E. %e sles > an a-ute highly -o00uni-able infe-tion -hara-teriHed by fe,er+ rashes and sy0/to0s referable to u//er res/iratory tra-t. #eath is due to -o0/li-ation+ e.g. se-ondary /neu0onia usually in -hildren under yrs. old. 9easles is se,ere a0ong 0alnourished -hildren with fatality >5-100%. EC+ nded )ro4r m on Immuni= tion AE)IB > was laun-hed in Quly 1>76 by #76 in -oo/eration with '67 and C5IC*). :residential :ro-la0ation 5o." .Quly >+1>>81 < R de-laring the /eriod fro0 2e/te0ber 16 < 7-tober 1"+1>>8 as the ?igtas %igdas 9onthS and laun-hing the :hili//ines 9easles *li0ination Ca0/aign. O"?ecti@e& %o redu-e the 0orbidity and 0ortality a0ong infants and -hildren -aused by the si4 -hildhood -o00uni-able diseases. .0easles+ di/htheria+ /olio+ he/atitis+ et-.1 )rinci+les & 1. %he /rogra0 is based in e/ide0iologi-al situationA the s-hedules are drawn on the basis of the o--urren-e and -hara-teristi- e/ide0iologi-al features of the disease. . %he whole -o00unity rather than Just the indi,idual is to be /rote-ted+ thus 0ass a//roa-h is utiliHed. !. I00uniHation is a basi- health ser,i-e and su-h it is integrated in to the health ser,i-es being /ro,ided for by the ;6C. Elements& %arget 2etting Cold -hain logisti- 0anage0ent Infor0ation+ *du-ation and Co00uni-ation Assess0ent and *,aluation of the :rogra0Ds 7,erall :erfor0an-e 2ur,eillan-e+ studies and resear-h Nursin4 Res+onsi"ilities& 1. *0/hasiHe the need for i00ediate isolation when early -atarrhal sy0/to0s a//ear. . If i00une seru0 globulin is a,ailable . ga00a 3lobulin1+ e4/lain this to the fa0ily and refer to the /hysi-ian or -lini- gi,ing the ser,i-e. !. 7bser,e -losely the /atient for -o0/li-ations during and after the a-ute stage. ". %ea-h+ de0onstrate+ guide and su/er,ise ade@uate nursing -are indi-ated. 5. *4/lain /ro-eedings in /ro/er dis/osal of nose and throat dis-harges. 6. %ea-h -on-urrent and ter0inal disinf

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II. NON9CO%%UNICABLE DISEASES A. C rdio@ scul r Dise ses AC$DB > ha,e be-o0e the greatest threat to )ili/inos today. CB# ha,e ,aried and 0ulti -auses and ris= fa-tors+ ranging fro0 infe-tious agents+ en,iron0ental and -onstitutional -auses+ so0e inherited and so0e a-@uired. A.# Con4enit l *e rt Dise se AC*DB < by far the 0ost /re,alent ty/e of heart disease a0ong -hildren. %hey 0ay in,ol,e the heart and its great ,essels alone or 0ay e4ist together with abnor0alities in other syste0s. A.' R7eum tic Fe@er!R7eum tic *e rt Dise se AR*D1 < an auto-i00une disease+ that is+ the /atient de,elo/s antibodies whi-h rea-t to the bodyDs own antigens in the -onne-ti,e tissues of the heart+ as well as in other syste0s. A.. *y+ertension < is a /ersistent ele,ation of the arterial blood /ressure. 6y/ertension is ,ery -o00on -hroni- -ondition whi-h affe-ts a signifi-ant /ro/ortion of adult /o/ulation and whi-h 0a=es an i0/ortant -ontribution to hu0an 0ortality. A.2 Isc7emic *e rt Dise seusually -aused by the o--lusion of the -oronary arteries by thro0bus for0ation in areas of narrowing and hardening in these arteries. C rdio@ scul r Dise se Control )ro4r m :ener l Str te4ies of Dise se Control& 1. /ro0ote the fa-tors that /re,ent the o--urren-e of i0/ede the /rogression of the disease+ and . re0o,e$di0inish the fa-tors that -ause or -ontribute to the o--urren-e and /rogression of the disease. In Cardio,as-ular #isease Control+ efforts should be -on-entrated on /ri0ary /re,ention. Prevention of CVD occurrence: 1. 2/are the indi,idual fro0 a lifeti0e of /ain+ suffering and li0ited a-ti,ity+ fro0 unfulfilled drea0s+ or early death be-ause of the /rogressi,e nature of the disease. . 2/are the fa0ily fro0 tre0endous e4/ense+ abnor0al fa0ily life and anguish. !. 2/are the -o00unity fro0 huge -a/ital and o/erating e4/enses for 0edi-al fa-ilities for the -hroni-ally ill CB# /atients and fro0 unhealthy and un/rodu-ti,e 0e0bers who otherwise -an -ontribute to -o00unity de,elo/0ent. 2/e-ifi- /rote-tion fro0 CB# is also a-hie,ed by the re0o,al of the ris= fa-tors or redu-tion in their le,els. Nursin4 Res+onsi"ilities

