FLUID AND ELECTROLYTES

NPN 205

FLUIDS
50-60% of the human body is water (decreases with

age) Body fluids are classified according to their location with most of the bodys fluids found within the cell
Intracellular Extracellular (mainly responsible for transport of nutrients and wastes)

Fluid compartments are separated by selectively

permeable membranes that control movement of water and solutes The process of homeostasis involves delivery of oxygen and nutrients to the cells and removal of waste

Transport of Water and Fluids

Osmolality: concentration of a solution determined by the number of
dissolved particles per kilogram of water. Osmolality controls water movement and distribution in body fluid compartments solution

Diffusion: the random movement of particles in all directions through a Active transport: movement of solutes across membranes; requires
expenditure of energy

Filtration: transfer of water and solutes through a membrane from a region

of high pressure to a region of low pressure solution to a more concentrated solution

Osmosis: movement of water across a membrane from a less concentrated

Fluid Pressures (Starlings Law)

ECF and ICF fluid shifts occur related to changes

in pressure within the compartments Fluid flows only when there is a difference in pressure 3 types of body fluids
Isotonic Hypotonic Hypertonic

Hydrostatic Pressure and Colloid Osmotic Pressure

Tissue fluids and plasma in the capillaries have

hydrostatic and colloid osmotic pressure Hydrostatic pressure forces fluid and solutes through the capillary walls When the hydrostatic pressure inside the capillary is greater than the pressure in the surrounding interstitial space, fluids and solutes inside the capillary they are forced out into the interstitial space This also happens in the reverse

Albumins Role in F/E Balance

Reabsorption prevents too much fluid from leaving the

capillaries Albumin is a large molecule and will not pass through the capillary membrane When fluid filters through the capillary, the protein albumin remains behind When the concentration of albumin increases, fluid begins to move back into the capillary wall by osmosis The pulling force of albumin in the intravascular space is called plasma colloid oncotic pressure

Plasma Colloid Osmotic Pressure

Interstitial Spacer

Capillary

Solutes

Regulation of Fluid Volume

Kidneys
Capillary pressure forces fluid through the walls and into the tubule At this point H2O or electrolytes are then either retained or excreted The urine becomes more dilute or more concentrated based on the needs of the body

Regulation of Fluid Volume, cont.

Antidiuretic hormone (ADH)
Produced by the hypothalamus Stored in the pituitary gland Restores blood volume by increasing or decreasing excretion of water Increased osmolality or decreased blood volume stimulates the release of ADH Then the kidneys reabsorb water Also may be released by stress, pain, surgery, and some meds

Regulation of Fluid Volume, cont.

Renin-angiotensin-aldosterone system
Renin secreted in kidney Amount of renin produced depends on blood flow
and amount of Na in the blood

Produces angiotensin II (vasoconstrictor) Angiotensin causes peripheral vasoconstriction Angiotensin II stimulates the production of aldosterone

Regulation of Fluid Volume, cont.

Aldosterone
Secreted by the adrenal gland response to angiotensin II The adrenal gland may also be stimulated by the amount of Na and K + in the blood Causes the kidneys to retain Na and H2O Leads to increases in fluid volume and Na levels Decreases the reabsorption of K+ Maintains B/P and fluid balance

Regulation of Fluid Volume, cont

Atrial natriuretic peptide or factor (ANP) (ANF)
Cardiac hormone Released in response to increased pressure in the atria (increased blood volume) Opposes the renin-angiotensin-aldosterone system Stimulates excretion of Na and H2O Suppresses renin level Decreases the release of aldosterone Decreases ADH release Reduces vascular resistance by causing vasodilation

Fluid shifting 1st space shifting- normal distribution of

fluid in both the ECF compartment and ICF compartment. 2nd space shifting- excess accumulation of interstitial fluid (edema) 3rd space shifting- fluid accumulation in areas that are normally have no or little amounts of fluids (ascites)

REGULATION OF FLUID VOLUME

Diagnostic Tests for F/E

Urine studies
Urine Urine Urine Urine Urine pH Urine specific gravity osmolarity creatinine clearance sodium potassium

Blood Studies
Serum Hematocrit = 40-54%/men, 3847% for women Serum Creatinine = 0.6 1.5 mg/dl BUN = 8-20 mg/dL Serum osmolality Serum Albumin 3.5-5.5 g/dL Serum Electrolytes

ASSESSMENT FOR F/E BALANCE

History of potential factors which place patient

at risk Vital signs I/O Body weight Skin Mucus membranes Vascular system

FLUID VOLUME DEFICITE

Hypovolemia: isotonic extracellular fluid deficit Deficiency of both water & electrolytes Caused by decreased intake, vomiting, diarrhea, fluid shift Dehydration: hypertonic extracellular fluid deficit Deficiency of water Caused by water loss related to high blood glucose, inadequate ADH production, high fever, excess sweating

Assessment of Fluid Deficit

Hypotension Weak rapid pulse Temperature decreased if hypovolemic,
and increased in dehydration Weight loss Skin turgor poor in dehydration and possible edema in hypovolemic Concentrated urine and blood

Treatment of Deficit
Correct cause IV fluids I and O Skin care Assist with ADLs

FLUID VOLUME EXCESS

Extracellular: isotonic fluid excess Excess of both water and electrolytes Caused by retention of water and electrolytes related to kidney disease; overload with isotonic IV fluids Intracellular: water excess Excess of body water without excess electrolytes Caused by over-hydration in the presence of renal failure; administration of D5W

FLUID VOLUME EXCESS/Assessment

Isotonic
Hypertension Bounding pulse Crackles, dyspnea Weight gain Edema in extremities JVD Irritable, confused

Hypotonic
Systolic B/P ^ Decreased pulse Increased respirations Weight gain Cerebral edema Irritable, confused

FLUID VOLUME EXCESS/ Treatment

Isotonic
Correct cause Restrict H2O and Na Diuretics Digitalis Possible dialysis

Hypotonic
Correct cause Restrict H2O intake IV fluids with E-lytes

FLUID VOLUME EXCESS/Nursing Care

Isotonic
Monitor for excess excretion of H2O R/T diuretics Maintain fluid restriction Consult dietary for salt restrictions Watch for skin problems HOB ^ 30 degrees

Hypotonic
IVs and meds as ordered I/O Oral care and ice chips Safety precautions Seizure precautions