student view, fluid and lytes, chpt 17(1) (3)

8/20/2019 Student View, Fluid and Lytes, Chpt 17(1) (3)

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Fluid and

ElectrolytesChapter 17

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.


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Learning Outcomes

• Describe the composition of the major bodyuid compartments.

• Dene processes in!ol!ed in the regulationof mo!ement of "ater and electrolytesbet"een the body uid compartments.

• Discuss the etiology# laboratory diagnosticndings# clinical manifestations# and nursingand collaborati!e management of the

follo"ing acid$base imbalances% metabolicacidosis# metabolic al&alosis# respiratoryacidosis# and respiratory al&alosis.


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Learning Outcomes

• Describe the etiology# laboratory diagnosticndings# clinical manifestations# andnursing and collaborati!e management ofthe follo"ing disorders%• E'tracellular uid !olume imbalances% uid

!olume decit and uid !olume e'cess

• (odium imbalances% hypernatremia andhyponatremia

• )otassium imbalances% hyper&alemia andhypo&alemia

• Describe the composition and indicationsof common *+ uid solutions


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Fluid Compartments ofthe ,ody



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Electrolytes

•(ubstances "hosemolecules dissociate into

ions "hen placed into"ater

•Cations% positi!ely charged

• Anions% negati!ely charged



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2o!ement of uids

•Di3usion

•Facilitated Di3usion

•4cti!e transport

•

Osmosis



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5hat Controls Fluid andElectrolyte 2o!ement6•Osmotic pressure•Fluid tonicity

•ydrostatic pressure

•,lood pressure from heartcontraction

•Oncotic pressure

•Osmotic pressure caused byplasma proteins



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Fluid 8onicity



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Fluid (pacing

•First spacing

•ormal distribution

•(econd spacing•4bnormal 9edema:

•8hird spacing

•Fluid trapped and una!ailablefor use



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;egulation of 5ater,alance

•ypothalamic$pituitaryregulation

•

;enal regulation•4drenal cortical regulation

•Cardiac regulation

•


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ursing 2anagementursing Diagnoses

ypo!olemia• Decient uid

!olume

• Decreased cardiacoutput

• ;is& for decientuid !olume

• )otentialcomplication%ypo!olemic shoc&

yper!olemia• E'cess uid !olume

• *mpaired gas e'change

•

;is& for impaired s&inintegrity

• 4cti!ity intolerance

• Disturbed body image

• )otentialcomplications%)ulmonary edema#ascites



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*+ Fluids

•)urposes

•2aintenance

•

5hen oral inta&e is not ade=uate•;eplacement

•5hen losses ha!e occurred

•

8ypes of uids categori>edby tonicity



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*+ Fluids

• *sotonic

•E'pands only ECF 9intra!ascular!olume:

•o net loss or gain from *CF

•*deal to replace ECF !olumedecit

•?sed fre=uently for surgerypatients



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*+ Fluids

• ypertonic• E'pands and raises

the osmolality ofECF

• Dra"s uid intointra!ascular space

• 2onitor• ,lood pressure

•

Lung sounds• (erum sodium le!els

• ypotonic• 5ater mo!es from

ECF to *CF 9cellsand interstitial

spaces: by osmosis• *CF and ECF "ill

achie!e samee=uilibriumthrough osmosis

• 2onitor forcerebral edema



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*ntroduction

•2aintain a steady balancebet"een acids and bases to

achie!e homeostasis

•5hat &inds of health

problems lead toimbalance6



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p

•2easure of ionconcentration

•,lood is slightly al&aline atp 7.0@ to 7./@

•A7.0@ is acidosis

•B7./@ is al&alosis



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4cid$,ase ;egulation

• 2etabolic processes produceacids that must be neutrali>edand e'creted

• ;egulatory mechanisms

•,u3ers

•;espiratory system

•;enal system



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Clinical 2anifestations of4cid$,ase *mbalances• ,ased on p# not source of imbalance

• 4cidosis

•Central ner!ous system 9C(:

depression•-ussmaul respirations

• 4l&alosis

•

C( irritability•ypocalcemia



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,lood


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4cid$,ase 2nemonic;O2E•;espiratory

•Opposite

•4l&alosis p )aCOG

•4cidosis p )aCOG•2etabolic

•E=ual

•4cidosis p CO0•4l&alosis p CO0



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)ractice 4,<*nterpretation Case G•5hat imbalance is this6•p 7.1H

•

)aCOG 0H mm g•)aOG 7I mm g

•CO0J 1@ mE=KL



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)ractice 4,<*nterpretation Case 0•5hat imbalance is this6•p 7.I

•)aCOG 0I mm g•)aOG I mm g

•CO0J GG mE=KL



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)ractice 4,<interpretation Case /•5hat imbalance is this6•p 7.@H

•)aCOG 0@ mm g•)aOG 7@ mm g

•CO0J @I mE=KL


student view, fluid and lytes, chpt 17(1) (3)

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