Fluid and Electrolyte Balance Unit Nine Ahmad Ata

Objectives: Discuss the function, distribution, movement and regulation of fluid in the body. Identify factors affecting normal body fluid. Discuss the risk factors and causes and effect of the fluid. Select appropriate nursing diagnosis for client’s with altered fluid. Implement measures to correct imbalances of fluid. Evaluate the effect of nursing and collaborative intervention on the client’s fluid.

Body fluid and electrolyte: About 46 to 6o % of the average adult weight is water.

Water may serve as: Medium of metabolic reaction with cells. Transporter for nutrients, waste products, and other substance. A lubricant. Shock absorber. Regulate and maintain body temperature.

The proportion of water decreases with aging because fat, age and sex effect of total body water. (Infant 70 – 80%).

Distribution of body fluids: The body fluid divided in two major compartments: A) Intracellular fluid (ICF): Is found with on the cells of the body. its constitute 2/3 of the total body fluid in the adult.

b) Extracelluar fluid (ECF): is found out side of cell and account 1/3 of the total body fluid it’s subdivided into three compartments: 1) Intravascular fluid or plasma: is found within vascular system. 2) Interstitial fluid: is found surrounding the cell and includes lymph. 3) Transcellular: includes cerebrospinal fluid, pleural, peritoneal and synovial fluid.

Composition of Fluids plasma interstitial intracellular Cations Na 140 146 12 K 4 4 150 Ca 5 3 10 Mg 2 1 7 Anions Cl 103 104 3 HCO 24 27 10 SO4 1 1 - HPO4 2 2 116 Protein 16 5 40

Function of ICF & ECF: ICF: is vital organ to normal cell function, its contain solutes such as oxygen, electrolytes and glucose. It provides a medium in which metabolic process. ECF: it is the transport system that carries nutrients and waste product from the cell.

Movement of body fluid and electrolyte: Osmosis: Is the movement of water across cell membranes, from the less concentrated solution to more concentrated solution. In other word water move toward higher concentration.

Sodium is the major determinant of serum osmolality. Solutes are substance dissolved in liquid. Solvent: is the component of solution that can dissolve in the solutes. Crystalloid: salts that dissolved readily in to true solution. Colloids: substance such as large protein molecules that do not dissolved in true solution. Sodium is the major determinant of serum osmolality.

Diffusion: Is the continual intermingling of molecules in liquid, gases by random movement of the molecules.

Filtration: Is the process where by fluid and solutes moved together across a membrane from one compartment to another. Hydrostatic pressure: is the pressure exerted by fluid with closed system on the wall of container in which it contained.

Active transport: substance can move across cell membranes from a less concentrated solution to amore concentrated one by active transport.

Regulating body fluid: The average adult drinks about 1500ml per day but need to 2500ml per day this added volume is acquired by the food. The thirst center is located in the brain, this center trigger by osmotic pressure and angiotensin II .

Hormonal regulation

Regulation of ECF

Fluid out put: Urine: normal urine out put 1500ml per 24hrs or at least 30ml per hours. Insensible loss through the skin as perspiration and through the lung a water vapor in the expired air. Loss through the intestine (feces)

Obligatory losses: approximately 500ml of fluid must be exerted through the kidney to eliminate metabolic waste product and feces, respiration and perspiration to maintain body temperature. The average daily fluid out put for an adult 2500ml/ day.

Client at risk for fluid and electrolyte imbalance: Post operative client. Client with sever trauma or burn. Client with chronic disease as congestive heart failure. Client who are permitted NPO. Client with intravenous infusion. Client with special drainage. Client who receiving diuretic

Factor effecting fluid and electrolyte balance: Age: infant have greater water need and greater loss due to greater metabolic rate. Environment excess heat stimulates the sympathetic nervous system and cause person to sweat.

Diet: in nutritional deficiency, the body preserved the protein by breaking down the fat and glycogen. Stress: water retention and increase the production antiduritic hormone. Illness: burn, renal disorder

Disturbances in fluid and electrolyte: Hypovolemia: result from in oligurea to anurea Hypovolemic shock when intravascular fluid is depleted. Hypervolimia: when increase blood volume.

Type of edma: Dependent edma: found in the lowest part body. Pitting edma: edema that leaves a depression or pit after finger pressure is applied on the swollen area.

Sodium (Na): Is the most abundant cation in the extracelluar fluid and major contributor to serum osmolality. Function of sodium: controlling and regulating water balance. Maintaining blood volume Transmitted nerve impulses.

Normal level is 135 – 145 mg/dl. Hyponatremia: sodium deficit in the blood. Hypernatremia: sodium excess in the blood. Sodium is found in many foods, such as processed cheese, table salt.

Potassium: Is the major cation in intracellular fluid. Function of potassium: Maintain ICF osmolality. Transmitting nerve impulses. Regulate cardiac impulses. Skeletal and smooth muscle function. Regulate acid base balance

Hypocalcemia: calcium deficit in the blood. Potassium is found in many fruits and vegetables, meat, fish, milk. Normal level of potassium is 3.5 – 5.3meq/l. Hypokalemia: potassium deficit in the blood. Hyperkalemia: potassium excess in the blood. Hypocalcemia: calcium deficit in the blood. Hypercalcemia: calcium excess in the blood.

Loss of water and electrolyte: Vomiting. Diarrhea. Excessive sweating. Ployuria. Fever. Nasogastric suction. Abnormal drainage. Anorexia. Nausea Impaired swallowing.

Finding associated with fluid and electrolyte imbalance: Skin: dry pale, cool skin, reduce skin Turgor. Oral cavity: dry mucous membrane, absence of salivation. Weak rapid pulse. Decreased blood pressure. Decreased central venous pressure

Decreased urine out put. Increased hematocrit. Thirst. Flat neck vein.

Fluid volume excess: Excess intake of sodium – containing intravenous fluid. Excess of ingestion of sodium in diet. Heart failure. Renal failure. Liver cirrhosis.

Clinical manifestation: Weight gain. Fluid intake greater than out put. Moist mucous membrane. Tachycardia. Increased blood pressure. Distended neck vein. Dyspnea and crackles. Mental confusion.

Nursing care plan Assessment: Nursing history: Date include fluid and food intake, output. Recent fluid losses. Sign of fluid deficit. Common sign of electrolyte disturbance. Medication.

Clinical measurement: Daily weights, vital sign, fluid intake and output (I&O), serum electrolyte, complete blood count (CBC). Serum osmolality, urine specific gravity.

Nursing diagnosis: Fluid volume deficit related to dehydration. Fluid volume excess related to heart failure. Altered oral mucous membrane related to fluid volume defict. Impaired skin integrity related to dehydration Decreased cardiac output related to hypovolemia. Altered tissue perfusion related to decreased cardiac output.

Implementation: Assess clinical manifestation of hypo or Hypervolimia. Provide fluid and electrolyte orally. Foods. Intravenous therapy can prescribed for those reason Provide salts if needed. Provide glucose for metabolism. Provide water soluble vitamins

Monitor intake & output. Monitor lapratory finding. Provide frequent oral care. Monitor weight. Assess for edma. Place patient in fowler position. Assess breathing sound, inspiration and expiration (crackles). Provide safety for client

Any Qustions??