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Taylor Fundamentals of Nursing Chapter 39: Fluid, Electrolyte and Acid-Base Balance
Terms in this set (75)
Total Body Water (or Fluid)
Refers to the total amount of water, which is approximately 50% - 60% of body weight in a healthy person.
Intercellular Fluid (ICF)
- The fluid WITHIN cells
- 70% of the total body water
- 50% of the adult's body weight
- Includes lymph
Extracellular Fluid (ECF)
- All the fluid OUTSIDE the cells
- 30% of total body water
- 20% of the adult's body weight
- EXCLUDES the intravascular + interstitial compartments
Includes cerbrospinal fluid, pericardial fluid, synovial fluid, intraocular fluid and pleural fluids, as well as sweat and digestive secretions
- Regulated primarily by the thirst mechanism located within the HYPOTHALAMUS
- The thirst center is stimulated by intracellular DEHYDRATION + decreased BLOOD VOLUME
- Water contained in food is the second largest source of water for the body + the amount of water ingesteddepends on the diet
- Water is an END PRODUCT of the oxidation that occurst during the metabolism of food substances, specifically carbohydrates, fats and protein
What two factors stimulate the thirst center?
2.) Low blood volume
Average Daily Fluid Intake
- 2,600 mL per day
- 1,300 mL comes from ingested water
- 1,000 mL comes from ingested food
- 300 mL comes from metabolic oxidation
2 Ways Fluid is Lost in the Body
1.) Sensible Loss: Can be measured and include urination, defecation + wounds.
2.) Insensible Loss: Cannot be measured or seen and includes sweat and water vapor from lungs during respiration.
- 2,500 - 2,900 mL per day
- 1,500 mL from urine
- 600 mL from sweat
- 300 mL from breathing
- 200 mL from feces
- Dextrose (D)
- Water (W)
- Saline (S)
- Dextrose 5% in water (DsW)
- Normal saline 0.9% NaCl (NS or NaCl)
---- 0.45% NaCl
---- 0.25% NaCl
1 L of Body Fluid = ? lb or ? kg
1 L of Body Fluid = 2.2lb or 1kg
2.2lb or 1kg = ? L of Body Fluid
2.2lb or 1kg = 1 L of Body Fluid
Considerations of the Older Adult
- Reduced cardiac, renal and respiratory function
- Decreased muscle mass
- Multiple medications that can affect cardiac and renal function
- Excessive use of laxatives
- Decreased thirst response
- Dehydration is loss of more than 3% of body weight
- Be very careful with fluid replacement measures in older adults due to the risk of fluid overload
Ringers LActate (Lactated Ringers)
- Sodium chloride, sodium lactate, potassium chloride and potassium lactate.
Major Electrolytes in ECF
Sodium, chloride, calcium and bicarbonate
Major Electrolytes in ICF
Potassium, phosphorus, magnesium
- Chief electrolyte of ECF
- Normal serum level is 135-145 mEq/L
- Regulates extracellular fluid volume
- Na+ loss or gain = loss or gain of water
- Affects serum osmolarity
- role in muslce contraction + transmission of nerve impulses
- Regulation of acid-base balance as sodium bicarbonate
- ENTERS the body through gastrointestinal tract from dietary sources
- EXITS the body though gastrointestinal tract, kidneys and skin
- TRANSPORTED out of the cell by the SODIUM-POTASSIUM PUMP
- REGULATED by RENIN-ANGIOTENSIN-ALDERSTRONE system
- Elimination and reabsorption regulated by kidneys
- Sodium concentrations affected by salt and water intake
Sodium Found in What Body Secretions?
