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Location of Fluid- inside blood and lymph vessels Vascular Location of Fluid- Between Cells Interstitial Location of Fluid- within cells Intracellular Vascular fluid function maintenance of adequate blood volume, bp and cardiovascular system function Interstitial Fluid Function transportation between the blood and the cell cytoplasm Interaccellular fluid function maintains cell size and function Intercellular fluid potassium, phosphate and sulfate Extracellular fluid sodium, chloride and bicarbonate factors maintain balance in distribution of ECF protein content in blood (albumin, Hgg), integrity of the vascular endothelium (keeps fluid in) and hydrostatic pressure inside the blood vessels (pushes fluid out) how much of adult is ICF? ECF? 2/3 and 1/3 how much of body weight is fluid 45-80% who contains less fluid? fat people ICF? fluid within the cells, also know as cytosol ecf fluid found outside of the cells plama the fluid componement of blood What makes ECF balance intravascular fluid (1/3) and interstitial fluid (2/3 ) Osmolarity proportion of dissolved particles (solute) in a volume of fluid (mOsm/L) normal rantge is 280-300 mOsm?L Anti-diuretic Hormone (ADH released when osmolarity is increased patient urinates less, urine becomes concentrated, body fluids become less concentrated also opposite occurs if osmolarity is decreased Adrenal Gland (glucocorticosteroids) stress promotes renal retension of NA nand water Renin Splits angiotensinogen into angiotensin I which converts to angiotensin II, a potent vasoconstrictor Angiotensin II stimulates release of aldosterone Aldosterone regulates sodium reabsorption in the kidney water always follows sodium What results with low arterial bp renal sympathetic, lown Na+ diet= release of renin series of chemical events= vasoconstriction aldosterone: regulates Na+ uptake What results from high arterial Bp releases ANP= inhibit loss of Na cardiac hormone-vasodilation- aDH What is BNP ventricle of heart hormone, decrease blood volume- decrease aldosterone, diuresis Diffusion movement of a solvent or solutes from an area of higher solvent or solute concentration to an area of lower solvent or solute concentration in constant motion -Maintaining electrical neutrality- state in which the numbers of anions and cations are balanced within each fluid compartment is the normal condition within compartments Osmosis movement of a fluid through a semipermeable membrane oHyperosmolar and hypoosmoar oEqualize solution concentrations on both sides of the membrane oWith semipermeable membrane- water always moves to in the direction of greater concentration of dissolved particles •From are with more water to are with less water that is more concentrated filtration transfer of water and dissolved substances through a permeable membrane form a region of high pressure to one of low pressure oHydrostatic pressure (pressure exerted by fluid against the walls of a container) promotes the flow of fluid out of the capillaries •Occurs within the kidney's glomerular capillaries and in blood capillaries Active transport ions and other molecules are moved across membranes from an area of less concentration to an area of greater concentration oSodium-potassium adenosine riphosphatase is one example o Specific carrier molecule binds with each ion transported against the concentration gradient o Decrease cell temp, d supple of glucose and nutrients available to the cell and exposing the cell to medications or toxins can inhibit active transport o Sodium-potassium pump- for every ATP, three molecules NA in and two molecules K out Osmolarity proportion of dissolved particles (solute) in a volume of fluid (mOsm/L)- normal range is 280-300 mOsm/L higher the osmolarity- the greater its pulling power for water Serum Osmolarity- concentration of particles in plasma Normal- 280-300 mOsm/L Urine Osmolarity- 500-1200 Isotonic Fluid osmotic concentration equal to that of body fluids Hypertonic Fluid of greater concentration than in body fluids- cells shrink H2O>electrolytes cause- excess sodium, glucose, inadequate fluid intake, thirst response not working, no food, vomiting, diarrhea, high solute intake (feedings), larger amounts of diurectics can cause-renal failure, heart failure, to much IV, high corticosteroids- stress response Hypotonic Fluid of lower concentration than in body fluids- cells swell electrolytes>H2O excessive fluids in intracellular space enemas, over usage of hypotonic solutions, increase water Hyperosmolar and hypoosmolar indicate? fluid deficit or excess Excess or deficit isotonic isomolar ECF Hypertonic or hypotonic intracellular who is at greatest risk for fluid and electrolyte imbalance very young and the older adults Weight to fluid volume ratio 1 kg reflects retention of 1 liter of ECF Assessment for Imbalances- I and O should be equal for 24 hours I and O record must be accurat Assessment for Imbalances- Daily Weights comparison of daily body weight sis the best way to confirm fluid balance Assessment for imbalances Evaluate trends over the past 48 hours change in mental status? vital signs? abnormal tissue hydration or muscle tone or sensation Respirations may compensate for electrolyte or acid base imbalances Pulse: strong, full, bounding, or weak and thready? Pulse rate is a sensitive indicator BP: Orthostatic BPs, take when patient lying down and compare to BP when sitting and standing; a drop of more than 15 mm Hg systolic or 10 mm Hg diastolic with an increase in pulse rate frequently means ECF volume depletion. Assessment- objec intake and output body weight integumentary assessment vital signs neck veins central line pressures bowel assessment Assessment- Lab and Diagnostic Tests serum electrolytes, plasma osmolarity, urine osmolarity, urine specific gravity, arterial blood gas Assessment Findings for Volume Depletion postural hypotension, tachycardia, absence of JVP at 45, decreased skin turgor, dry mucosa, supine hypotension, oliguria, organ failure