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1. 9aintenan-e of Ideal &ody 'eight 'eight -ontrol is useful for /re,enting and -orre-ting high blood /ressure and diabetes. %he goal of the body weight should be within 15% of desirable weight. . #iet and 9odifi-ation of #ietary )ats #ietary edu-ation 0ust be initiated. #ietary -hanges re-o00ended for obese indi,iduals with or without hy/ertension. !. 20o=ing$%oba--o A,oidan-e Co0/lete -essation of -igarette s0o=ing should be ad,ised to all indi,iduals+ whether he$she is hy/ertensi,e or not and /arti-ularly those with s/e-ial ris= of C6#. 5i-otine in-reases blood /ressure a-ti,ity ". *4er-ise regular e4er-ise /rogra0s+ fa-ilitate weight -ontrol and in-rease -ardio/ul0onary sta0ina. 5. 9onitor non-/har0a-ologi-al 0ethods and drug ad0inistration. B. C ncer > ran=s third in leading -ause of 0orbidity and 0ortality in the :hili//ines. A disturban-e of growth -hara-teriHed /ri0arily by an e4-essi,e /roliferation of -ells without a//arent relation to the /hysiologi-al de0ands of the organ in,ol,ed. C ncer Control )ro4r m ACC)B > /resently the two 0ost i0/ortant 0odes re-ogniHed in the redu-tion of -an-er in-iden-e are /re,ention and early dete-tion.7ne-third of all -an-ers are -urable if dete-ted early and treated /ro/erly. %reat0ent of -an-er needs a 0ulti-dis-i/linary tea0 a//roa-h. %here are three 0aJor for0s of treat0ent of -an-er: 1. 2urgery . ;adiation %hera/y !. Che0othera/y Can-er that -annot be dete-ted early+ whi-h is usually /resent at an ad,an-ed stage at diagnosis and whi-h -an be -ured+ -an be offered su//orti,e or /alliati,e -are. %his is the a-ti,e+ holisti- -are of /atients and their fa0ilies gi,en by a 0ulti-dis-i/linary tea0 of /hysi-ians+ nurses+ nutritionists+ et-. %he #76-:CC: has su//orted the :alliati,e Care of )ili/ino Can-er :atients by/ro,iding free 0or/hine tablets to indigent /atients+ /arti-ularly in go,ern0ent hos/itals. %he #76-:CC: also su//ort :hili//ine Can-er 2o-iety+ In-.-6os/i-e Care :rogra0+ re-ogniHing at as the first and lead agen-y. Nursin4 Res+onsi"ilities 1. ;efer i00ediately any -ase of sus/e-ted disease to /hysi-ian. . 2hare with /atient and fa0ily =nowledge on a,ailable resour-es for a--urate diagnosis and ade@uate treat0ent. !. Assist and guide fa0ilies in a,ailing of e4isting health resour-es and fa-ilities. ". ;e-ord history of sy0/to0s + whi-h will hel/ /hysi-ian arri,e at an a--urate diagnosis.

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5. Assist /hysi-ian in the /erfor0an-e of e4a0inations and diagnosis test as aids to diagnosis and treat0ent. 6. Condu-t nursing de0onstrations to /atient or fa0ilies on /ro/er nursing -are+ /arti-ularly on /ost-o/erati,e -are of dis-harged hos/ital -ases and ter0inal -an-er /atients who ha,e to be ta=en -are of at ho0e. 7. Assist the /atient and fa0ily in 0a=ing ne-essary adJust0ent and de,elo/ing /ro/er attitudes towards /res-ribed treat0ent. 8. :ro,ide guidan-e+ -ounseling and su/er,ision in the 0anage0ent of -ase at ho0e. >. :arti-i/ate in the /lanning and i0/le0entation of rehabilitation /rogra0 for /ost-o/ and other -ases in need of this ser,i-e. 10. 6el/ /atient and fa0ily understand the 0ost i0/ortant fa-ts about -an-er. 11. Condu-t and /arti-i/ate in health edu-ation /rogra0s on -an-er for allied health wor=ers and the general /ubli-. C. <idney Dise ses > there are about 6+500 yearly deaths in the -ountry se-ondary to ,arious =idney diseases. ;enal diseases threaten to be one of the leading -auses of death if there will not be an effe-ti,e /re,ention and -ontrol /rogra0s to address the /roble0. )re@enti@e Ne+7rolo4y )ro4r m > redu-e the o--urren-e of =idney diseases and end-stage renal diseases to !000 -ases a year. In-rease awareness and /ra-ti-e of /re,enting renal diseases a0ong high ris= grou/s to 80%. In-rease awareness on signs and sy0/to0s of =idney diseases. I0/ro,e a--ess and 0edian waiting ti0e for renal trans/lantation. Nursin4 Res+onsi"ilities 1. In-rease awareness and /ra-ti-e of /re,enting renal disease through: ade@uate water inta=e balan-ed diet good /ersonal hygiene regular e4er-ise regular &: -he-=-u/ -o0/lete i00uniHation for infants and -hildren /ro/er 0anage0ent of throat and s=in infe-tions yearly urinalysis . In-rease awareness of signs and sy0/to0s of =idney disease as ede0a and high blood /ressure. !. ;outine s-reening for urinary tra-t infe-tion+ diabetes and =idney diseases.

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