Gastric and intestinal secretions
- Major cation of ICF
- Normal serum is 3.5-5.0 mEq/L
- Controls intracellular osmolarity
- Regulator of cellular enzyme activity
- Role in the transmission of electrical impulses in nerve, heart, skeletal, intestinal and lung tissue
- Role in protein and carbohydrate metabolism
- Role in cellular building
- Leading sources
- MOST ABUNDANT electrolyte in the body
- 99% of body calcium is stored in bone
- 1% inside cells
- 0.1% in ECF
- Normal serum levels 8.6 - 10.2 mg/dL
- Regulated by Parathyroid hormone + calcitonin
- Role in blood coagulation and in transmission of nerve impulses
- Helps regulate muscle contraction and relaxation
- Activates enzymes that stimulate essential chemical reactions in the body
- Absorbed from foods in the presence of normal gastric acidity and vitamin D
- Lost via feces and urine
- Primarily excreted by gastrointestinal tract; lesser extend by kidneys
- High serum phosphate results in decreased serum calcium level; low serum phosphate leads to increased serum calcium
- Second most abundant ICF cation after potassium
- Normal serum value 1.3 - 2.3 mEq/L
- Metabolism of carbohydrates in proteins
- Regulated by parathyroid hormone
- Activator for many intracellular enzymes
- Role in neuromuscular function
- Acts on cardiovascular system, producing vasodilation
- Enters via gastrointestinal tract
- Eliminated by kidneys
- Major ECF anion
- Normal serum value 97 - 107 mEq/L ("911")
- Major component of interstitial + lymph fluid; gastric and pancreatic juices, sweat, bile + saliva
- Acts with socium to maintain osmotic pressure
- Role in the body's acid-base balance; combines with hydrogen ions to produce hydrochloric acid
- Enters via gastrointestinal tract
- Almost all comes from salt
- Normally paired with sodium ; excreted and conserved with sodium by the kidneys
- Regulated by aldosterone alongside sodium
- Low potassium level leads to low chloride level
- Major ICF anion
- A BUFFER anion in both ICF and ECF
- Role in acid-base balance as a hydrogen buffer
- Regulated by parathyroid hormone
- ACTIVATED by VITAMIN D
- Promotes energy storage
- Promotes carbohydrate, protein and fat metabolism
- Bone + teeth formation
- Regulation of hormone + coenzme activity
- Role in muscle + red blood cell function
- Enters body via gastrointestinal tract
- Sources include all animal products
- Absorption is diminished by concurrent ingestion of calcium, magnesium + aluminum
- Eliminated by kidneys
- Phosphate + calcium are inversely proportional; an increase in one results in a decrease in the other
Normal Serum Values: SODIUM
135 - 145 mEq/L
Normal Serum Values: POTASSIUM
3.5 - 5 mEq/L
Normal Serum Values: CALCIUM
8.6 - 10.2 mEq/L
Normal Serum Values: MAGNESIUM
1.3 - 2.3 mEq/L
Normal Serum Values: CHLORIDE
97 - 107 mEq/L
Normal Serum Values: BICARBONATE
25 - 29 mEq/L
Normal Serum Values: PHOSPHATE
2.5 - 4.5 mg/dL
3 IV Fluid Administration Routes
3.) Intraosseous (into bone, often tibia)
- Keep Vein Open
- Run infusion 30 mL/hr
- To Keep Open (same as Keep Vein Open)
- Run infusion 30 mL/hr
Volume To Be Infused
- The concentration of particles in a solution
- Its pulling power
Heart + Blood Vessels
- Circulate nutrients + water throughout body
- Circulate blood though the kidneys under sufficient pressure for urine to form (pumping action of the heart)
- React to hypovolemia by stimulating fluid retention (stretch receptors in the atria + blood vessels)
- Regulate blood volume + sodium and potassium balance by secreting ALDPSTERONE (a mineral corticoid secreted by the adrenal cortex)
1.) The primary regulator of aldosterone appears to be angiotensin II, which is produced by the renin-angiotensin system. A decrease in blood volume triggers this system and increases aldosterone secretion, which causes sodium retention (and thus water retention) and potassium loss
2.) Decreased secretion of aldestrone causes sodium and water loss and potassium retention
- Cortisol, another adrenocortical hormone, has only a fraction of the potency of aldosterone
- However, secretion of cortisol in large quantities can produce sodium and water retention and potassium deficit
- Stores and relases the antiduretic hormaone (ADH, manufactures in the hypothalamus), which acts to allow the body to retain water. It acts chiefly to regulate sodium and water intake and secretion. Functions of ADH include:
1.) Maintains osmotic pressure of the cells by controlling renal water retention or ecretion
a. When osmotic pressure of he ECF is greater than that of the cells (as in hypernaturemia-excess sodium-or hyperglycemia), ADH secretion is increased, causing renal retention of water.
b. When osmotic pressure of the ECF is less than that of the cells (as in hyponaturemia), ADH secretion is decreased, cauising renal exretion of water.
2.) Controls blood volume ( less influential than aldosterone)
a. When blood volume is decreased, an increased secretion of ADH results in water conseration.
b. When blood volume is increased, a decreased secretion of ADH results in water loss
Increases blood flow in the body by releasing thyroxine, leading to increased renal circulation and resulting in increased glomerular filtration and urinary output.
- Inhibits and stimulates mechanisms influencing fluid balance; acts chiefly to regulate sodium and water intake and excretion
- Regulates oral intake by sensing intracellular dehydration, which triggers thirst (thirst center located in the hypothalamus)
- Neurons, calls osmoreceptors, are sensitive to changes in the concentration of ECF, sending appropriate impulses to the pituitary gland to release ADH or hibit its release to maintain ECF volume concentration.