Assessment Findings for Volume Overload hypertension, tachycardia, raised JVP/ gallop rhythme and edema, pleural effusions, pulmonary edema, ascites, organ failure Input and Output measurment (1oz=20 mL) every 8 hours- urine output, abnormal loses, IV therapy, medical problems/ medications, wounds, tubes and drains, ice ships, salt considerations, stool, diaphoresis, vomiting, diarrhea, flow sheet, standard containers, DW, metric System, output as accurate as possible Nursing Diagnosis for ECF deficit diuretics- deficit of vascular and interstitial fluid volume decreased urine output, increased urine concentration, weight loss, increased pulse rate and hypotension, decreased venous filling, decreased pulmonary artery pressure, decreased central venous pressure, thirst, decreased skin turgor, decreased pulse volume or pressure, chages in mental state, increased body temperature, dry skin, dry mucous membranes Nursing Diagnosis for ECF excess cause: hyperaldosteronism, excess fluid intake, excess sodium intake, renal failure, heart failure, and liver failure edema, weight gain, SOB, orthopnea, fluid intake greater than output, third heart sound, pulmonary congestion on chest radograph, abnormal breath sounds and rales, change in respiratory pattern, changes in mental status, increased chentral venous pressure and pulmonary arter pressure, jugular vein distention, oliguria, decreased specific gravity of the urine Nursing Diagnosis for Water Deficit serum osmolarity is greater than 300 mOsm/L increased specific gravity of the urine, lethargy, disorientation, delusions, irritability, convulsions, coma thirst oliguria or anuria, tachycardia Nursing Diagnosis for Water Excess serum osmolarity is less than 280 mOsm/L low specific gravity of the urine, confusion, headache, anorexia or nausea or vomiting, weight gain, cramps, delirium, personality changes, convulsions, coma Urine Output > 1300 mL/day Nursing Intervention- Teaching individualized dietary teaching plan provide the client with a list of foods that are high or low in the identified electrlyte Nursing Intervention- Increasing Oral Fluids force fluids or push fluids are general terms indicating that increased fluid intake is required place fluids within the client's reach plan how much teh client should consume each shift Nursing Intervention- Restricting oral fluids ice melts to one half its volume and should be noted avoid salty or sweet fluids Nursing Intervention- IV prevent or treat fluid and electrolyte imbalances Possible Outcome Criteria The client maintains equal intake and output within 300 mL in 24 hours The client does not experience an increase or decrease in weight of more than 1 kg/day By discharge, the patient verbalizes that he does not have excessive thirst By discharge, patients urine concentration will decreased. Fluid and Electrolyte Imbalance Loss through kidneys, skin, GI, lungs Vomiting Diarrhea Diaphoresis Use of diuretics Stress Chronic illness Renal failure, cardiac failure, liver failure, respiratory failure Surgery Pregnancy Electrolytes chemical compounds that separate in solution into separate particles that carry electrical charges Cations (+) Have a positive charge Sodium, potassium, calcium, magnesium Anions (-) Have a negative charge Chloride, phosphate, sulfate, bicarbonate Cations and Anions are measured in? Milliequivalent (mEq) Sodium Most abundant Cation in ECF Normal level is 135-145 mEq/Liter Regulate- plasma osmolality, works with K+ & chloride, acid base, kidney regulation (ADH), cell membrane, ATP, neuromuscular activity Affects mental status and blood volume Found in processed food and table salt Cheese, eggs, fish, milk, poultry, processed & can foods, medications, MSG Hyper vs Hypo Potassium Normal range: 3.5-5.0 mEq/L Essential for normal cardiac, regulates intracellular osmolality, enzyme action for cellular metabolism, neural impulses, and muscle function and contractility of all muscles, regulation of proteins Aldosterone and Insulin control ECF levels of K+ Insulin promotes transfer of K+ into skeletal muscle and liver cells Aldosterone enhances renal excretion of K+ Kidneys have a major role in potassium balance Also excreted in stool and perspiration Avocado, dried fruit, bananas, nuts, chocolates meat Hypo vs Hyper Calcium Found in bones and teeth Normal range: 8.9-10.1 mg/dL (deciliter) Skeletal & heart muscle(contraction, excitability, activation, relaxation), bone integrity, blood clotting, wound healing, nerve impulse, membrane permeability Large portion of serum calcium is bound to albumin (protein) A portion is "ionized" calcium Reciprocal relationship with Phosphorus Parathyroid, vitamin D, and Calcitonin regulate balance Dairy, sardines, whole grains, leafy green vegetables Hypo vs Hyper Only changes in ionized levels cause signs and symptoms associated with calcium imbalances Ionized Calcium range: 4.0-4.9 mg/dL. Check the albumin level when checking the calcium. If albumin is low, the serum Ca level will probably also be low, but the Ionized Ca level might be normal. Assess ionized level before treating with Calcium replacement. Parathyroid: causes increased levels by increasing intestinal and renal reabsorption of calcium and releasing calcium from bone. Magnesium Normal range is 1.4-1.75 mEq/L Mostly found in ICF and bones Regulates neuromuscular function and cardiac activity, enzymatic reactions, electrical impulse nerves & muscles, thiamine/thiamine regulation, DNA, PTH, aldosterone Alterations often paralleled by changes in K+ Deficiency is often accompanied by hypocalcemia Kidney regulates Green leafy vegetables, legumes, citrus, peanut butter, and chocolate Phosphorus Mostly in ICF and bones Normal range: 2.5-4 mg/dl Red Blood levels controlled by renal excretion under the influence of vitamin D and parathyroid hormone Important in energy metabolism, structure of bones and membranes, and synthesis of RNA and DNA, muscle function, acid base, cell membrane Reciprocal relationship with calcium Dairy, meats, vegetables, fruits, cereal