Absorbs water + nutrients that enter the body via this rougt
- Regulate calcium + phosphate balance by means of partthyroid hormone (PTH). PTH influences bone REABSORPTION, calcium absorption from the intestines and calcium reabsorption from the renal tubes.
Increased secretion of PTH causes?
- Elevated serum CALCIUM concentration
- Elevated serum PHOSPHATE concentration
Decreased secretion of PTH causes?
- Lowered serum CALCIUM concentration
- Lowered serum PHOSPHATE concentration
Pitting Edema 2+
4mm pit that last longer than 1+
Fairly normal contour
Pitting Edema 1+
Slight indentation 2mm
Normal contours associated with interstitial fluid volume 30% above normal
Pitting Edema 3+
Deep pit 6mm
Remains second after pressing with skin swelling obvious by general inspection
Pitting Edema 4+
Deep pit 8mm
Remains for a prolonged time after pressing with frank swelling
- Fluid can no longer be displaced secondary to excessive interstitial fluid accumulation
- NO pitting
- Tissue palpates as firm or hard
- Skin surface shiny, warm or moist
Fluid Volume Deficit (FVD)
- Caused by a loss of BOTH water + solutes in the same proportion from the ECF space CALLED a HYPOVOLEMIA (or isotonic fluid loss)
- Both osmotic and hydrostatic pressure changes force the interstitial fluid into the intravascular space i an effort to compensate for the loss of volume in the blood vessels
- As the interstitial space is depleted, its fluid becomes hypertonic + cellular fluid is then drawn into the insterstitial space, leaving cells WITHOUT adequate fluid to function properly.
- FVD results from the loss of body fluids, especially if fluid intake is decreased
- Young children, older adults and people who are ill especially at risk for hypovolemia
Third Space Fluid Shift
- Refers to a distributional shift of body fluids into the transcellular compartment, such as the pleural, peritoneal (ascites), or pericardial areas; joint cavities; the bowel; or an excess accumulation of fluid in the interstitial space
- The fluid moves out of the intravascular spaces (plasma) to any of these spaces. Once trapped in these spaces, the fluid is not easily exchanged with ECF.
- A deficit in ECF volume occurs
- The fluid has NOT been lost but is UNAVAILABLE for use
- May be related to a disruption in the colloid osmotic pressure (decreased albumin), increased fluid volume ( excess IV fluid replacement, renal dysfunction), increased capillary hydrostatic pressure (heart failure, hyponaturemia or an increase in the perneability of the capillary membrane (gross tissue trauma)
- May occur as a result of a severe burn, bowel obstruction, surgical procedures, pancreatitis, ascites or sepsis.
Fluid Volume Excess (FVE)
- Also called HYPERVOLEMIA
- Caused by malfunction of the kidneys and heart failure (results in excess fluid in lungs)
- Due to the increaed extracellular osmotic pressure from the retained sodium and water, fluid is pulled form the cells to equalize the tonicity. By the time the intracellular and extracellular spaces are isotonic to each other, an excess of both water and sodium is in the ECF, whereas the cells are nearly depleted.
- Excessive ECF may occur in the intravascular or interstitial spaces
- Accumulation of fluid in the interstitial space is known as EDEMA
Fluid volume excess
Fluid volume deficit
Accumulation of fluid in the INTERSTITIAL space
Hyponaturemia + Hyponaturemia
- SODIUM deficit or excess
- Hypo is sodium DEFICIT < 135 mEq/L
- Hyper is sodium EXCESS > 145 mEq/L
- Sodium DEFICIT (hyponaturemia) may occur due to: vomiting, diarrhea, fistuals, sweating or as a result of the use of diuretics
- The decrease in sodium causes fluid to move by osmosis from the less concentrated ECF to the ICF space. This shift in fluid leads to a swelling of cells, with resulting confusion, hypotension, edema, muscle cramps and weakness and dry skin. Cerebral edema can lead to seizures and premanent neurologic damage + death.
- Sodium EXCESS caused by fluid deprivation, diarrhea, hyperventilation, burns.
- In sodium excess, fluids leave the cells because of the increased extracellular osmotic pressure, causing them to shrink and leave the cells without sufficient fluid. May result in signs of neurologic impairment, restlessness, weakness, disorientation, delusion and hallucinations.
Most abundant electrolyte in ECF
< 135 mEq/L
> 145 mEq/L
Hypokalcemia + Hyperkalcemia
- POTASSIUM deficit or excess
- HYPO potassium DEFICT <3.5 mEq/L
- HYPER potassium EXCESS >5 mEq/L
- Hypokalcemia may result from: vomiting, gastric suction, alkalosis, diarrhea or as a result of use of diauretics
- When ECF potassium falls, potassium moves form the cell, creating an intracellular potassium deficiency. Sodium + hydrogen ions are then retained by the cells to maintain isotonic fluids.
- Skeletal muscles are generally the first to demonstrate potassium deficiency. Signs include: muscle weakness, leg cramps, fatigue, paresthesias dysrhythmias
- Hyperkalcemia may result from: renal failure, hypoaldosteronism, use of medicaions such as potassium chloride, heparin, angiotensin-converting enzyme (ACE) inhibitors, nonsterodial anti inflammatory drugs (NSAIDs) and potassium sparing diuretics. May result in cardiac arrest if not corrected.
Hypomagnesemia + Hypermagnesemia
- MAGNESIUM deficit or excess
- Hypo magnesium DEFICIT <1.5 mEq/L
- Hyper magnesium EXCESS >2.5 mEq/L
- Hypomagnesemia may occur with nasogastric suction, diarrhea, withdraw from alchohol, administration of tube feedings, parenternal nutrition sepsis or burns.
- Hypomagnesia results in muscle weakness, tremors, tetany, seizures, heart block, change in mental status, hyperactive tendon reflexes and respiratory paralysis
- Hypermagnesemia occurs when renal failure or excessive magnesium intake (with antacids or laxatives).
- Hypermagnesia results in nausea, vomiting, weakness, flushing, lethargy, respiratory depression, coma and cardiac arrest.
Hypophosphatemia + Hyperphosphatemia
- Phosphorus deficit or excess
- Hypo phosphorus DEFICIT
- Hyper phosphorus EXCESS
- Hypophosphatemia <1.8 mEq/L
- Hyperphosphatemia >2.6 mEq/L
- Hypophosphatemia can result from alchohol withdraw, diabetic ketoacidosis, hyperventilation, insulin release, absorption problems, and diuretic use.
- Signs of hypophosphatemia are: irritability, fatigue, weakness, paresthesias, confusion, seizures and coma
- Hyperphosphatemia is commonly caused by impaired kidney excretion and hypoparathyroidism
- Hyperhposphatemia can result in tetany, anorexia, nausea, muscle weakness and tachycardia.
Hypochloremia + Hyperchloremia
- Chloride deficit and excess
- Hypo chloride DEFICIT
- Hyper chloride EXCESS
- Hypochloremia < 69 mEq/L
- Hyperchloremia >106 mEq/L
- Hypochloremia can result from severe vomiting and diarrhea, drainage of gastric fluid (GI) tube, metabolic alkalosis, diauretic therapy and burns.
- Hypochloremia may result in hyperexcitiability of muscles, tetany, weakness and muscle cramps
- Hyperchloremia can result from metabolic acidosis, head trauma, increased perspiration, excess adrenocortical hormone production, decreased glomerular filtration
- Hyperchloremia signs and symptoms include: tachypenea, weakness, lethargy, diminished cognitive ability, hypertension, decreased cardiac output, dysrhythemias and comas.
A test for latent TETANY in which carpal spasm is induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes. A positive test may be seen in hypoCALEMIA and hypoMAGNESMIA
The nurse is instructed by the physician that the client needs an intravenous fluid that is not likely to pull fluids into the vascular space. The nurse recognizes that the physician is suggesting which kind of fluid?
A hypotonic solution has a lower osmolarity than plasma; therefore, fluid would move out of the intravascular space rather than pulling fluids from the tissues into the vascular space.
What type of solution has a LOWER osmolarity than plasma?
Will cause fluids to move OUT of the intravascular space RATHER THAN pull fluids from tissues into the vascular space
What is the rate of administration for packed red blood cells?
1 unit over 2 to 3 hours, no longer than 4 hours
A decrease in arterial blood pressure will result in the release of:
Decreased arterial blood pressure, decreased renal blood flow, increased sympathetic nerve activity, and/or low-salt diet can stimulate renin release.
What is the standard drop factor of microdrip tubing?
Microdrip tubing, regardless of manufacturer, delivers a standard volume of 60 drops/mL. Macrodrip tubing manufacturers, however, have not been consistent in designing the size of the opening. Therefore, the nurse must read the package label to determine the drop factor (number of drops/mL)
Daily Sodium Intake Recommendation
Not more than 2,300 mg/day OR no more than 1,500 mg/day for persons 51 years of age and older.
Major control over the extracellular concentration of potassium within the human body is exerted by:
What size needle use for a large bolus IV catheter?
LARGE 18 gauge +
Dehydration is considered a loss of ________% of body weight
3% or more
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